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mediscope Jun 2009

hole y e K e h th Throug teele S s i r h Dr C h t i w ster w o e i P v r m e t a In rve Ex e N l a i icine d e M Cran c i Academ Reviews

+ y r e v t o n c e s i m D p o l e v e D Manchester Medical School’s Student Magazine


What’s Inside

mediscope EDITORIAL TEAM

12 16

Q+A

   What is the best discovery/invention    the world has ever known?

interview with dr chris

Andrew Cheng

cranial nerve exam

James Goodman

Year: 4, MRI Q+A: Toilet paper... genius!

Year: 4, MRI Q+A: The wheel

20 28

Ahmed Hankir a career in academic medicine Manchester Medics Football club

Year: 4, Wythenshawe Q+A: Gutenberg’s printing press

Lucy Hollingworth Year: 4, Wythenshawe Q+A: High heeled shoes

Khimara Naidoo

Year: Intercalating - Pathology Q+A: The microscope

26

Medical blogging

Prizzi Zarsadias

Year: 4, MRI Q+A: 1,3,7-trimethylxanthine aka caffeine

Contributors n  Puiu Cristian - Computer Sciences, Romania  n  Justin Healy - MBChB Year 4, Wythenshawe n  Christopher Jacobs MBChB Year 3, Wythenshawe  n  Loralie Rodrigues - MBChB Year 3, MRI Issue 5 Chief Editor: Ahmed Hankir Web: www.mediscopeonline.com Editors: editor@mediscopeonline.com Article Submissions: articles@mediscopeonline.com Competition Entries: competitions@mediscopeonline.com Production & Layout: Andrew Cheng  n  Front, Editorial, Education, Poster, Careers, YourScope, Society Prizzi Zarsadias n  Info, Features, Careers, Reviews Dedication: The Mediscope Editorial Team respectfully dedicate this issue to Tom Donaldson who sadly passed away in February 2009 while on his elective.


06.09

EDITORs’ LETTER

T

he theme for issue five of Mediscope is Discovery and Development. We hope that this humble effort acknowledges and pays tribute to the women and men, in the words of Professor Diczfalusy, “who dream of things that cannot be and ask why not?” In their tireless endeavour the audacious few, some overt but most obscure in their labour, aim to push the frontiers of humankind. We salute their determination and persistence to unravel the mysteries of the universe. This Mediscope issue includes an array of articles for a diverse readership. Introspection can breed internal discovery as is made apparent in the One Week article by Ben Amies in YourScope. Reuben Roy carries the flag for the Manchester Medics in University Challenge and elaborates on his adventures in our Beyond the Call of Medicine feature. Compiling this issue of Mediscope has been extremely challenging for the team as a whole. Our hard work has not gone unnoticed, however, and we are very pleased to announce that Medicope Magazine were awarded the first prize in the 2009 Student Team Working Awards in the extracurricular category sponsored by PricewaterhouseCoopers. We would like to say a big thank you to all of those who have made this project possible, particularly the Medical School.

Mediscope Editorial Team 08-09

InFO FEATuREs EDuCATIOn

COnTEnTs CAREERs

sOCIETIEs

YOuRsCOPE REVIEws

4 Val Wass Providing insight into the world of Academic Medicine

16 Poster How to do a Cranial Nerve Examination

25 YourScope Mediscope asks the Medics

5 Nothing to Lose, Much to Gain Applying for academia

18 Surgical Checklist Ticking off patient safety

26 Medical Blogging A virtual soapbox for the anonymous?

6 Diabetes Virus A trigger for childhood diabetes?

19 Competition Winners

28 Scalpel Manchester’s surgical society

6 Also in the News Health news from around the world 7 Malaria Vaccine An answer to an epidemic 8 Through the Keyhole Laparoscopic surgery 9 Under Construction A DIY surgical simulator

19 How Not to Get Struck Off Advice from the MPS 20 A Career in Academic Medicine An indepth analysis 21 Hypothetical Holiday Working in the Summer 22 Neonatology Caring for the tiniest of patients

28 Manchester Medics Mens FC Top of their game 29 Manchester Medics Womens FC Narrowly pipped 29 Serenity Project In Tanzania Helping abroad 30 So You Want To Be A Brain Surgeon? Careers book

10 University Challenge Beyond The Call of Medicine

23 Interview with the Orthopods Not just brains, brawn and bones

11 Time to Get Personal The future of personalised treatment

24 One Week An eye opener for Ben Amies at Christie Hospital

31 Cuckoo Crazy A different way to spend your Friday night

12 Interview with Dr Chris Steele From This Morning

25 The International Medical Student From Qatar

31 The Last King of Scotland Zheng vs McAvoy

30 Series: Clinical Cases Uncovered The PBL companion


4 6 7

Valerie Wass - Academic Medicine

infoscope Diabetes Virus

Malaria Vaccine

infoscope

Academic Career Pathways:

Opportunities not to be Missed Professor Val Wass (Professor of Medical Education) understands that on entering

medical school it is hard to identify where you want to be in twenty years time. For those who can imagine themselves as a future professor or hospital dean, she assures us that the goal is really worthwhile but students should start planning ahead. 4 mediscope 06/09


T

he

infoscope changes

Modernising

introduced Medical

by

able at all the Manchester teaching hos-

supported by the Medical School and

Careers

pitals and offer a four month Academic

available between Year 4 and 5. This is a

(www.mmc.nhs.uk) have made

rotation within the two year programme.

relatively unique opportunity compared

it increasingly important to plan ahead. If

These rotations are devoted to pursuing

to other medical schools.

you are keen to include research and aca-

research (clinical or in medical education).

You may be aware that, across the UK,

demic education activities in your future

We have nineteen Academic Clinical Fel-

many medical students intercalate after

clinical role then

lowships across a range

the first two years. Therefore, having a

it can be use-

“ exciting possibilities fer 25% protected time now exist but are open to to develop proposals national competition ” for PhDs and take a

second degree can really help if you are

training fellowship. For

students doing so has almost trebled over

well structured CV is very advantageous.

those with PhDs there are fifteen clini-

the last three years. The advantages of

Those of us enjoying the challenges and

cal lectureships which enable doctors to

intercalation are becoming increasingly

rewards of Academic posts would really

continue their research alongside clinical

recognised. So consider this carefully and

encourage you to think ahead and make

training. A wide range of support and ex-

don’t overlook opportunities at the end of

use of opportunities available to you.

citing possibilities now exist but are open

Phase 1.

ful to recognise this now. The pathway is often competitive.

of specialties which of-

A

Why is this important? The NHS is keen to foster and develop high qual-

to national competition. It is important to be prepared.

seeking a career in a competitive speciality. Intercalation here in Manchester is becoming more popular. The number of

We ask at Academic interviews, “Where do you see yourself in ten years

ity clinical researchers. A working party

What should you do to set yourself up

time?” Don’t be modest. If you feel your

was set up in 2005 (The Walport Report

in a good position for an academic career?

future lies in a highly competitive spe-

http://www.nccrcd.nhs.uk). The Report

Intercalation to achieve a second degree,

cialty, as a lead in medical education or

made recommendations for specific train-

in addition to an MBChB, is undoubt-

doing some research alongside clinical

ing programmes to encourage young doc-

edly important. A first or upper second

medicine start building

tors to develop the qualifications needed

class Bachelors or a Masters degree gain

your CV now. You

to compete and progress in the academic

important points on application forms for

will not regret tak-

arena.

these posts. There are many opportunities

ing the opportu-

The pathway offers opportunities at

to intercalate either between phase 1 and

nity even if you

all stages of your career. Manchester was

2 or in the clinical years. We are also for-

ultimately change www.medicine.manchester.ac.uk/

particularly successful in bidding for these

tunate at Manchester to have the Masters

your mind. Aim

posts. Academic Foundation jobs are avail-

in Medical Sciences Research programme

high!

www.medicine.manchester.ac.uk/ postgraduate/mres/medicalsciences

academicclinicians/northwest/

www.nccrcd.nhs.uk/intetacatrain/

NOTHING TO LOSE

ACADEMIC FOUNDATION APPLICATIONS:

www.acmedsci.ac.uk

cation form and interview(s) some evidence of academic achievement (undergraduate examinations, presentations, publications, essay prizes etc), a sense of career focus and ambition, and equally important, a generous show of enthusiasm. There is no limit to how many deaneries you can apply to, with no detrimental consequences to future MTAS applications. Much in common with research itself, if you don’t try, you won’t find out – but if you are successful, the rewards and further opportunities are considerable. Resist conceding to any sense of self-doubt or whispers of the scale of the competition – both are often overstated. In applying for academic foundation jobs there is little to lose and much to gain, and if you are interested, I would strongly encourage you to apply. Good luck!

MUCH TO GAIN

For those of you interested in making groundbreaking medical discoveries and being paid to travel the world to present them, Academic Foundation training is the logical next step after medical school. Each UK deanery allocates a small number of academic foundation training positions every year. Recruitment takes place between May and September; clinical MTAS applications begin after. Those who recruit for the academic foundation training positions seek candidates who they expect to capitalize on the opportunities that the programmes provide to augment academic skills. They will expect you to be aware of ongoing research activities at the specific institution(s) relevant to your field of interest. Some interview panels will expect you to have made contact with the appropriate academics. A strong applicant will demonstrate through their appli-

USEFUL LINKS:

IMRAN YUSUF

ACADEMIC FOUNDATION TRAINEE OXFORD, COMMENCING AUGUST

06/09 mediscope

5


infoscope

vIral trIgger for chIldhood dIabetes

T

he incidence of type 1 diabetes is

would be detected in the type 1

increasing every year and there

diabetic samples, owing to the improved

is currently no way to prevent

sensitivity of new techniques and highly

its onset. Genetics play a substantial role

sophisticated equipment. In keeping with

in the development of diabetes; however

Dr Foulis’ expectations, approximately

environmental factors may also be

60% of the children with type 1 diabetes

involved. More specifically, the theory

showed the presence of enteroviruses. It

that viruses could be one of the potential

was also found that 40% of adults with

causes of diabetes has been hypothesized

type 2 diabetes had signs of the infection

for decades.

in insulin-producing cells. Researchers

Recent UK research does suggest that a common virus may be the trigger for the development of type 1 diabetes. Pancreatic tissue samples were collected during autopsy from 72

By John Moore

speculate that the infection affects the ability of the cells to make insulin, which

“ 60% of the children with type 1 diabetes showed the presence of enteroviruses ”

children across the UK who had died less

in combination with the greater demand

involved, how the beta-cells are changed

than 12 months after being diagnosed

for insulin in obese people, is enough to

by infection and... to develop an effective

with type 1 diabetes. The samples were

trigger the onset of the disease.

vaccine... which we hope will drastically

compared with those of 50 children

Professor Noel Morgan told the

reduce the number of people around the

BBC, “The next stages of research are

world who develop type 1 diabetes, and

Alan Foulis suspected that enteroviruses

to identify which enteroviruses are

potentially type 2 diabetes also.”

local

natIonal

InternatIonal

Manchester

n The petition by The Christie Hospital, which was handed to Gordon Brown requesting the return of £6.5m in donations, lost when the Icelandic bank Kaupthing Singer and Friedlander collapsed in October 2008, has been granted.

n In January 2009, a woman became the first in the UK to give birth to a baby who is free from the BRCA1 ‘breast cancer gene’. The private clinic at University College Hospital used the technique known as pre-implantation genetic diagnosis to select embryos free from the gene.

n Sir Alex Ferguson has backed a campaign by one of his former players to increase awareness of multiple sclerosis (MS). A national survey by the MS Society found the North-West had the worst knowledge of the disease in the country with almost half unable to name a single symptom and a third thinking there was a cure for MS.

n Elizaabeth Adeney, aged 66, has become Britain’s oldest mother, beating the previous record by four years. She was forced to undergo IVF treatment in the Ukraine as most British clinics do not treat patients above the age of 50.

also In the neWs

JAMES GOODMAN

without the condition. Research leader Dr

n A pioneering safety device – the safety cannula, which features a self-activating safety clip, has been introduced in the A&E department at Manchester Royal Infirmary. Mr Stewart, clinical director of emergency services says, “Before we introduced this safety device we were running at around 19 needle-stick injuries a year in this department. In the year after its introduction, we had not had a single incident...”

6 mediscope 06/09

n The 500,000th pacemaker operation in the UK has taken place at St George’s Hospital, London. The first pacemaker, the size of a pram wheel, was fitted in 1958 and had to be plugged into mains electricity leaving patients stuck in hospital and at the mercy of the electricity supply. n The NHS confederation (which represents 95% of NHS organisations) has released a report saying the NHS faces its biggest financial challenge in its history. It forecasts a funding shortfall of £15 billion over the next decade.

n President Obama has vowed to seek, “a cure for cancer in our time.” His $10 billion economic stimulus package echoes Richard Nixon’s ‘war on cancer’ in 1971. Obama said, “It will launch a new effort to conquer a disease that has touched the life of nearly every American, including me, by seeking a cure for cancer in our time.” Both his mother and grandmother died of cancer. n GlaxoSmithKline (GSK) has started final phase trials on its groundbreaking anti-malarial vaccine, Mosquirix, which will be tested on 16,000 African children. If successful, the vaccine, which is 50%55% effective, will be filed for regulatory approval in 2011. GSK has also just made their ‘diet pill,’ Alli (Orlistat) available over the counter to people in the UK with a BMI greater than 28. n French surgeon Professor Laurent Lantieri has performed the world’s first full face transplant in Paris on a man who was severely burned in 2004. Professor Ian Hutchinson, a surgeon at Barts and the London hospital said, “The issue here remains that this is a huge operation – but not a life-saving one.”


malaria vaccine to begin trials

T

he twenty-fifth of March 2009 marked the second World Malaria Day. It coincided with the news that Sanaria, a Maryland-based company in collaboration with

the PATH Malaria Vaccine Initiative (MVI) is to launch Phase 1 clinical trials of a unique vaccine candidate. Although there are several malaria vaccines already in advanced clinical development, most consist of recombinant or genetically engineered antigens or epitopes of malaria parasites, and have shown only partial effectiveness. Sanaria’s vaccine candidate, an attenuated form of the Plasmodium falciparum sporozoite (the most deadly malaria parasite), is the first of its kind in the malaria vaccine field. “Initiation of this trial expands the spectrum of malaria vaccines in clinical development today,” said Dr Christian Loucq, the Director of MVI. There is hope that evidence from previous studies, which suggests that Sanaria’s vaccine has the potential to confer high levels of protection against malaria, will be reproduced in the present trial, which will involve 104 volunteers and began in mid-May. Malaria kills one million people every year, mainly young children and pregnant women in sub-Saharan Africa. The

infoscope

By Ambrose Boles

THE FACTS „„ Malaria is a major global health problem, affecting the inhabitants of tropical and sub-tropical regions of the world, particularly sub-Saharan Africa „„ It is caused by the parasitic infection of one of four Plasmodium species, of which P. falciparum is the deadliest and the focus of most research „„ The vector for the malaria parasites is the female Anophelene mosquito, which transmits the infection between humans „„ The clinical features of malaria depend on the malaria parasite but usually include swinging fever and rigors, accompanied by non-specific symptoms such as abdominal pain, headache and diarrhoea „„ Complications include hepatomegaly, encephalopathy, severe anaemia, jaundice, hypoglycaemia and convulsions „„ Diagnosis is by identification of the parasites in the red blood cells or parasite antigens in the blood „„ Treatment depends on the malaria parasite, but is assumed to be P. falciparum until proven otherwise. The most effective antimalarials are currently the artemesinins-combinations

last three decades have seen the burden of malaria rebound dramatically following the unsuccessful Malaria Eradication Programme of the mid-fifties, in part due to the failing efficacy of affordable antimalarials and insecticides. In the 1990s the Roll Back Malaria Initiative responded to this alarming trend by promoting malaria control strategies, such as indoor residual spraying and insecticide treated bed-nets for vector control, intermittent preventative therapy in pregnancy, and early and effective treatment for children. These strategies have made gains in reducing the malaria burden in many countries. However, the need for a malaria vaccine has become more pressing in recent months following reports of a new malaria strain in western Cambodia that is resistant to even the most effective chemotherapeutic treatment (a combination of antimalarials including the drug artemesinin). In recent years, there has been a renewed focus on malaria eradication as a long-term goal. In 2007, the Bill & Malinda Gates Foundation thrust malaria eradication to the forefront of the global health agenda. This was endorsed by the World Health Organisation, but if the goal of eradication is to be realised, a constant pipeline of new tools to fight malaria would be crucial. In a recent conference, Dr Loucq commented that, “History has shown that vaccines are the most powerful tool to control and eliminate infectious disease.” Professor Michael Good, the Director of the Queensland Institute of Medical Research has described Sanaria’s recent announcement as a “watershed event” in the realisation of this ultimate goal. 06/09 mediscope

7


8 Laparoscopic Surgery featurescope 10 Beyond the Call of Medicine 11 Personalised Medicine 12 Dr Chris Interview

featurescope

through the

Keyhole Consultant Surgeon Mr Muntzer Mughal, Consultant in General and Upper GI Surgery, reminisces on his innovative invention and paves the way for future practioners of this Art

I

qualified as a doctor from Manchester University in 1977. With the first phase of my lifelong ambition to be a surgeon achieved, there followed several years of ongoing training and

the trainer was published in 1991. This year, it will be twenty years since I was appointed a consultant and first heard of laparoscopic surgery. The practice of surgery has

examinations and in 1989 an appointment as Senior Lecturer in

been transformed by advances in laparoscopic surgery. High resolu-

Surgery in the department headed by Professor Sir Miles Irving. Now

tion imaging means that we can see better than the naked eye in con-

retired, he remains an inspiration to many, a charismatic man of razor

ventional open surgery. Instruments have been developed to execute

sharp intelligence, boundless energy, and has a knack of predicting

every action, such as dissection, suturing, stapling, sealing and divi-

future developments. Soon after I joined his unit, he summoned me

sion of large blood vessels. There is virtually no operation that hasn’t

into his office, having returned from one of his many trips abroad,

been carried out laparoscopically, and in many cases, the laparoscopic

and described how he had witnessed a laparoscopic cholecystectomy.

operation is the norm. Robot assisted surgery, of which robots such as

I had only ever heard of a diagnostic laparoscopy, a procedure that

the Da Vinci robot are employed, is now common practice. Originally

was mainly in the domain of gynaecologists, but could not envisage

developed to facilitate remote surgery, such robots have found a

how a surgical procedure could be performed laparoscopically. On

niche where surgery is required in limited space, such as the pelvis

Tuesday 12th June 1990, I joined a number of surgeons at the Leeds

and in the paedatric age group. Robots can also be programmed to

General Infirmary to watch Joe Petelin, a surgeon from the USA,

scale down the operators movements and reduce tremor.

perform this operation. We could not believe what we saw. We

All this has resulted in an enormous benefit to the patient, such

watched in awe at the television images of the operation in progress

as smaller scars, less adhesions and shorter hospital stays. Patients

and there was a standing ovation as the gallbladder was delivered

have accepted and often demand keyhole surgery. It wasn’t always so.

through the patient’s umbilicus!

In the early nineties, many surgeons launched into this field without

I was charged by Professor Irving to develop laparoscopic surgery at Hope Hospital and he arranged for me to visit Professor Dubois in Paris, an early pioneer. I returned from my visit a convert, and set about drawing up a shopping list of instruments. Getting hold of the kit was incredibly difficult, since there was just one company that manufactured the instruments and it could not satisfy the demand. The second hurdle was training, since there were no more than a

adequate training, fearing that if they did not do so, patients would desert them. This resulted in a dramatic rise in complication rates and

“There was a standing ovation as the gallbladder was delivered through the patient’s umbilicus!”

handful of individuals who had any experience of this new surgery

mortality in safe, common operations such as cholecystectomy. The

in the U.K. I decided to make a simulator so that I could practice

situation is quite different now, with proper training programmes,

with my colleagues and theatre team. A trip to the local B&Q to

mentoring and accreditation.

purchase the materials and a few hours work in my garage resulted

What about the future? Undoubtedly there will be further devel-

in the simulator show in Fig 1, that still survives to this day, 19 years

opments in technology, to make operations easier and safer. Surgeons

after its invention! A few hours practice and I was ready to perform

are also beginning to explore novel concepts, such as natural orifice

my first operation in 1990, assisted by a senior colleague. It took us

transluminal endoscopic surgery or ‘NOTES’. The idea is to gain ac-

four hours, but the patient was up and about the next day and ready

cess to the abdominal cavity through the gastrointestinal tract or the

for home. The traditional open operation would have taken me 40

genital tract in women, to enable scarless surgery. Cholecystectomy,

minutes, but the patient would have stayed in hospital for 5 to 7 days.

appendicectomy and splenectomy through the vagina or the stomach

Laparoscopic surgery had come to Hope Hospital. My description of

have already been described!

8 mediscope 06/09


Under Construction...

feature scope featurescope

Standing on the Shoulders of Giants. Alisdair Gilmour, a fourth year medical student, experiments with DIY medicine and discovers the rewards that can be reaped by tapping into the creative potential of the human mind.

W

hen you consider the term ‘laparoscopic simulator’, what is the first image that comes to mind? Perhaps it is a complex and expensive virtual reality machine. Regardless of what image your mind has conjured up, it is unlikely to be that of two cheap plastic boxes with a web-cam attached with blue-tack! The idea for such a contraption occurred to me during a laparoscopic skills day organised by Scalpel (The University of Manchester’s surgical society) in Preston. Hearing of Mr Mughal’s £75 DIY simulator from the early 1990s prompted the following thought: why can’t you use a plastic box, webcam and laptop? While such a basic simulator could not provide a realistic environment, it would nonetheless facilitate the learning of basic laparoscopic techniques, such as knot tying. The benefits of such training would not be restricted to laparoscopic surgery as many specialties utilise an endoscopic approach and thus require such skills. Hence, developing their dexterity and visual-spatial coordination is going to be a key aim for many aspiring surgeons.

Rather predictably however, such a set-up was not a novel idea and several authors have published details of similar devices. Compared to commercially available simulators, the devices already in print are cheap, costing approximately £40-100 to construct. However, this generates a new challenge: how to build a laparoscopic simulator on a medical student’s budget! A figure of £15 pounds was suggested. This sum was only for materials, as most students already possess a computer and web-cam. Two black boxes were obtained (£2.99 each) from a local DIY superstore. Opaque boxes consisting of thin, malleable plastic were selected as this makes allowance for modification. Two battery-powered LED lights were obtained at £3.99 each to provide a suitable light source. Other essential items were sticky tape, blue-tack, A4 paper and elastic bands. Suture material and catheters may be obtained from those fabulously helpful folk known as skills technicians! Building the simulator (total cost approx £14) was essentially a case of experimentation. The total time required is less than an hour, but the featured design is constantly in development.

The implements pictured are retired instruments borrowed from Mr Mughal, which are inserted through holes in the plastic. Many hospitals use ‘disposable’ instruments that once cleaned, are very handy for practice at home. Thus, most students should be able to lay their hands on laparoscopic instruments, providing they speak nicely to the correct person! Alternatively, manual manipulation of conventional surgical instruments under camera vision can be achieved by cutting two large holes into the side of the box. Although this may seem rather pointless, by using the web-cam software, it is possible to flip and/or mirror the image. Anyone has the ability to build their own DIY surgical simulator and devise suitable tasks. Although there is not yet evidence that this simulator improves surgical skills, it surely cannot hurt to try and improve these valuable skills.

then and Now: Fig1 (above) - Photos of Mr Mughal’s simulator. Fig2 (left) - Alisdair’s updated version, complete with a screen shot of the action!

06/09 mediscope

9


Beyond the Call of Medicine:

Reuben Roy Rises up to the

CHALLENGE

In this issue’s regular feature, Reuben Roy, an intercalating medical student, sheds light on brain training, quiz scandal and show biz entrances.

consisted of a 20 minute chat with the productune! The quiz requires around 25 minutes of ers of the show. Apparently, they like to ensure filming time. Afterwards, retakes are filmed that the teams are not too old (following com(even Paxman fluffs his questions - with some plaints in previous years) and that we are not regularity). Shots are taken of the audience apsecret quiz champions! Earlier series have had plauding, and the closing shots are filmed many teams with ‘professional’ quizzers (Mastermind, times. The intense filming of the quiz, followed Brain of Britain etc.) on them, which is now by the much more relaxed audience shots, all firmly discouraged. contribute to this somewhat surreal experience. Manchester has a very good reputation for In terms of my medical education, I cannot quizzing, thanks to the work of Stephen, a quiz say that having a broad general knowledge has enthusiast. We have weekly practice sessions been especially useful, though it is sometimes in JRUL, which handy on a ward increase to twice a round when the ocweek as recording casional consultant draws nearer. An enjoys testing the opposition team is drawn from former Univerrest of the team with odd questions. However, sity Challenge contestants, the quality of which an in depth knowledge of the speciality would is consistently high. From my experience as a probably be more useful, for both the ward contestant, I now appreciate that you can never round and in the long term! really prepare for a show like University ChalIt would be safe to say that although the lenge and that the practice sessions are invaluteam members have good general knowledge, able for the development of the team; initially I do not think any of us are particularly brilliant we were not aware of when to buzz or which when it comes to our own course subjects. topics each member was strongest. Somewhat Whether our brains have made a sacrifice to rehelpfully, the sessions also also provide a good tain this (mostly rubbish) knowledge instead of opportunity to learn new facts! Regarding the that related to our degrees is open to debate... development of ‘tactics’, we were just mindful to slow our answering of the bonus questions (in which the team confers), as this consumes quizzing time, so is beneficial when ahead. CoNGRAtULAtIoNs Filming of an episode takes around 45 to second year medical stuminutes. The producers try and make dent Andrew McMaster who successfully it as enjoyable as possible; each completed the 24th Marathon Des Sables featured team is formally announced in the last issue. The 202 Kilometre event (126 miles) took to the audience and enter place over five days in the Sahara Desert. Andrew completed the stage to the Rocky the course in a fantastic time of 30 hours 11 minutes 43 sectheme onds and came 206th out of 812 international competitors. Full

“each team enters the stage to the Rocky theme tune!”

report to follow in next issue.

*sword-shaped

d

o you know what xiphoid means in Latin* (were you even at that anatomy demonstration)? Or that triage is derived from French (to sort, to separate)? Medical knowledge can be quite handy for a University Challenge quiz team, so it is not surprising that medics often seem to make up part of the opposition. Before our win this year, The University of Manchester last triumphed in 2006. However, we cannot help but feel disappointed with the recent result, since we won as a consequence of the opposition’s misconduct and the BBC’s efforts to protect themselves from yet another quiz scandal, rather than from a true winning performance. The selection process for the team takes place in March each year and is organised by Stephen Pearson, a librarian based at the John Rylands University Library (JRUL). The first round of selection involves a written quiz covering a very broad range of topics, from science and history, to politics, literature and geography. The 12 highest scoring applicants are then invited back to the second round of selection, which takes the form of a buzzer quiz consisting of old University Challenge starter questions and lasting for around 45 minutes. Stephen is very careful in the selection process, ensuring a balance of knowledge between the sciences and humanities. Thus, the highest score in the two quizzes does not ensure automatic selection; it is the questions answered which matter the most. Having selected a team, we then formally apply to enter the show. Following our application to the show, we were invited to an audition/interview in order to determine our suitability. This

Left to right: Stephen Pearson, Henry Pertinez, matthew Yeo, Simon Baker and Reuben Roy


feature scope

Ti m e

P

t e g to

ment of a patient’s disease or disposition by using molecular knowledge to achieve the best

possible medical outcome for that individual.” Un-

l a n

o s er

P

ersonalised medicine is defined as “the manage-

doubtedly, the 20th century’s so-called ‘blockbuster’ era of drug discovery has brought us a long way. However, it is no myth that most drugs now prescribed exhibit different efficacy between patients. Furthermore, there are also safety issues: some people experience severe adverse effects whilst others do not. The reality is that patients are all different and the great hope is that discovering the differences in their genetic profiles will take healthcare away from the ‘one size fits all’ approach into a new era of personalized medicine. Since the completion of the Human Genome Project at the turn of the century, research has started to focus

a recent report issued by the United States Department of Health and Human Services, ‘Personalised Health Care: pioneers, partnerships and progress,’ pinpoints personalised medicine as an integral part of healthcare systems of the future. Mark Hawthorne, intercalating medical student asks what exactly is personalised medicine and will it ever be possible to achieve?

on the genetic components of individual diseases. Perhaps the most promising area is the ‘genome-wide association studies’ utilising Microarray technology. A sample of DNA from a patient can be added to a Microarray and the genes being over- or under-expressed can be detected by scanning it into a computer. The patterns of gene expression subsequently identified could lead on to the discovery of crucial biomarkers. A biomarker is a biological substance that can be used as an indicator of either a normal physiological process, pathological process or a pharmacological response to a therapy. The BCR/ABL gene (or the Philadelphia Chromosome) is an important biomarker found in some patients with Chronic Myeloid Leukaemia. The eventual goal following biomarker discovery is the development of a targeted therapy, as was the case with Gleevec™, which is now used to inhibit the BCR/ABL gene in these patients. There are clearly huge challenges along the road to personalized medicine including technical issues. Although an increasing number of Microarray studies are being performed, their impact to clinical medicine remains relatively subtle. One of the main reasons is that each experiment generates a huge volume of data and researchers often encounter ‘data overload’. If researchers become more adept at translating experimental data into more clinically relevant information, personalized medicine will start to become a more feasible option but the challenge then is likely to be overcoming the cost of the new drugs. To put things in perspective, Gleevec™ currently costs around £50,000 per year. Thus, as more targeted therapies become available, healthcare budgets will be put under an ever increasing strain.

06/09 mediscope

11


featurescope

U

nfortunately, gone are the days when I can lounge in bed watching This Morning. Today, however, I actually get to see it being filmed

in London… Dr. Steele, who prefers the more relaxed ‘Dr. Chris’, is letting me shadow him for the day. I want to learn

Holly Merrick

about the impact the media can have on health aware-

meets

ness (and maybe do some celebrity spotting at the same time!)

Dr Chris

On the 6.10 train from Manchester Piccadilly to London Euston the man across from me looks pretty surprised when Dr. Chris comes to sit next to me! My first impression of the nation’s favourite GP is just how nice he is. His calm and composed manner soon puts me at ease and makes me ponder on what a great family doctor he must be as we chat about the day’s proceedings. From the train station we take his chauffer-driven car to the studio. We are given a tour around the set which is surprisingly quite small in real life. Unfortunately, no one has arrived just yet… Dr. Chris has been appearing on This Morning since 1988 whilst also working as a GP in South Manchester. He specialised in smoking cessation, a special interest which found him locking horns with the Secretary of

Holly Merrick, intercalating medical student, interviews Dr Chris Steele on the set of This Morning where he has worked for over twenty years

12 mediscope 06/09

INTERVIEW

State to get nicotine gum put on NHS prescription. He had been ‘breaking the rules’ and prescribing it at his Smoking Cessation Clinics because the NHS did not recognise smoking as a dependency, or nicotine as having any therapeutic effect to treat it. A tribunal vindicated Dr. Steele and he then travelled worldwide lecturing on the subject and making many media appearances. This gave him experience for his role on This Morning. He has pioneered the use of the TV medium, and now the internet, to inform and educate the public on health matters. His most notable health matter on This Morning was the controversial live breast and testicular examinations. The examinations received just a few complaints which were then followed by hundreds of letters of thanks for saving the lives of viewers who, on performing the exams on themselves, found lumps and consequently went early to their doctors. Chris has to do a lot of homework. He gets a brief the night before the program on what he will be consulted on. This can, however, change at a moment’s notice if there is breaking news on a medical matter that the viewers would be interested in. In today’s show he is talking about bowel cancer because it’s Beat Bowel Cancer Week. There is a patient on the show who is telling her own cancer survival story and the message that Dr. Chris wants to convey to the audience is, ‘Don’t die of embarrassment’. Sometimes Dr. Chris talks about what’s new in health care in an item called, ‘What’s New, Doc’, but the most nerve-racking part of his job are the live phone-ins, where viewers call in to speak to Chris about their ailments on national television. As I watch Dr. Chris describe the red-flag symptoms of bowel cancer I can’t help but think that someone, somewhere, is watching the TV and thinking, “that sounds like my symptoms?” This is practicing medicine on a national scale. Mixed in with the other items on fashion, celebrities and makeovers is a piece of life-saving journalism. Dr Chris comes through the door to do our interview while he is removing the last smudges of foundation on his face...


feature scope me: so where did you train and what was it like? Dr. Chris: I trained in Manchester actually at the MRI, very enjoyable, great days. It was obviously different to the course now, the structure has completely changed. I didn’t work too hard; I was more interested in the social side of medical school life. I was social secretary of the MSRC. I was also in a rock band. me: What was the band called? Dr. Chris: Man Friday... we did a lot of gigs and we had a mobile disco too. We used to organise parties for the medics and bring the mobile disco to them. I didn’t necessarily attend all the lectures or the ward rounds, but I got through in the end.

the experience I had. When Nicorette was launched they invited me out to Canada. I was lecturing to doctors but that was a front. The real reason was to publicize the gum to the public and the media. I went to Toronto in Canada and they asked me to speak to the media. They got me a media trainer from New York. She told Are me what to say and what not from to say. We spent all day media training and when she showed me the first take and the last take of the day they were totally different. So then I went off around Canada doing about 15 to 20 interviews a day. I got a lot of experience in two weeks. After Canada I went all over the place. When This Morning was created they couldn’t find a suitable doctor. They said to Richard and Judy we are dropping the medical article and they said, “Have you tried our doctor?”

saving their lives

me: Is there anything that’s come up that you have not wanted you to comment on? Dr. Chris: I am careful about what I say regarding abortion and euthanasia. I will talk clinically about these issues but I won’t give my personal opinions on them.

Dr Chris

This Morning?

me: do you think the work that you have done has raised the public’s awareness me: Why did you choose to become a GP? about their health? Dr. Chris: For the independance. I didn’t Dr. Chris: Oh yes. Quite a few years back I want to climb the ladder. I just wanted to did the first breast examination live on air. get out and do my own thing. I argued for years to get that put on the show but ITV wouldn’t allow bare breasts me: So how did you make the transition on mid-morning television. Eventually to This morning? they said yes, as long as it is done in the Dr. Chris: It’s a long story but the short best possible taste. I showed the viewers answer is I was Richard and Judy’s GP. The how to examine their breasts. There was a long answer is, many years ago I started huge response from women saying thank taking an you to This MornI did intering for saving their on air...there was a huge response from lives. There were est in women saying thank for smoking hundreds of cases cessation like that. I then did a and I testicular examinaopened clinics in Withington and Wythention live on air. shawe which were very popular. No one knew about using nicotine as a treatment me: So do you have any influence then. Then Nicorette gum came out and on what items make it on to the I had 60 to 200 patients in a clinic comshow. ing along each week for six weeks. So, if I Dr. Chris: Oh yeah. The had 100 patients coming to a clinic for 6 shows been going for weeks and gave them all Nicorette that’s 20 years and I was 600 patient weeks experience. That’s a on the first lot of experience. So I became an expert one. I used to in nicotine gum because no one had had decide every

the first breast exam

week about that part of the shows content but now we are very news reactive. Today though I did suggest talking about bowel cancer because it is ‘Beat Bowel Cancer’ week and they accepted that idea. It is mainly a team decision however.

me: When you were speaking to the patient on the show about their bowel cancer you didn’t want to focus too much on her age (she was only in her 30s and suffered from ulcerative colitis) because it might cause panic. do you worry about this? Dr. Chris: Yes you have to give a balanced view. I did say it is more common in the over fifties but one in ten are under. If we focused on her age too much people might think that bowel cancer is very common in young peopleI have never managed to get all the points I want to get across in any of my shows so far me: Has being in the public eye left you open to a lot of criticism? Dr. Chris: Yes. At first it upset me. I spend a lot of time doing my homework. People think I just walk on set. I spend about 4 or 5 hours researching each piece. So I know whatever I say is scientifically correct. You can’t please everyone all the time and you get complaints from medics as well as the laypeople. There was more of that in the early days though. me: What’s your most memorable moment on this morning? Dr. Chris: I think prob-

06/09 mediscope

13


featurescope ably the breast examination and testicular examination because when we did it we saved lives. The guys who wrote in about finding a lump in there testicle were young men you know.

were students. When the new term starts they ask me, “Are you Dr. Chris from This Morning?” Then in the evening they go home and boast to their friends!

me: What’s it like having celebrity status? Dr. Chris: (Modestly) Oh it’s all right. I don’t have great celebrity status. The program isn’t peak viewing at mid-morning, so not everyone has seen it. The program is an institution though because it has been going on for so long. Its part of some people’s morning routine. When it started the plan was only to run for 3 months and here we are 20 years later.

me: As you say it’s quite chaotic how do you balance your work and home life? Dr. Chris: Now I have left general practice all I do is media work. I write for a few magazines and do radio work. At home the top floor of the house is offices. So I mainly work from home. That can have its drawbacks. I tend to work late; I am a bit of a night owl.

me: do you feel like your patients treat you any differently? Dr. Chris: The big effect is from new patients. My old practice was in Fallowfield in Manchester so a majority of patients

me: What do you do to combat your stress? Dr. Chris: I like gardening and I play the

piano and the electric organ. me: do you still have the band going? Dr. Chris: No, well in the band I played bass guitar but then I progressed to the electric organ. I have four kids and the eldest is a musician from the Brand New Heavies. Me: How do you communicate effectively with patients? Dr. Chris: Smile! Find out what the patient is really concerned about and what they are thinking. me: finally, what tips do you have to give to medical students so they can become good doctors? Dr. Chris: I would just say work hard and play hard. From my interview with Dr. Chris I concluded that he is a very down to earth and genuine chap, despite his welldeserved star status. He left the first-class carriage to sit in standard class with me and we spent the rest of the return journey talking about medicine and how the course has changed.

scalpel Undergraduate surgical Conference 16th - 23rd August 09 Manchester £155 per person Future Excellence

SATURdAY 7th noVemBeR 2009

International Medical Summer School

WHAT? An opportunity for any UK medical undergraduate to present their work at a national conference, hear prestigious keynote speakers and attend unique skills sessions.

A unique week of educational and social events aimed at all levels of medical students, offering knowledge and insight into a selection of competitive medical specialties, putting you one step ahead of your peers.

WHen? Saturday, 7th November 2009

Highlights of the event Provide insight and enhance understanding of the most competitive surgical and medical specialties Endow with a taster of basic clinical and surgical skills in the specialty Empower the student with guidance on developing a strong portfolio in their chosen career Exciting social activities and programmes in the evening

Further information and applications:

www.doctorsacademy org

14 mediscope 06/09

Closing date for applications 17th July 09

WHeRe? University Hospital of South Manchester, Wythenshawe noW ACCePTInG ABSTRACTS: for posters and/or oral presentations on surgical case studies, audits and original research. Submission deadline is Thursday, 1st October 2009. PRIZes: will be given for the best oral presentations and posters.

INteRested? Visit our website for further information...

www.scalpelmanchester.co.uk


II - Optic

S

VISUAL ACUITY - sharpness and clarity of vision. • Place standard sized Snellen chart 6m in front of patient. • Ask the patient to cover one eye and read out loud the lowest line they can clearly see. • Repeat with the other eye. + Ask them to read out loud text from a novel or newspaper to assess near vision. Visual fields - area of vision of each eye. Confrontation method: • Sit facing the patient 1m in front of you. + Ask the patient, “Is any part of my face missing or blurred” to test for central vision loss. • Ask them to cover one eye whilst you cover your own eye which is directly opposite, i.e. if patient covers their left eye, you cover your right. • Ask them to keep their head still and maintain focus on your open eye. • Compare the patient’s visual field with your own by using small finger movements or a red tipped pin, coming in diagonally from each of the four outer quadrants. + Test the blind spot. Compare the patient’s blind spot with your own by using a red tipped pin, coming in horizontally towards the centre from the temporal side. The blind spot is normally located 15° to the temporal side.

I - Olfactory

S

+ Check if the nasal passages are clear. • Ask the patient if they can identify common smells from scent bottles (usually coffee, vinegar, vanilla). Test each nostril separately. • Alternatively, ask patient if they have had recent problems with smelling food.

Reflexes - tests optic (afferent) and oculomotor (efferent). Warn patient about bright light! Accomodation • Ask the patient to look over your shoulder into the corner of the room. • Place your finger 30cm in front of patients face and ask patient to refocus onto your finger. • In a normal response, their eyes should converge and pupils should constrict. Direct light reflex • Shine a light from the side into patient’s eye. Look for pupil constriction in that eye. Consensual light reflex • Shine a light from the side into patient’s eye. Look for pupil constriction in the opposite eye. • Repeat direct and consensual reflexes with the patient’s other eye. + Relative Afferent Pupillary Defect (RAPD) • Shine a light into the patient’s eye. Pupils of both eyes should constrict. • Move the light to the other eye. Normally both pupils should remain constricted. • If one eye’s optic nerve is damaged, both pupils would dilate instead of remain constricted because the brain interprets this as a decrease in light being presented. + Colour vision - Test colour vision using Ishihara test plates. + Fundoscopy - The eye examination is not complete without visualising the internal eye.

III, IV, VI - Oculomotor, Trochlear, Abducens

M

Inspection • Ask the patient to look straight at you. Note common abnormalities: strabismus (squinting), ptosis (drooping eyelids) and proptosis/exophthalmos (protruding eyes). Ocular movements • Sit facing the patient 1m in front of you. • Place your index finger equidistant between yourself and the patient and ask them to focus on it. • Ask the patient to follow your index finger without moving their head. Check vertical, horizontal and oblique planes. Drawing an ‘H’ is ideal. Look for nystagmus (jittering to-and-fro movements). + Ask the patient if they see double during any time (diplopia). + Place your finger at the top of the patient’s vision. Rapidly move your finger towards the floor and look for lid lag. Normally there is perfect coordination of eyelid movement. + Ask the patient to focus onto one point on your face and maintain this focus. Cover one of their eyes. Their uncovered eye should remain stationary and fixed in focus. If the patient has strabismus and their uncovered eye moves to refix focus, that eye was squinting. Repeat test with other eye.

Poster Design by Andrew Cheng

III IV VI

V - Trigeminal Sensory • Ask the patient to close their eyes and to respond if they feel sensation on their face. • Use a cotton wool ball to assess and compare the left and right side of ophthalmic (forehead), maxillary (cheek) and mandibular (midway along jaw) branches. Motor - Muscles of mastication. • Ask the patient to clench their teeth. Feel both sides for contraction of the masseter and temporalis muscles. • Ask them to open their mouth wide and resist, whilst you try to close it.

Reflexes Jaw jerk • Warn and explain procedure to the patient beforehand. • Ask them to let their mouth open loosely. • Place your finger horizontally across their chin and tap lightly with tendon hammer. • The normal response is either a slight closure of the jaw or more commonly, no respon Corneal reflex • You would not elicit this is an OSCE, but just be aware of it. • It is elicited by touching the patient’s cornea using a fine tip of cotton wool. Blinking is response. Tests V1 (afferent) and VII (efferent).


How to do a...

Cranial Nerve Examination by Andrew Cheng

XII - Hypoglossal

M

• Ask the patient to open their mouth to inspect the tongue. Look for deviation and fasciculation. • Ask them to stick their tongue out and move it from side to side. • Assess tongue power against resistance by asking the patient to use their tongue to push out their cheek, whilst you press your hand against it.

IX

X

XI - Accessory

M

+ Inspect the sternocleidomastoid and trapezius muscles for wasting and asymmetry. • Assess SCM muscle power against resistance by asking the patient to turn their head to one side and press against your hand. Repeat on other side. • Assess trapezius muscle power against resistance by asking the patient to shrug shoulders whilst your push downwards on them.

IX, X - Glossopharyngeal, Vagus

SM

• Ask the patient to open mouth and say ‘Ahhh’. Inspect palate and uvula with torch and note any deviation of the uvula. • Ask them to cough. Assess the character of the cough and their speech. • If you suspect swallowing is normal, ask the patient to swallow a small amount of water. + If you have concerns about safety, you would ask Speech And Language Therapists (SALT) to perform a swallowing assessment. • Test taste if you have not already done so. The glossopharyngeal nerve innervates the posterior 1/3 of the S tongue.

VIII - Vestibulocochlear

Basic tests • Ask the patient to close their eyes and to respond if they hear a noise. • Starting on one side, rub/click your fingers away from the patient’s head and bring the noise closer towards their ear. Repeat on the other side. • Alternatively, whisper numbers into their ears and ask them to repeat. • Ask them to walk in a straight line, stand still and close eyes. Weber’s test • Tap a 512Hz tuning fork and place base on patient’s forehead in the midline. • In conductive deafness, the tone is heard loudest in the affected ear because external sounds are depressed, amplifying bone conduction. • In neural deafness, the tone is heard loudest in the unaffected ear.

SM

Rinne’s test - testing for conductive deafness. • Tap a 512Hz tuning fork and place next to the patient’s ear to test air conduction. Then apply the base of the tuning fork to the mastoid process to test bone conduction. Ask them which sound was louder to them. • Normally, air conduction > bone conduction (Rinne’s +ve). However, in conductive deafness, bone conduction > air conduction (Rinne’s –ve). In neural deafness, Rinne’s test remains positive.

VII - Facial

SM

Sensory - The facial nerve innervates the anterior 2/3 of the tongue. • Ask the patient to identify common tastes from tasting bottles (sweet, salty, bitter, sour). • Test each side of the tongue in turn.

nse at all! the normal

Motor • Ask the patient to raise eyebrows, smile and show teeth. • Ask them to close their eyes and blow out their cheeks against resistance supplied by you. + Note: In a unilateral upper motor neurone lesion, function in the upper part of the face is preserved because there is bilateral cortical innervation of the upper facial muscles. However, in a unilateral lower motor neurone lesion (e.g. Bell’s Palsy), the upper facial weakness is unilateral.


18

Surgical Checklists

19

How to Avoid Being Struck Off

educationscope 19 Competition Winners

m

educationscope

Surgical checklists Ian Hollingworth is a flight crew instructor at Emirates Airline, having previously flown as a Captain with British Airways on Boeing 747 and Boeing 737. Prior to this he was a pilot instructor on fast jets in the RAF.

H

aving been involved in all aspects of flight operations for around 30 years I have witnessed the development of CRM (Crew, or Team Resource Management),

SOP’s (Standard Operating Procedures for aircraft operations), decision making techniques and checklists. These developments, and many more, have had one core focus and this has been to improve overall flight safety; in particular, the reduction of error that may lead to an aircraft incident or accident. It is plain to see that these changes have actually worked; globally, the number of passenger aircraft lost or destroyed and the number of deaths and injuries from aircraft accidents has reduced markedly since the 1970’s. The civilian aviation industry and medicine (surgery in particular) have much in common. For instance both, quite obviously, involve professionals making safety and performance-critical decisions often under challenging circumstances;

an aviation-based perspective The WHO surgical checklist

Pre-Anaesthesia: * Has patient confirmed Iden tity, procedure, site, consent? * Are all safety checks complete ? * Site marked? * Specific patient risks; allergies, aspiration difficulties, drugs, blood loss. Contingencies in place

Pre- Incision: * All team members introduce d by name and role * All confirm patient, site, proc edure * Anticipated critical events and timeline: review by surgeon, anaesthesia prof essional, nursing team leader * Antibiotic and drug review * Critical imaging available / displayed * Back-up procedures and equip ment

Post-surgery | Prior to patie nt leaving theatre: * Name of patient, procedur e correctly recorded * Instrument, sponge, needle count all correct * Specimen labelling correct * Instrument and equipment shor tfalls correctly logged * Whole team review key conc erns for post-op care and recovery * Correct hand-over of patie nt confirmed

both involve work within large, multi-cultural organisations. The Human Factors in both working ‘societies’ are huge….and when human beings interact with increasingly complex technology (and with each other), there is always room for error. It is interesting to witness therefore that clinical organisations are

Above, I have illustrated a potential framework checklist for surgery; I am sure that you could add considerable detail. Much of this clearly mirrors the way the professional flight

now beginning to use versions of techniques and procedures

crew accept an aircraft for service and then brief all team

that aviators regard as the norm. At the same time, the way in

members prior to departure. Risks and threats are constantly

which clinicians work together as a team is also being chal-

re-evaluated throughout the flight regime until all passengers

lenged. This, in turn, opens up a myriad of new questions on

are safely disembarked and the aircraft is handed onto the next

best practice.

crew or licensed engineer.

Checklists are fundamental to a safe airline operation; from

If you haven’t yet used a checklist, my guess is that they

the moment that a pilot reports for work right until leaving the

will become increasingly common, perhaps mandatory, as your

aircraft, he or she is checklist driven.

career progresses.

18 mediscope 06/09


m o nemnics winners! Congratulations to Aaron Poppleton and Emma Crewe, the winners of our mnemonics competition

one of eC’s psych-related mnemonics to help you take an anorexia history: d: Dieting increase e: Exercise increase A: Appetite supplements? Laxative use? d: Diuretics use

f: Fear of wt gain A: Amenhorrhoea t: Thin BMI < 17.5/ tired/ troubled/ tooth decay?

educationscope

AP’s helpful hint to remember Crohn’s disease Treatment C: Change lifestyle A: Antibiotics s: Surgery s: Steroids I: Immunosuppressants e: Elemental diets

loralie rodrigues won last issue’s competition with her Lettuce Sandwich for insomnia:

Signs/Symptoms (3 for each) C: Cardiovascular [Anaemia, DVT, blood in faeces] L: Limbs [Clubbing, arthritis, osteoporosis] o: Occular [Iritis, conjunctivitis, episcleritis] G: GI [Diarrhoea, SI obstruction, malnutrition] G: General [Weight loss, malaise, aphthous ulceration] s: Skin [erythema nodosum, pyoderma gangrenosum]

“I’m not sure of the mechanism of action here; apparently lettuce has very sedative properties! My theory is that it’s probably the most boring thing you will ever eat so having concluded that being asleep is more interesting, one would be likely to surrender to the latter!”

How to avoid being struck off 1.

2.

W

herever you are in the world the chance of being removed

3.

from the medical register is a

clear and present danger. Sara Williams chats to MPS Medicolegal Adviser Dr Richard Stacey about how to avoid being struck off. Here is a list of the ten most likely ways to be erased from the medical register. Cases like these involve students and junior doctors on a daily basis and are a recurring theme for Dr Richard Stacey (DRS) who deals with such incidents. Always remember, the Medical Act

4.

(1983) allows the GMC to consider matters that occurred before a practitioner was registered, including those as a student. If you have any queries about the issues raised in this article contact MPS on 0845 605 4000 or querydoc@mps.org.uk

5.

IGnoRInG YoUR PRofeSSIonAL ReSPonSIBILITIeS To YoUR PAtIeNts dRs – Your first duty is to your patients, this may mean that you have to occasionally work beyond the end of your shift.

ALTeRInG oR noT mAKInG AdeQUAte ReCoRds dRs – Your notes will form the basis of any potential defence case. Clearly state the date and time the note was made and do not tamper with the original notes (remember computer notes are audit trailed). Make sure any forms that you complete are factually correct and, where relevant, the information can be corroborated by the medical records. IndeCenT BeHAVIoUR ToWARdS PAtIeNts oR CoLLeAGUes (InCLUdInG ImPRoPeR SexUAL ReLATIonS WITH PATIenTS). dRs – Be aware that patients may mistake inadvertent touching as being improper; e.g., when performing fundoscopy, beware of any loose clothing touching the patient and when applying/removing a blood pressure cuff, be careful not to inadvertently touch the chest area. You must follow the Trust’s chaperone policy. Always explain what you are going to do and why. BReACH of ConfIdenTIALITY dRs – Be aware of inadvertent breaches of confidentiality (e.g. ‘corridor talk’). It is your responsibility to remain professional at all times, even when off duty. mAKe fALSe CLAImS ABoUT YoUR QUALIfICATIonS oR exPeRIenCe dRs – You should complete all application forms in a factually

accurate way and be able to provide copies of documentation when requested.

6.

dISHoneSTY, InCLUdInG THefT And fRAUdULenT ReSeARCH ResULts dRs – You should be careful when completing expense forms, provide original receipts and keep copies for your records. Do not be tempted to forge signatures on any document and ensure that any submitted work is either your own or thoroughly referenced and attributed.

7.

IRReSPonSIBLe PReSCRIBInG And mISUSe of dRUGS dRs – Avoid prescribing for yourself or for anyone with whom you have a close personal relationship. Do not use illegal substances.

8.

ImPRoPeR deLeGATIon dRs – You must not delegate tasks to people with inadequate skills and training. Equally you should not work outside your field of competence always take advice from a colleague if you are unsure.

9.

TReATmenT WITHoUT ConSenT dRs – You should follow Trust guidelines in terms of taking consent and only take consent if you have a good understanding of the risks and benefits of the proposed procedure. Document everything.

10. PRACTISInG WHen A CARRIeR of InfeCTIoUS dISeASe dRs – If you know that you have or think you may have a serious infectious disease or a condition that may affect your performance, you should consult your GP and/or the Trust Occupational Health Department without delay and follow their advice.

06/09 mediscope

19


20 Academic Medicine careerscope 21 Working Summer 22 Neonatology 23 Interview with the Orthopods

careerscope

Academic Medicine IN DEPTH A CAREER IN

What exactly is it, where does it stand in the realm of clinical medicine and who is it for? Intercalating medical student Sotonye Tolofari provides answers to all your questions about this dynamic field.

SOTONYE TOLOFARI

T

he unprecedented advances in basic and clinical science have been extraordinary over the past

century, with the UK playing a leading role in the world arena. The contribution of academic medicine to these developments has, undoubtedly, been beyond compare. So what exactly is academic

previous BSc or MSc. Publications in any

medicine and why would you want a

peer-review journal are obviously great,

career in it? Academic medicine traditionally is a

although hard to come by, but you’d be now more medical students than ever,

surprised how many consultants are

term encompassing three major roles that

with a 28% rise since 2000. Fortunately,

willing to take on medical students for

have been coined as the ‘three pillars’ of

these changes have not gone unnoticed

research.

academia. These roles include; educating

and in 2004, the government set up a

medical students and junior colleagues,

number of organizations, such as the UK

North-West deanery said that prior to

standard clinical practice and novel

Clinical Research Collaboration (UKCRC)

the career pathway introduced in 2007,

scientific research.

that have provided recommendations

“There was no formalized structure to

for change to recruitment, training and

academic training and many aspiring academics were encouraged to, or op-

WHY do IT?

Dr Jon Miles, Academic lead of the

A

career progression of young academics.

recommendation made by the UKCRC.

students can apply directly for academic

rewarding. An academic career also

So what are these new career pathways

posts at foundation level. The F2 year will

provides lifelong prospects of intellectual

and how can you get involved?

contain a four month academic rotation

cademics are responsible for

Changes to the career pathway of aca-

portunistically took up academic training

educating the next generation

demics are perhaps the most substantial

prospects”. Under the new system,

of medics and this can be very

challenge and autonomy. A common misconception is that academics are poorly remunerated; however recent literature demonstrates that apart from private practice, academics and clinicians have

providing opportunities for teaching and

GeTTInG InTo ACAdemIA

P

research. Thorough training pathways

erhaps the first exposure to

will continue in specialist training. There

any sort of scholastic activity

will be an estimated three years of clinical

at medical school would be an

training in your specialty (e.g. Surgery,

intercalated degree, as it allows you to

Pathology, Radiology) as an academic

Many authors have referred to

explore research in a lab based or clinical

clinical fellow. Here, approximately a

academic medicine being in ‘crisis,’ as

manner. Some universities also offer MB-

quarter of your time will be dedicated

illustrated by the number of clinical

PhD schemes, which are essentially an

to teaching and research roles. Upon

academics in the UK falling by up to

intercalated PhD (Doctor of Philosophy)

completion of this phase, there will be

27% since 2001. Despite this, there are

offered to those who have done a

opportunities to apply for a training

financial parity.

20 mediscope 06/09


careerscope fellowship, which will extend a further

to obtain grants and continue research

ing, research, practice) appears to be an

three years providing opportunities for

before completing clinical training. Upon

invaluable discipline within medicine,

full-time research resulting in a PhD and/

completion of training, senior clinical fel-

which is essential for both the continuity

or publications. The clinical lectureship

lowships, lectureships and professorships

of the medical profession and its growth

period is for those with a PhD or MD

are available.

and development.

(Medical Doctorate) and may extend

A career in academic medicine that

up to five years. This period gives time

encompasses the ‘three pillars’ (teach-

WANT TO LEARN ABOUT ACADEMIC MEDICINE? THEN READ PROFESSOR VAL WASS’ ARTICLE IF YOU HAVEN’T ALREADY!  Adapted from; medically and dentally qualified academic staff: Recommendations for training the researchers and educators of the future UK Clinical Research Collaboration Academic Careers Sub-Committee of modernising medical Careers and the UK Clinical Research Collaboration.

L A C HETI

T O P HY HOLIDAY

Undertaking a research project over the summer can be a fun and challenging way to spend your holidays while at the same time giving you an exposure to the forefront of research. So where can you find a research project that takes students for the summer period? One option is to find summer research placements with organisations that offer short projects in their field of interest. Successful candidates could also be offered a maintenance grant of up to £180 a week. Another option is to independently search for one of the ongoing research projects at any UK based university. You then need to write to the senior research supervisor to see if they are willing to take you on for the summer period. Several organisations offer awards to undergraduate students every year which are specifically aimed at supporting students on their vacation research projects. However the student must have agreed upon a suitable project with their supervisor in advance of applying. Awards usually have terms and conditions and thorough research is recommended. Why limit yourself to the UK?! Many other countries (especially the US) have a variety of similar research and funding opportunities and a large number of them are open to British students as well.

Have we managed to tempt you into academic medicine?

Vinit shah has some tips on how to boost your academic medicine CV and enjoy a taste of things to come... all during your summer holidays!

List of some of the funding organisations: - The Wellcome Trust- awards up to 250 awards every summer and is highly recommended - The Nuffield Foundation- awards up to 400 awards every year

Some organisations that provide placements: - Cancer Research UK LRI Summer student scheme in Greater London - The Imperial College London offers the UROP program

06/09 mediscope

21


careerscope Dr Srabani Samanta, a consultant neonatologist at Saint Mary’s Hospital, sheds light on this rapidly advancing speciality.

T

Neonatal Medicine

he word ‘neonatology’ basically

extremely rewarding. There is also the

monitoring of their blood gases, serum

means the ‘science of the

challenge of caring for or helping babies

electrolytes, infection status and blood

newborn’. A neonatologist

with complex surgical, cardiac, metabolic

glucose.

is a doctor specialising in this field. Neonatology is a relatively new

and neurological conditions to simply survive. It often poses some strong

Neonatologists need to be proficient in basic practical skills, including managing delivery room

subspeciality of paediatrics, which offers

emergencies, assisted ventilation,

diverse challenges such as providing

ultrasound examinations of the head and echocardiography. Good communication is extremely important as it involves perinatal counselling, having to break bad news to parents and supporting them through the bereavement process. Central to being a good neonatologist is to possess personal qualities such as empathy, kindness and humility, combined with a dedicated commitment to the specialty.

tRAINING IN NeoNAtoLoGY To be trained as a neonatologist one needs to complete basic paediatric training and post graduate examinations ethical dilemmas surrounding life and

in paediatrics (MRCPCH). During

intensive care to very young and fragile

death decisions. It is a very ‘hands on’

the first three years of ST training in

patients.

specialty with opportunities to learn and

paediatrics, it would be expected that the

develop different advancements in the

trainee would spend at least six months

this field unless you elect to do a SSC in

medical field e.g. Use of High Frequency

in a tertiary neonatal unit. The next stage

neonatology. For many junior doctors

Oscillation as a mode of ventilation.

would be to apply for National Training

It is difficult to gain experience in

doing neonatology as a part of their

Numbers (NTN) in Neonatology to

Paediatric rotation, it reminds them of

WoRK of A neonAToLoGIST

the long hours and routine baby checks.

The day to day work of a neonatologist

in year six of ST training. This requires

If you can see beyond this, then it is

entails looking after babies in the

having done neonatology at ST4/5 level

one of the most exciting and rewarding

Neonatal Intensive Care Unit (NICU),

and either tertiary neonates or specialties

specialties in medicine and is quickly

a special area devoted to the care

allied to neonatology in ST year six (these

advancing its training, research and

of critically ill babies. Babies born

can include cardiology, genetics, PICU,

technology.

prematurely need to be in NICU to

neurodevelopment).

pursue a career as a tertiary neonatologist

provide support to various organs until

WHAT mAKeS neonAToLoGY exCITInG And CHALLenGInG?

they are mature enough to manage without. For example, they are often

JoB PRoSPeCTS In UK And ABRoAd

The main factor which drives most

nursed in incubators to keep them warm,

This is a fast growing field with fierce

neonatologists to pursue this profession

need ventilatory support for immature

competition for places. There are many

is the challenge of looking after extremely

lungs and need parenteral nutrition

opportunities for neonatologists to work

ill infants; some on the borderline of

to help them grow and tolerate gentle

abroad, especially in Australia, New

viability. Caring for a 500 gram baby

increments of milk feeds. To provide

Zealand and Canada. Opportunities also

and seeing them achieve normal to near

these they must have arterial line and

exist in developing countries although

normal development a few years later is

central venous catheters and need regular

resources are limited.

22 mediscope 06/09


careerscope NAME: Mr Lindsay Muir SPECIALTY: Consultant Hand Surgeon

Interview with the orthopods

WHERE DID YOU TRAIN? I graduated from the University of Glasgow and then I did my House Officer jobs in Glasgow Royal Infirmary. I went on to do my fellowship training in Liverpool before starting as a Registrar in Orthopaedics. I then went to France for 6 months to study hand surgery. After that, I came back to the UK and continued as a hand fellow in Withington, followed by a shoulder surgery placement at Wrightington Hospital. Then in 1996, I applied for the post of Consultant Orthopaedic surgeon at Hope Hospital and have been there ever since. WHY HAVE YOU CHOSEN THE HAND? It offers a great combination of trauma and elective surgery. I also find hand anatomy fascinating, beautiful and versatile. I marvel at the way such a small organ can do so much from picking up a pin to stroking a baby’s cheek to hammering a fence post. WHEN AND WHAT MADE YOU DECIDE TO SPECIALIZE IN ORTHOPAEDICS? I decided in my third year of medicine that I wanted to do surgery. In my fourth year, after having enjoyed my Orthopaedic placement, I decided to pursue Orthopaedics. Just goes to show you that these placements do have an impact on how you choose your specialty. WHAT ARE THE BEST ASPECTS OF ORTHOPAEDICS? It’s very gratifying and interesting. Patients get better quicker. AND THE WORSE ASPECTS? Paperwork. DOES GENDER AND SIZE MATTER? No. We have several female Orthopaedic surgeons on the rotation. For size, perhaps a heavier-built person may be better suited to the heavy-duty surgery. WHAT ADVICE WOULD YOU GIVE TO MEDICAL STUDENTS INTERESTED IN A CAREER IN ORTHOPAEDICS? Practical aptitude. Especially with surgery, one must have good hand skills and being able to do hand-related crafts tend to help. CV-wise, we’ll be looking at publications, audits and Orthopaedic placements, for example SSCs. ARE THE JOKES ABOUT ORTHOPAEDIC SURGEONS TRUE? (Laughs) in the past, it did attract larger-built people, but it’s now more science-based and not so much pure mechanics. OUR THEME IS ‘DISCOVERY AND DEVELOPMENT’. IS THERE ANYTHING YOU’D LIKE TO ADVISE STUDENTS REGARDING THAT? “Ars longa, Vite Brevis”. (The art is long; the life is short. –Hippocrates)

by Michelle Ting

NAME: Mr Hassan Dashti SPECIALTY: Consultant Spinal Surgeon WHERE DID YOU TRAIN? I graduated from Dundee University in 1991. During my postgraduate training I was allocated to various different postings. I worked as a House officer, Anatomy demonstrator, Research Registrar and then as an Orthopaedics Registrar in Dundee until 2002. WHY THE SPINE? I found it challenging, interesting and intriguing, more so than the other specialties. WHEN AND WHY DID YOU DECIDE TO DO MEDICINE, THEN ORTHOPAEDICS? I did my pre-med in the States, intending to become a chemical engineer. During a research placement, the professor discouraged me from engineering and advised me to study medicine. Since my first year as a medical student I’ve wanted to do Orthopaedics, from knowing other Orthopods.

WHAT ARE THE BEST ASPECTS? The challenge of diagnosis. WORSE ASPECTS? Time constraints. IF YOU WERE ON AN INTERVIEWING PANEL LOOKING TO HIRE, WHAT KIND OF CHARACTERISTICS WOULD YOU BE LOOKING FOR? Someone intelligent, interesting and interested to learn. Someone with whom you can interact easily. Also, someone with good hand-eye coordination. WHAT ADVICE COULD YOU GIVE MEDICAL STUDENTS FOR THEIR CV? CVs are misleading; someone with a good CV may not necessarily be good in the work, from personal experience. But it should be varied, with outside interests and one should write honestly. OUR THEME IS ‘DISCOVERY AND DEVELOPMENT’. WHAT ADVICE COULD YOU GIVE STUDENTS WITH REGARDS TO THAT? Growth is lifelong; when faced with a disappointment you must look for the silver lining that will allow you to grow and develop more than you would have if you hadn’t come against this particular problem.


24 One Week yourscope 25 The International Medical Student 25 YourScope Q&A 26 Medical Blogging

yourscope

one weeK by Ben Amies By the end of year three I had become disillusioned with Medical School

altogether. My SSC at Christie cancer

Andrew Cheng

hospital changed all of that. The first week was one week to change my perspective

on illness and medicine, life and death, and

the strength and fragility of a human being. This was one week to remind me why I

loved medicine and why I wanted to be a doctor in the first place.

MON

T

he first patient I saw was

an abrupt introduction to

cancer. Seeing patients near

death wasn’t all that familiar

to me; most patients in hospital aren’t

terminally ill after all. Weakness had made

pain and the uncertainty for however long it takes. They have the will to get up every day and to carry on with life, and carry on with their battle.

WED

N

othing strips someone of their identity like being

in hospital. Any ward is the

same; full of motionless and

her almost incapacitated. ‘She’s obviously

silent patients, dressed in the same hospital

with cancer aren’t all that obvious. It’s not

around, they lay stripped of their stories.

dying from cancer’ I thought. But it’s not so simple. The reasons people are admitted usually because they’re dying of cancer

but because they are dying from sepsis.

Chemotherapy is poisonous to all tissues;

it works by being more toxic to the cancer cells than normal ones. It also has a

propensity to destroy bone marrow

making infection a constant threat. This

woman, like many others in the hospital, wasn’t dying from cancer, she was dying from chemo.

TUE

I

t’s inspiring to see how people cope with their

disease. A diagnosis of ‘the

C word’ evokes a real terror

in people. How would you feel if it were you or someone close to you? It quickly

struck me that this fear was surmounted

by the belief that they were going to beat

this. Even the patients in their final weeks weren’t frightened. There’s something

in having cancer that makes people fight

through the exhaustion and vomiting, the

24 mediscope 06/09

gowns, sharing the same fear and solitude. Everyone has their own life story; looking Immediately it becomes apparent how

much patients would rather talk about

anything but being ill. All they want from us is to take an interest in who they are, and take their mind off where they are.

THU

I

n medicine we usually think

of death as the one outcome

we must never allow, beyond all others. An unforgettable

experience was to see for the first time a

patient for whom death was the cure, for

to prolong life was to prolong the pain and morbidity. ‘Do not resuscitate’ the form read in her notes. Can treatment really

be worse than death? Surely treatment can give her and her family a few more precious hours? But for some there is

nothing left but waiting. A slow death in

pain, powerlessness, and indignity stains

someone’s most sacred moment, when they finally succumb to their illness, when the fight just wasn’t enough.

FRI

T

oday was an extraordinary day. After what was not an

unexpectedly difficult week, I saw a very different side

to cancer. The clinic was for testicular

cancers. I stood silenced in the waiting

room full of men my age with cancer. Most other patients I’d seen this week were at

least over 50; I hadn’t thought of cancer as something as an immediate threat to my

own health – as I’m sure these guys hadn’t either. One tragedy is to be taken from the family and life you have built for yourself, but another altogether to be deprived of

the opportunity for those things altogether. These men were still so young. Most

amazing was how wrong my assumption

was. Not only were some walking into clinic with cancer, there were others walking in without cancer, cured. These men were

given a second chance to get on with their lives.

What a vision for the future, imagine if we could one day do this for all cancers? For

now, we can give support and hope to our

patients and the strength to continue with their ongoing battle.

We all go into medicine for different

reasons. For me it was for exactly what I’d

seen this week; to provide a better outcome and to alleviate a burden, and, if we can, to

cure. Since then I’ve held onto these ideals, as dear to me as my parents, to remind me of why I’m studying medicine at all.


The International Medical Student

yourscope Third year medical student Ayda Al-Hammadi shares her experiences with Mediscope and reveals to all the ambivalence of her odyssey so far.

W

hen I was accepted into Manchester medical school,

I was both pleased and afraid. I was aware that this was a golden opportunity for me, but by the same

token, was going to be a momentous change. When I

first arrived in Manchester, I had no friends at all and had never interacted with non-Arabs before. It was

a shocking experience. I did not know what to say in class (I was the only non-British student), I did not

have anyone to talk to outside of class and frankly, I

was totally lost. I always felt like I was a stranger and I was afraid of being judged as an outsider because I

was not British. I did not breathe a word in class for the first three weeks. After that, all I could muster up was a sentence or two related to the PBL case. I did not know

how to prepare for PBL and I had no one from which to seek advice. These were challenging times for me, but

I never considered quitting medicine, as it was, is, and

always will be my passion. I barely passed my first year exams, but was relieved nonetheless.

In my second year, I decided to change my

lifestyle and try to become more sociable and interact with as many students as possible. I did not care

background to me or not; I just wanted to integrate no matter what. With my new found confidence, I spoke with more students and I realized that my thoughts of others perceiving me as an unwelcome stranger

were actually wrong. Almost everyone reciprocated my overtures of friendship; some were even willing

to help me with PBL. This was reflected by a dramatic improvement in my exam grades.

Now in my third year, my self esteem has increased

so much so that I am now more confident than ever! I am loving my clinical years and am working as I hard as I can in order to become a good doctor.

The take home message here is that, as an

international student, it is understandable to be

afraid and feel like a complete stranger. However, it

is important and indeed possible to overcome those fears (most of which are unfounded), and to make an effort with others. I also hope that this article

increases awareness about how daunting it can be for international students to adapt to life in England. Special thanks to mom and dad who were

supportive in every step I’ve taken.

about whether I would find someone with a similar

Country of Origin: Qatar Capital City: Doha Official Language: Arabic

Your S cope Q+A ? ?? ? ?

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Why is your base hospital the best base hospital?

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??? ??Kirstin ? ? McGregor ? ? ?? ? ? ?

Official religion: Islam Currency: Riyal Population: 1,541,130

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- Year 1, MRI “Meeting some of the friendly (and very good looking) foundation students on a recent placement and realising clinical years may be a whole lot more fun than I’d originally thought they would be...”

Sophie Mylan - Year 4, Wythenshawe “For me, it is the undergraduate staff that make South so unique. They are friendly, approachable and never fail to do their best to support their students. They make a fantastic, dedicated team.”

John Patrick Byars - Year 3, Preston “Preston is the best because of our undergraduate department who dedicate the time and resources to ensure full commitment of the medical staff in our teaching. It may not have the night life of Manchester but compared to other base hospitals we do socialise more as a whole year, if not all 3rd to 5th years.”

Laura Derbyshire - Year 4, Hope “I’m based at Hope Hospital and really enjoy having my placements there. The staff are enthusiastic to teach students and are among the best in their specialities. The Salford community is extremely diverse, making history taking very interesting!”

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06/09 mediscope

25


Medical Blogging

yourscope

Prizzi Zarsadias

O

incite change, outrage or just plain vent

an unofficial careers advice blog since

frustration, these blogs are often both

August last year. It is aimed at final year

informative and entertaining to read.

medical students, but also provides

The other major genre of blog is

advice to all students. Alex has found that

what I call the ‘docu-diary’. These

blogs are “dynamic and informal, [they]

writers essentially dive into a goldfish

are ideal to get quick messages out. The

bowl to be gawked at by readers. From

ability to put content out quickly meant

ver the past decade medics

medical student to fully fledged doctor,

that I could answer specific questions

have posted millions of

the access to insight has never been

that I was receiving about the foundation

terabytes of words about

easier; particularly useful if you are

recruitment process”.

anything and everything on virtual

just about to step into similar territory.

internet diaries, better known as web

Manchester Medic is one such docu-

over enthusiastic writers can trip up

blogs. Under aliases, they pour out their

diarist. Admittedly, he writes the blog

and land in a whole heap of litigious

innermost thoughts for the readers’

primarily for himself,

dissection and delectation. Micro-

using it in much the

blogging or twittering is a more concise

same as a portfolio to

method which has recently seen a burst

reflect on his clinical

of popularity. Tweets are limited to

experience. He admits

140 characters, enough for two or three

“it is reassuring for me to know that

trouble. Many well established medical

sentences (or four if you abandon the

people aren’t able to associate what they

bloggers do not blog anonymously

laws of grammar!) Tweets can even be

read on my blog with me personally”.

and recommend that others shed their

texted to the site and as it takes only

This blogger also reads other blogs which

pseudonyms. Langhorn explains that

seconds to tweet, it has accelerated

he says “give me a wider picture of what

“being accountable for what you write

the speed at which news or trends are

life is like working for the NHS in the

is an important part of the integrity of

spread.

various sectors, and what to expect upon

the blog which is why I do not keep

qualification”.

my identity anonymous”. Langhorn

Be it ‘soap box’ blog or ‘docu-diary’,

Blogging offers the writer a virtual soapbox to clamber onto and preach, rant or berate with a convenient mixture of exposure and anonymity

www

There are a variety of flavours of

blogs, which is dependent on the agenda

There is an increasing number of

highlights Lord Darzi’s blog as a good

of the author. With pseudonyms like

blogs whose sole purpose is to inform

example of blogging without a disguise.

Dr Rant and Dr Shock, you’d be correct

readers. Institutions in particular, are

Anonymity can give you a false sense

in thinking that many blogs are written

utilising blogs to update the masses

of security to make comments from

by disgruntled hands. Blogging offers

including the University of Manchester,

which there have been repercussions in

the writer a virtual soapbox to clamber

the Student BMJ and the NHS (which

certain documented cases. Anonymous

onto and preach, rant or berate with a

also maintains a twitter feed for staff).

blogger, Manchester medic, concedes

convenient mixture of exposure and

Alex Langhorn is a careers consultant

that “there is always a risk that blogging

anonymity. Whether their aim is to

for the University and has been writing

anonymously can cause the blogger to

26 mediscope 06/09


yourscope become over confident and write in an

A medico-legal advisor from the MPS

inappropriate manner”.

highlighted relevant GMC guidance on

Responsible blogging should obviously maintain confidentiality. Unfortunately, a study published last

the matter of respect for colleagues (Good Medical Practice paragraphs 46-47). It appears that medical blogging

year in the US by the Journal of Internal

is a trend that is bound to continue to

Medicine found that after analysing 271

grow, but with this comes concerns over

blogs, 56.8% contained information that

confidentiality for both patients and

could potentially indentify patients

peers. There is a growing demand that

discussed in their blogs. The MDU

best practice on the web may need to be

published a fictitious case in its legal

as closely monitored as it is clinically.

clinic in 2006 about a doctor whose blog

However, concerns were raised over how

contained details which a patient felt was

this will encroach our freedom of speech.

sufficient to identify him by a third party.

It appears that the line between freedom

There are currently no UK cases

of speech and censorship will inevitably

that demonstrate a breach of patient

have to be drawn soon, but the question

confidentiality on blogs that the MPS

is, who will step up to the keyboard?

or the MDU could discuss publicly. However, breach of confidentiality of colleagues rather than that of patients has proved to be the greater problem. The MPS highlighted that there are cases of medics facing disciplinary action for their comments about colleagues on public forums such as message boards Blogs mentioned in this article: • http://manchestermedic.blogspot.com • http://manchestermedicalcareers. wordpress.com

and social networking sites. One such high profile case was the suspension of a junior doctor after they posted critical comments about Dame Carol Black on the Doctors.net message boards.

N O I T I T E COMP NER WIN

“A

stigma was originally a scar in the skin of ancient Greek criminals. It

was a sign to all that these people

were unclean, unsafe and unwanted. Stigma

persists today in society’s attitudes towards

those with mental illness. It is a stigma which

w

can see people unemployed and homeless,

cut off from family and friends. It is a stigma which can delay diagnosis, exacerbate symptoms and hamper recovery.

Unlike meningitis or Crohn’s disease, we

make judgements about a person’s character if they’re diagnosed with depression or

schizophrenia. We see weak personalities or deranged minds rather than medical

conditions that need understanding and care. It is this false division, this idea of a fundamental difference between the

At time of going to press The Times unmasked popular blogger NighJack as Detective Constable Richard Horton. In his award winning blog he criticised police activity and detailed disciplinary infringements. In a bid to preserve his anonymity Horton sought an injuction stopping the papers from revealing his identity. He failed. The High Court ruled blogging was in the public domain and therefore, under British law, authors of such blogs have no right to anonymity. Horton has since deleted his blog.

In the September 2008 issue of Mediscope, we launched the Dr Neel Halder Undergraduate Essay Prize For Psychiatry. Congratulations to Justin Healy, who took home the top prize of £400. Runners up were Bryony Clarke (£100) and Caroline Charlsworth (£50). Below is a brief extract of the winning essay. The full essay can be found at http://www.mediscopeonline.com/stigma.pdf

asthmatic lung and the psychotic mind,

The most successful anti-stigma campaign

that gives rise to much of the stigma that

is the ‘see me’ campaign in Scotland. The

being pushed to the periphery of society.

about those with mental illness. There are

surrounds mental illness.

These stigmatising beliefs lead to people

Though they are sick, they are not offered

sympathy and compassion but rather ridicule and abuse. These attitudes are internalised

and manifest themselves as ‘self-stigma’ - low self-esteem and negative feelings of self-

worth that are independent of the mental illness they suffer from. People may think

that they’re ‘going mad’ or just need to ‘pull

themselves together’, they don’t believe that

they have a real disease and will often blame themselves for how they feel. This leads to people hesitating before seeking help and needlessly suffering in silence.

campaign seeks to challenge media stories

that perpetuate myths and preconceptions also national adverts which give factual

information about the nature and realities of mental illnesses. The campaign also

encourages the public to talk to patients and

sufferers, to show that these conditions need

not define an individual, that they are not the

result of personal foibles and weaknesses but rather are real and debilitating diseases.

Challenging stigma is neither easy nor

quick. It is, however, essential if we want to weaken the hold that disease can have on people’s lives.

06/09 mediscope

27


28 Scalpel societyscope 28 Manchester Medics Mens Football Club 29 Manchester Medics Womens Football Club 29 SPIT

societyscope

scalpel - Laura Derbyshire

S

back at photos of how hospitals used to look, hear about the life of house officers in the 1950s and appreciate just how much medicine and surgery have evolved.. He went on to talk about how surgery is now based around a different disease spectrum and that it is becoming extremely sub-specialised. He was diplomatic in his predictions for the future and explained that he thought things could never go back to how they were, but integral to this change was advancement that could only have been

dreamt of when he was a junior house officer. This prestigious event was the start of another busy Scalpel calendar, which includes more lectures, surgical skills training, speciality study days and much more. Scalpel members are entitled to certain privileges, such as priority to popular lectures and discounts on events. For further information please visit: www.scalpelmanchester.co.uk

Manchester Medics Foot

T

he 2008/2009 season has been another successful year in the history of Manchester Medics Football Club. This year witnessed the achievement of not only one, but two league titles for the club. The first team secured the premier league for the second year running with a 3-0 victory over History. Throughout the tournament, the Medics First Team comprehensively outclassed the competition, who struggled to keep up with the pace set by the Medics. A key part of the league triumph was the consistency shown by the defence: centre backs Jamie Weber-McCartney and captain Chris Newark, and goalkeepers Steve Broome and Graham Finlayson. Dynamo Medics defied their tag of ‘third team’ by securing the second division title and with it, promotion to the first division. There, they will face an AC side who were bravely led out of relegation by captain Ben Darwent and centre-half Fraser MacNicoll, to climb to mid-table position, following a season where they were hampered by the loss of key players in a number of positions.

The season saw still more success, with the Manchester Medics Old Boys winning the Manchester Amateur League for the first time in their history, with four games in hand. In addition, the annual NAMS tournament, which was hosted in Manchester this April, saw the first team retain their crown as the best medics team in the country, despite stiff opposition from Sheffield in the final. We believe that this was a first for NAMS, having achieved the title without a single penalty shootout in the knockout stages!

Graham Finlayson

MENS

calpel is the University of Manchester’s student surgical society. With the help of surgical trainees and consultants, it aims to provide medical students with a deeper insight into the different surgical specialities and provides them with guidance on how to pursue a career in surgery. Last year Scalpel organised many exciting events including a trauma day, suturing workshops, laparoscopic skills sessions, a research presentation evening, numerous informative lectures, an audience with Professor Gunther von Hagen and a trip to the Bodyworks exhibition in the Museum of Science and Industry. The first event for this year’s calendar was a cheese and wine evening with Professor Harold Ellis, who spoke about his extensive surgical career within the NHS. It was fascinating to look


societyscope

Serenity Project in Tanzania S

PIT is registered nationally in Tanzania. I visited the remote and extremely poor village of Pommerin, South Tanzania this past summer to capture the desperate plight of its residents. This region not only has the highest incidence of HIV/AIDS transmission in the whole of Tanzania, but after some local research and

communication with local government officials, I was also staggered by the other seemingly insurmountable obstacles that this region faces. The increasing numbers of street orphans, the problem of poverty and the workload of one qualified doctor, who strives to cater for the needs of 27000 locals, are just a few.

It was a great privilege to be so warmly welcomed and taken care of by such a high spirited neighbourhood. Free from exaggeration, they were truly some of the kindest and happiest people I have encountered. The main take home message from my experience in Pommerin was that health is wealth, and what better than to promote this sentiment by creating a lasting legacy, which will hopefully help transform the lives of a whole community and future generations thereafter. Currently over £500 has been raised and will help towards building an orphanage and hospital, which are absent and urgently needed. Some of this money has been used effectively to build 3 new wells last October, providing safe and clean water. Recently the ‘Karaoke Night’ function proved very popular and successful. Get actively involved and make a real difference.

spit - Tabish Shah

M

MWFC has gone from strength to strength this season. Not only have we come top of our league, but have also had our most successful NAMS tournament in recent history, reaching the quarter finals without a single goal scored against us, only to be knocked out in a dramatic penalty shoot-out by Edinburgh. The club has seen the injection of new talent; Emily Cant up-front with her fancy footwork; our pocket-rockets Ellie Wood and Becky KW in midfield running rings around

Sitara Kuruvilla Jess Foster

the opposition and Lucy Halliday and Kate Armstrong keeping an impenetrable defence. Our coaches have been pivotal to our success with their ambition, dedication and occasional nagging! We’ve had some memorable socials in an array of fancy-dress, culminating in an invasion of Brighton and Birmingham, dressed as pom-pom wielding cheer-leaders on tour. We’re extremely proud of the club’s achievements and we hope next year will be equally, if not more prosperous!

WOMENS

ootball Club


30 SYWTBABS & Clinical Cases Uncovered 30 reviewscope Clinical Skills & Competition 31 Crazy Kings and Cuckoos

by simon eccles and stephan sanders - Tom Hansen, Year 3, Hope Hospital

T

reviewscope

representation of all you need to accomplish to move from FY1 to consultant. Every speciality is compared by competitiveness, salary, work-life balance, on-call activity, and boredom/burnout ratio. It also mentions

Co

m

We have three copies of SYWTBABS to give away! To be in with a chance send in the

pe

best career advice you’ve ever received.

ti

If Neel Burton’s Clinical Skills for OSCES has

ti

caught your eye, you’re in luck, we’ve got

he space available to review this

amusing myths such as “arrogant, divorced,

book does not give it justice, but

Porsche driving, wannabe surgeons” for

two copies up for grabs. Simply send in the

here are a few facts you need

cardiology and then gives the reality “a

worst thing you have said/heard in an OSCE!

to know. It answers almost every

pleasant surprise, some… are still

question, from the simple “how do

married!”

I become a consultant?” to “how

on

Submit your entries by September 30th to competitions@mediscopeonline.com!

It also includes alternative

do I become an expedition doctor

careers to the traditional clinical

any medic. If you don’t know what you want

on Everest?” It lets you know all

medicine, such as forensic medicine,

to do, this book is a great start. If you do, be

about Modernising Medical Careers,

entrepreneurship, law, and journalism. To

everything your crusty old “back when I was

finish, there is an excellent section on getting

a house officer” consultant can’t answer. For

a job and staying competitive during your

each speciality (over 100), there is a graphical

career. I heartily recommend this book to

clinical cases uncovered - Andrew Cheng, Year 4, Mancester Royal Infirmary

C

P

linical Skills for OSCEs covers virtually all the possible OSCE stations you will ever encounter

at medical school. It is a brightly colourcoded book, which makes browsing and locating particular topics a simple task. The quality of this book is impressive, conveying information in absorbable English and in well presented diagrams. Each topic

other topics in this series:

clinical skills for osces by neel burton - Lisley Salimin, Year 4, Mancester Royal Infirmary

prepared to change your mind.

4/5

£16.99

ISBN:9780199231966

editors take the advantages of PBL to create easily digestible textbooks. Each chapter contains a patient orientated case designed

roblem based learning. Whether

to explore a specific topic.

you love it or hate it, the Gener-

Whereas other textbooks fire information

al Medical Council have decided

into our brains in a brute force manner, these

that it’s here to stay. There is no deny-

books make you think thoroughly about spe-

ing that a case-based

cific conditions. Instead of list learning, read-

curriculum will create

ers are better equipped to appreciate and

better prepared doctors.

form their own understanding of a disease.

However, many people struggle to en-

There are currently thirteen books in the

is explained as a structured OSCE

gage with PBL, having come from force

series covering core material from cardiology

station. It takes the reader through

fed systems of sixth form. Students

to paediatrics, to more obscure topics such as

the station step-by-step, in a concise and

often fail to identify the

radiology and infectious diseases. With each

comprehensive manner, concluding with top

depth of knowledge

book containing roughly twenty cases, there

exam tips. The tips include the conditions

that they must possess.

are no bases left uncovered.

most commonly examined and related questions that may be asked. My only qualm is despite a systematic explanation in every station, it does not actually give examples on how you can phrase history

Furthermore, once objec-

CCU’s lack of diagrams and snappy

tives are made, we quickly fall back into

summaries are its main downfall, and was

the list-ticking techniques of learning that

clearly not designed for those needing the

we’re all so familiar with. Clinical Cases

‘final cram’ before exams. However provided

taking questions. To summarize, this is a

Uncovered (CCU) is a new se-

they are used wisely, CCU may become an

very concise yet informative book, making

ries of books designed to tackle

invaluable PBL companion for clinical medical

it a very effective tool for revision.

5/5

£24.99

ISBN:9781904842590

30 mediscope 06/09

these pitfalls. Rather than present clinical medicine as lists of symptoms and management plans, the CCU

students.

4/5

£19.99 each Blackwell Wiley


CUCKOO cRAZY It’s a Saturday night, you’re ready to let your hair down...but what do you do? JENNA BURTON thinks the answer might be to pay Crazy Wendy a visit at Thai E Sarn

G

reviewscope experienced before. Diners are allocated less space per metre squared than that of a multiparity fetus. Chairs are stacked on top of each other, room for your dinner plate is negligible... and attempting to work your way towards the bathroom is undoubtedly not worth the effort of any relief eventually obtained. It’s also quite a way from the 41/42 bus route and invariably the food does not quite resemble what was originally

oing for a beverage was done most nights this week

ordered. Yet, this is an absolutely fantastic evening out. Despite

- reference only to phase 1 students here – the post second year medic is far too sensible a species

paying your fair share for food and drink here, they are only

for mid-week drinking! Have PBL gatherings saturated your

a minute part of what this restaurant actually has to offer.

love for the deliciously (non) daring Dansak and delights of

Once the last chili is chewed and final fork replaced -

the curry mile? They maybe light on the wallet but not light on the lipase needed for digestion. Robinskis… really? Again? Or do something with a little va va voom

“Move aside for the old school renditions of Thai transvestite Crazy Wendy”

tables, chairs and people alike move aside for the old school musical renditions of Thai transvestite Crazy Wendy. Wendy is definitely not admired for her singing ability. In fact, her ability to hold a note is somewhat

this Saturday... Not meaning sweet loving (though if you are lucky enough to have found someone then by all means enjoy the sweet act of love making under the moonlight this Saturday evening)! For everyone else, give

questionable. Thankfully, she generously offers around the microphone to willing customers. Dance on chairs, hog the microphone and agonize over how unfair it is for a man to have such an enviable woman’s figure.

Crazy Wendy’s a try… Located on Burton Road, West Didsbury, the little gem known as

Take away is at 15% discount, but why don’t you sacrifice the

Thai E Sarn can be found buzzing and boisterous on a Saturday night.

space and comfort of eating in your own home for the cramped,

Coined as a “unique dining experience” it genuinely is like nothing

rowdy and hilariously entertaining environment of the restaurant?

yuran zheng’s movie review

The Last king of scotland

S

ince the list of medically related films churned out by Hollywood can be written on a post-it note, Mediscope is literally scraping the barrel for appropriate films to review. The Last King of Scotland was released in 2006 with James McAvoy in the lead role as Nicholas Garrigan. He’s young, he’s a Scot, he’s in Africa and he’s a medical student. But that’s not all…Idi Amin (Forest Whitaker) is in the neighbourhood; and according to Wikipedia he “was a (sic) Ugandan military dictator and the president of Uganda from 1971 to 1979.” He is the “Last King of Scotland”. Garrigan is a fictional character, being fortunate enough to be placed into the time Amin was in power. He is an idealist at first, searching for excitement and the chance to do good, but he is unexpectedly given the role of personal physician to the leader and witness to the madness of King Amin. Like most “based on a true story” films, liberties are taken to “sex up” a potentially boring story. It glues together a mish-mash of news stories and urban myths of the

time to create its compelling story. You get a real sense of McAvoy’s uncertainty of his role in Amin’s life and see everything through his innocent eyes. Whitaker’s portrayal of Amin is impressive. He is imposing, unpredictable, but charming. OSCAR got it right and he carries the film and makes you question whether this man is a victim of circumstance or just a monster. It’s a great story with great direction, but there’s nothing that leaves me wanting to see it again. The film will keep you enthralled throughout its running time; a good tense drama/ thriller that builds up momentum until the end, reaches its climax and then makes you wonder what the point of the two hours was.

3/5

06/09 mediscope

31


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Mediscope Magazine - Issue 5