UCL MEDICAL SCHOOL STUDENT MAGAZINE
An Hour With Dr Christian Jessen . IBSc Graduation 2015 . Medicine is Brilliant . Stroke in the 21st Century . Radical or Ethical? . An Elective in Nepal . Transgender Healthcare: Educating Tomorrowâ€™s Doctors . RUMS Sport 2015/16 . Edinburgh Fringe Festival
UCL Medical School Student Magazine First Term 2015 Vol.1 No.1 Editorial Committee Editors-in-Chief Rebecca Mackenzie and Sophie Bracke Sub-Editors Rebecca Kells and Tara Carlin Treasurer Raj Pradhan Communications Constance Wraith Website Editor Marius Pernea Layout Editor Rebecca Mackenzie Cover Design Kate Mackenzie News Editors Rebecca Kells, Emma Lewin and Anamika Kunnumpurath RUMS Review Out of Hours Christen Van Den Berghe Research Editor Andrew Cole Alumnus Interview Editors Adesh Sundaresan and Sophie Bracke Article Editors Lucy Reffell and Rebecca Fisher Welfare Editors Vignesh Gopalan and Robyn Brown Sports and Societies Editor Lucy Porter Comment Editor Paris Hosseini Book Review Editor Katie Hodgkinson
Find us at: http://myrums.com/rums-review/ Email: email@example.com Disclaimer: The views and opinions expressed in this magazine are those of the authors, and do not reflect those of the editors, UCL Medical School or RUMS Medical Students’ Association.
President’s Foreword..............2 Editorial..........................................................3 News..........................................................................4 Out of Hours
Professor Peter Delves and Dr Jayne Kavanagh...............7
The latest from Professor Yellon and the Hatter Cardiovascular Institute..................................................10
An hour with Dr Christian Jessen...................................13
Mental Maps: The Neuroscience of Navigation Dr Caswell Barry...............................................................16 Transgender Healthcare: Educating Tomorrow’s Doctors Christen Van Den Berghe........................................17 Radical or Ethical? How Far Should We Go to Improve Quality of Life? Dr Nicholas Herodotou...............19 An Elective in Nepal: The Day of the Earthquake Dr Laura Williamson..........................................................21 Stroke in the 21st Century Professor Anthony Rudd...........23 Don’t Forget… Medicine is Brilliant! Professor Jane Dacre............................................................25
Comment and Correspondence....27 Welfare LIVE. WORK. PLAY. Moving out of halls and starting clinics.................................................................28
The Royal Society of Medicine......................................30
Sports and Societies Round Up
RUMS Sport 2015/16 Andy Webb....................................31 Start of term reports.........................................................32 In Focus: Edinburgh Fringe Festival Ankit Bhatt....................35
Book & Event Reviews...................................37
Welcome to the RUMS Review This magazine is opening up a new chapter in RUMS. Very often RUMS is seen as an organisation focused on its sports teams, which offers little else to the wider community. However, it is increasingly becoming clear that RUMS is so much more than that. From the MDs recent forays in Edinburgh to the ever-expanding RUMS Music Society, we are beginning to demonstrate the many talents possessed by our medical students. This magazine is another step in that process. I would like to take this opportunity to thank Rebecca and her team who have worked tirelessly to make the RUMS Review a success. It is fantastic to see younger members of RUMS taking the reins and creating what is quite clearly an outstanding product. I would also like to thank all of the contributors to this initial edition of the RUMS Review. It is very difficult to make an idea come to fruition and without the support of the medical school, its alumni and some of the current teaching staff it could never have happened.
I hope this magazine will showcase some of the best that RUMS has to offer and look forward to future editions. Alex Maidwell-Smith, MBBS Year 5 RUMS Medical Students’ Association President
Welcome Being a part of RUMS is very special - why you might ask? We believe it is due to the fantastic medics who comprise RUMS: the students for whom this magazine is designed. With this in mind, we plan to provide a narrative within RUMS; a medium in which to express ourselves and celebrate our successes throughout our time at medical school.
This Issue Our launch edition, which has taken form throughout the summer, sets the scene for what we hope will become a vibrant forum in which to explore what matters to you as a medical student. Firstly, we get up-close and personal with the ‘stalwarts’ of our medical education - UCL medical school’s lecturers. We would like to thank both Professor Peter Delves and Dr Jayne Kavanagh for being so amenable to our request and, as ever, they have spared no detail! Research focuses on the work of Professor Yellon at University College Hospital’s Hatter Cardiovascular Institute. Andrew Cole explores every aspect, placing particular emphasis on how Professor Yellon has established himself in the field of cardiovascular research. The account will inspire all students interested in emulating Professor Yellon’s successful research career. This edition’s alumnus interview is for all those budding medical journalists out there. Best known for TV programmes Embarrassing Bodies and Supersize Vs Superskinny, Dr Christian Jessen discusses his time at UCL, his illustrious career, and the future of our profession. Our article section begins with the fascinating work of Dr Caswell Barry, who explains UCL’s recent findings into the neuroscience behind neural navigation, whilst medical student Christen Van Den Berge demonstrates why UCL leads the way in educating doctors about transgender healthcare - a topic which has recently received a large amount of media attention. Quality of life is at the forefront of any medical decision, and Dr Herodotou encourages us to question our limitations by taking us through his ethical conundrum. Following this, past medical student Dr Laura Williamson offers an insight into the aftermath of the Nepal earthquake, and the esteemed Professor Rudd, the national clinical director for stroke, describes advances made into the treatment of stroke, and outlines what still needs to be done in order to improve services for patients. Lastly, but by no means least, RUMS Review is proud to have an inspirational article by Professor Jane Dacre, which serves to remind us of the possibilities that a career in medicine has to offer. We then turn our focus onto life at UCL with our welfare team offering their words of wisdom on how to make the most of the upcoming academic year. Lucy Porter and Andy Webb take a look at the year ahead for all RUMS sports and societies, while Ankit Bhatt recalls the MDs antics whilst in Edinburgh! Government changes to Junior Doctor Contracts dominates our comment and correspondence section; Paris Hosseini breaks down exactly what this will mean for junior doctors. RUMS Review endeavours to follow the progress of the campaign, and we urge you to respond, write and get in contact with your views and opinions. To finish, Sam Scott enlightens us about the annual Women in Surgery conference. We also take a look at book reviews and medical student events across London.
The Future RUMS Review is produced by students, for students, and therefore it will be through the contribution and involvement of you, the readers, that will determine the direction of the magazine; covering topics which matter to you. Too often, the successes and work of medical students goes unnoticed. We hope to provide an opportunity for you to share your achievements with peers and colleagues alike. In our next issue, we are pleased to announce that we will be working in collaboration with both the Medical School and the RUMS Alumni Association. This will allow us to improve the communication between staff and students, whilst keeping you fully updated on current affairs. We hope that our alumni readers will enjoy catching up on life in RUMS, and our student readers will look forward to finding out about the progress of former students. We would like to thank the editorial team for their incredible hard work, commitment and encouragement; it has been a pleasure to work with them, and we look forward to the year ahead. We would also like to thank Alex Maidwell-Smith, Raj Pradhan, Dr Paul Dilworth and Dr Deborah Gill for their support from the very beginning and, Briony McArdle, for the many opportunities she has provided for us. Lastly, we would like to thank all of our contributors and sponsors without whom we would not have such a fantastic launch edition. Good luck to everyone for the year ahead! Rebecca Mackenzie and Sophie Bracke MBBS Year 2 RUMS Review Founding Co Editors-in-Chief We welcome all comments, feedback and contributions. If you would like to get in touch with the team, then please email firstname.lastname@example.org
NEWS Congratulations to the IBSc Class of 2015 The summer of 2015 has been full of exciting events, but for the 3rd year students there was none more important than their IBSc graduation on the 26th of August. The air of relief and happiness was palpable at Senate House. After collecting their robes, the 300 students could be seen making their way from Senate House to Bedford Square Garden for their graduation ceremony. There was an abundance of smartly dressed individuals, with some incredible high heels, preparing for what was the last graduation of the day. The ceremony celebrated 3 years of hard work, with the graduation breaking up the long 6 years of study to recognise students’ huge efforts and achievements, as well as providing motivation for their upcoming clinical years. Prof Stephen Davies was the Orator, and Vivienne Parry OBE was the Presiding Officer. There were two particularly important moments of the ceremony. First of all was the inspiring graduation speech by UCL alumnus Dr Christian Jessen, in which he encouraged the students to “keep learning, keep pushing, keep surprising yourself ”. Secondly was the awarding of the Faculty Medal to Simrun Virdee, a particularly high-achieving individual in a class of spectacular students. The next step in their medical journey begins in September when they are to start their clinical studies, something they were clearly looking forward to at their graduation. Congratulations to all the students who reached the significant milestone of obtaining their IBSc this year. EL
Vertical Modules to be renamed The Medical School has announced that, as of September 2015, the Vertical Modules course will be renamed Clinical and Professional Practice. The decision was announced in an email sent by the Academic Lead for Clinical and Professional Practice, Dr Faye Gishen, and will mean that medics joining UCL this year will be subject to the renaming of the modules. The vertical components of the MBBS course are taught throughout the whole course and to first and second years in weekly group sessions at the three different medical school sites. They comprise of subjects within Medicine that fall outside of the main scientific bracket, such as clinical and communication skills, ethics and law, and sociology. It gives students a basis of preparation for clinical practice, giving them a chance to meet patients in the community and develop a professional and ethics-influenced approach to their careers. The email states that the name change ‘helps to clarify the nature of the vertical themes, i.e. they form the professional and generic components which shape the UCL rounded doctor and are regarded as ‘everybody’s business’.’ The change of name will not affect the content of the modules, or method of examination. RK
Division of Surgery staff cycle across Scotland for Prostate Cancer UK Staff members from the UCL division of Surgery and Interventional Science will be cycling the Scotland leg of the Deloitte Ride Across Britain to raise money for partner Prostate Cancer UK (PCUK). The participants, Dan Sinclair and Mark Cranmer, will take to the roads of Scotland and bravely tackle the 440-mile journey over a period of 4 days. A second partner will assist them: the Institute of Sport, Exercise and Health (ISEH). Prostate Cancer UK, a close research partner of the Division, has made invaluable contributions to its field. It has made advances into research and services as well as bringing much-needed awareness of prostate cancer in the UK. PCUK also provides funding for research on the disease; The University College Hospital (UCH) Urology team has been awarded several grants by PCUK, and the team’s work on a world-class diagnostic service for men with prostate cancer led them to win a prestigious BMJ innovation award for their submission: ‘Innovations in Prostate Cancer Care.’ Funds raised by the bike ride will help to fund further breakthroughs and developments such as this. Meanwhile, the ISEH will be providing expert health advice, injury prevention and endurance training for the team to help them face the 17,800ft hill climbs of the Scottish highlands. RK
UCL Medical Student Daniyal Jafree Returns From an Enriching Summer in Zurich Third year Medical Student Daniyal Jafree won a coveted spot on the Zurich Biology Undergraduate Summer School programme (BUSS) this year, a nine-week, intensive research-oriented course based at the University of Zurich. Having opened its doors in 2006, BUSS is now an incredibly prestigious programme welcoming applications from all Undergraduate Life Sciences students across the globe. Despite the fierce competition and rigorous application procedure, Mr Jafree contended with 700 other applicants to successfully secure his position in one of only twenty seats available this year. On commencing the programme, Daniyal was allocated to Professor Thierry Hennet’s laboratory at the University’s Institute of Physiology and this is where he undertook two fascinating research projects, rubbing shoulders with PhD students and Post-Doctoral Fellows. Daniyal worked with his team to carry out two projects, the first of which investigated the immunoregulatory effects of human milk oligosaccharides and the second involving the use of glycoengineering to study bacterial metabolism of specific monosaccharides. Daniyal acknowledges that these studies have “great implications upon our understanding of the origins of inflammatory bowel disease and also the individual interactions of the gut microbiota, which is poorly understood”. The weeks spent at Prof Hennet’s lab facilitated Daniyal’s proficiency in a variety of techniques integral to many lab-based projects. Western blotting, flow cytometry and SDS PAGE were just some of these skills and as a medical student considering the pursuit of a PhD or MSc in the near future, BUSS has certainly furthered Daniyal’s journey towards achieving his ambitions. Outside the lab, the gifted undergraduates were taught to critically analyse papers and to develop a strong understanding of the art of scientific writing. They also attended journal clubs and seminars. All of this assisted in the creation of an enriching environment. Dr Martin Jinek from the University of Zurich’s Department of Biochemistry, who Daniyal accounts as “one of the pioneers of the new genome editing system CRISPR”, was one of the eminent speakers to deliver a memorable lecture to the twenty international attendees of this year’s programme. While in Zurich, Daniyal was also looking for opportunities to enhance his clinical experience. He undertook an observership at University Hospital Zurich where he was granted the privilege of witnessing open fetal surgery for Spina Bifida. Upon hearing of Mr Jafree’s interests in paediatrics and congenital defects, Professor Martin Meuli, head of paediatric surgery at University Children’s hospital in Zurich, invited Daniyal to gain an exclusive insight into this innovative procedure carried out at only five facilities in Europe. As an aspiring clinical academic, Daniyal described it as “an honour and an amazing experience to ‘get ahead of the game’ and see a procedure that hasn’t been introduced to the UK yet!” Now that Daniyal is back from an enlightening summer, there is no doubt that his time in Zurich has broadened his views on the world of scientific research. He is currently working on an article for the Student BMJ with a Medical Student he met at the Summer School and together they are endeavouring to raise awareness of just how fulfilling it can be to work at the cutting edge of science. Daniyal hopes “to attract more medical students to the lab environment based on the excellent experience and broad perspectives”, cultivated during the nine weeks at BUSS. We would like to congratulate Daniyal on his commendable achievements and wish him the very best for the future. AK
UCL introduces Postgraduate Certificate in Clinical and Professional Education Starting from the 2015-16 academic session, UCL will be offering a Postgraduate Certificate in Clinical and Professional Education. This is a new and exciting modular programme that offers healthcare professionals of all disciplines a fantastic opportunity to solidify their skills in Medical education. With optional modules ranging from “Leadership Skills for the Healthcare Professional”, to “Quality Improvement in Health Care”, this qualification has been designed with the needs of today’s healthcare professional at the forefront of its objectives. In addition to the core module in ‘Teaching and Learning in Medical Education’, participants are required to study up to three self-selected modules, thus facilitating a truly tailored course to suit their unique professional backgrounds. Modules are taught via distance learning, face-to-face teaching methods and virtual learning devices, all of which are utilised to achieve a blended learning experience. Small group work, virtual seminars and a plethora of online resources are all important components of this course but module tutors will always be on hand to assist when needed. Coursework will be the medium of assessment. A principal aspect of this award is its emphasis on understanding the theories forming the basis of current clinical practice. At the same time, the teaching will focus on equipping participants with the practical skills that are critical to meeting the standards for educators in our healthcare system. For postgraduates looking to network and progress onto more formal roles in their institutions, this certificate is a perfect opportunity to make a significant advance in the right direction. The certificate can be awarded as a two-year part time format or as a completely flexible course lasting up to five years. Distance learning modes of study are also available. For further details and to find out how you can apply, please contact email@example.com or visit the UCL website. AK
UH Success United Hospitals (UH) encompasses all the London medical schools – Barts, GKT, Imperial, RUMS and St George’s – and every year there are several events in which all member medical schools compete against one another. This year, RUMS has been hugely successful in the UH events.
In March, Rugby took part in the final of the United Hospitals Cup, the oldest rugby cup competition in the world. They were competing against Imperial at Ealing RFC in what turned out to be a dramatic evening. However, with tremendous support from the stands, and securing a 20-6 score, RUMSRFC was victorious, winning the trophy back after 128 years. In April, the MDs took part in the UH Comedy Revue, where they were defending their title after winning the previous year. This year the event was held at St George’s and was a fantastic night filled with the best wit of the UH medical schools as they competed for the Moira Stuart cup. Fantastically, the MDs won. RUMSBC has also had a hugely successful year with UH. The club takes part in a number of UH events each year, including the Allom Cup, UH Head, Winter and Novice Sprints and Bumps, and the medical school with the greatest total points from all UH events is declared the winner. This year, RUMSBC gained the most points overall and so thus became UH Champions. In June, RUMS Cricket Club were triumphant winning the UH T20 Cup by beating Barts in the final, and likewise Badminton were also victorious, winning the UH Shield. Finally, RUMS tennis had phenomenal success in the United Hospitals League Cup which is the second oldest tennis cup competition in the world and this year was held at the Olympic Park. The Mixed Team were runners-up in their competition and the Men’s Doubles Team beat strong Barts opposition to win theirs. RUMS has clearly dominated across the London medical school scene this year and all of these UH successes are a credit to the exceptional skill, determination and teamwork within RUMS. Both the Rugby and Tennis UH Cup trophies will soon be displayed in the RUMS trophy cabinet and congratulations go to all participants who should be rightly proud of the excellent way in which they re p re s e n t e d their medical school. LP
RUMS Runs the Richmond Half Marathon Waking up before 7am on a Sunday is uncharacteristic for most RUMS students. However, on the 6th of September at 8am multiple UCL medics could be seen at Kew Gardens, preparing for their next challenge: a half marathon. As part of the Richmond Running Festival RUMS runners had the option to run either the full half marathon or, if this was a daunting prospect, a 10K course. For many, this was their first time running such a long distance and at the start the runners were nervous in anticipation of the feat. This was the culmination of many weeks’ - or in some cases a few days’ - worth of gruelling training. Both courses started at Kew Gardens and finished in the Old Deer Park. Participants could enjoy the picturesque setting as they ran, perhaps adding a unique spin on the traditional running experience. Jess Elliot, a third-year who ran the half marathon said, “The course was actually amazing, it was so pretty! I’d never been to Richmond before and we ran from Kew to Ham, all the way along the riverside past all the boathouses. It was so beautiful!” It also helped that, apart from the distance, the course wasn’t overly strenuous, being very flat for the most part. As a result, there was a very light, cheerful atmosphere, in keeping with the RUMS spirit. Students had a variety of reasons for wanting to take part: many were running for charities, such as MIND; some needed a new challenge after the relaxing summer holiday; others were looking for a reason to improve their fitness levels. But above all else, the RUMS runners were participating in order to have some fun. Indeed, the post-race music festival was a great opportunity for the runners to relax, have a drink and socialise with friends who they had not seen since the end of summer term. A huge well done to everyone who completed either race, there were some excellent results for RUMS within the 19-24 age group. Enjoy your newfound fitness! EL
New Academic Vice President Appointed From UCL
Professor Margaret Johnson, Professor of Medicine at UCL and eminent Consultant at The Royal Free NHS Trust, has been appointed as the new Academic Vice President of the Royal College of Physicians. Throughout her career, Professor Johnson has contributed to the medical profession extensively, culminating over 20 years of experience as a Consultant in Thoracic Medicine with a special interest in HIV/AIDS Medicine. She has made several profound contributions to the study of respiratory and infectious diseases as well as to the advancement of HIV-related services provided by the NHS. In 1989, she established the Ian Charleson Day Centre at the Royal Free Hospital- the first ever open access HIV clinic in the UK. She is currently Clinical Director of HIV services at this outstanding facility. Professor Johnson holds many esteemed positions, such as Senior Chest Physician and Research Lead of the HIV Unit at the Royal Free. These, together with her distinguished research profile, have been recognised by the Royal College of Physicians. Her election to the position of Academic Vice President- a huge commendation- will mean direct involvement in overseeing the academic activity of UK physicians, undeniably a vital area of professional development. Further to this, Professor Johnson will also be responsible for the management of the RCP’s academic programme and will do so for the next three years. A leading figure in healthcare today, Professor Johnson is an inspiration to all of us and we wish to congratulate her on this momentous occasion. AK
RUMS Celebrate Success as Trophies Go on Display RUMS clubs and societies have seen a successful summer. In sport, the RUMS Cricket club won the United Hospitals T20 Cup, and the RUMS Men’s Rugby Team won the United Hospital Challenge Cup.
The UCL Volunteering Services Unit also awarded the Best Newcomer Student Led Project of the Year to medical student action group, Viva La Vulva. The trophies are being proudly displayed in the Cruciform Hub. RK
New Non-Executive Director of UCLH Appointed Professor David Lomas, The Vice-Provost (Health) at UCL, is appointed as new non-executive director for UCLH. Professor Lomas is to replace Professor Sir John Tooke, who stepped down at the end of July. RK
Dr Kevin Fong to Run Series of Christmas Lectures The notable UCLH doctor and space medicine expert, Dr Kevin Fong, will film a series of Christmas Lectures entitled ‘How to Survive In Space’. The series will have three parts, and will include demonstrations. The ballot to attend the filming of the lectures is now closed, but the series will become available to watch at a later date. RK
New Anatomy Resource Available in Library Acland’s Video Atlas of Human Anatomy is now available in the library following enthusiastic feedback. Users can expect over 300 narrated videos featuring real cadaver specimens and 3D views. More information can be found at aclandanatomy. com/ RK
Dr Clifford Lisk Receives Award of Excellence From UCL Dr Clifford Lisk, who works as a consultant in acute medicine and geriatric medicine at Barnet Hospital, has been commended by UCL for his involvement in medical education. He received an Excellence in Medical Education award from the Medical School in July. We would like to congratulate Dr Lisk. RK
Curing Cancer Documentary is Nominated for Grierson Award A documentary featuring the UCH Macmillan Cancer Centre, which was broadcast on Channel 4 in October 2014, has been nominated for a prestigious Grierson Award. The documentary focuses on four patients, as well as the doctors at UCH involved in new treatments and research projects. RK
Message From Library – Welcome, New Students! We would like to welcome all new and returning students to the Cruciform Hub. Library staff will be very happy to help with any enquiries about finding books and online resources, using the self-service facilities, and getting started with IT connections and services. In the week beginning 28th of September tours of the Hub will commence at 10.00/11.00/2.00/3.00/4.00 Monday-Friday, starting at the Library Desk by the entrance. RK Rebecca Kells, BA English Year 2 Emma Lewin, MBBS Year 2 Anamika Kunnumpurath, MBBS Year 3 News Editors
OUT OF HOURS
They stand at the front of LT1 almost every day, regularly taken for granted. But have you ever wondered how they got to UCL? What exactly their jobs are or what their lives are like outside the lecture hall? We definitely do, so we’ve asked some of the medical school’s favourite lecturers our burning questions on their personal and professional lives. For our first issue, we went for two of the best-loved.
Professor Peter Delves is a Professor of Immunology and Vice Dean of Education in the UCL Faculty of Medical Sciences. He is responsible for all undergraduate and postgraduate taught courses in the Division of Infection and Immunity. Within the Medical School, he mainly teaches Year 1 and 2 students.
Tell us about your career: what did you study and where, what have been the highlights of your career, how did you get to UCL?
After graduating with a University of London BSc in Zoology and Botany I took up a Research Officer position in the Imperial Cancer Research Fund (ICRF, now Cancer Research UK) Medical Oncology Unit at Bart’s Hospital. They very generously allowed me ‘day release’ to undertake an MSc in Applied Immunology at Brunel University. By the end of this MSc I fully appreciated what a truly exciting subject Immunology is. After 5 years at the ICRF I moved to the Middlesex Hospital Medical School to undertake a PhD (‘The autoimmune response to thyroglobulin’) supervised by Ivan Roitt, who was at the time Head of the Department of Immunology. Ivan taught me much about research and, importantly, education - particularly how the two were inseparable. I stayed in the lab after finishing my PhD and in 1987 the Middlesex Hospital Medical School merged with UCL - and I’ve been here ever since!
Rather unfortunately, as is the case for the majority of scientists, I cannot claim any world-transforming discoveries or the invention of a miraculous drug. At best just some very small pieces of new information to add to the sum of knowledge and understanding, in particular, areas of autoimmune disease and reproductive immunology.
Nevertheless, if I look back over my career, there have been many personal highlights. The main source of pleasure has been the interactions with students and academics around the world.
One highlight would definitely be a 10 year involvement, with my colleagues Peter Lydyard, Nino Porakishvili and others, in helping restructure higher education in the Southern Caucasus. And of course there are many individual moments one remembers – like standing beside the huge indoor pool in the British ambassador’s gorgeous residence in Havana, a large cigar in one hand, a mojito in the other, discussing vaccines with Fidel Castro Jr. One of many rather unanticipated moments that crop up in one’s life. More recently I have been fortunate enough to develop links with a number of universities in China, an exciting place to be at this time in history. Finally, I have very much enjoyed being involved for many years in communicating the subject I love through a variety of publishing activities including textbooks and online learning resources.
Describe yourself in five words Modest, arrogant, manic, laid-back, restless.
What first sparked your interest in science and medicine? Taking my talking teddy bear apart to see why it spoke, thereby irreparably damaging it.
What’s the best thing about working at UCL and in London? Wonderful colleagues and its location at the centre of the world’s greatest, most multi-cultural city.
What are the best and worst things about teaching medical students? 7
Most students, most of the time, are engaged and eager to learn. The worst thing is the (understandable) obsession with ‘what do we need to know to pass our exams’.
Which one person has most changed What are the best and worst things the way you think about medicine about teaching medical students? and science? Best: the pleasure of working with students over six years and watch-
[It’d be] Really hard to pick just one person but I think it probably ing them turn into wonderfully competent and caring professionals. has to be Martin Raff (Emeritus Professor at the MRC Laboratory for Worst: when I don’t manage to engage students. Molecular Cell Biology here at UCL). His ability to seek out the really exciting areas of biological science, coupled with his ability to communicate with students at all levels, has been truly inspiring.
Which one person has most changed the way you think about medicine What are your greatest ambitions and science? that you have left to fulfil? My registrar when I was a junior doctor in Obs and Gynae. I kept bugLive fast and die old.
What is your favourite way to relax after a long day at work? Generally I find relaxing to be incredibly stressful but I do love live music, almost any genre.
What are your guilty pleasures? Pizza.
ging her for advice on managing patients and she advised me to work things out from first principles. It was a lightbulb moment. We’re still friends twenty years on.
What are your greatest ambitions that you have left to fulfil? To help in my small way make the world a fairer place. For starters, helping to end FGM, decriminalise abortion, tackle bullying and discrimination in medicine. I could go on!
What one piece of advice would What is your favourite way to relax you give to your students for their after a long day at work? futures? Leave all doors open and be nice to everyone.
Depends on what the day’s been like. If I’ve been stuck at my desk all day I like to socialise after work. If I’ve done a lot of talking/teaching/ attending meetings I prefer to read the paper and do the crossword or watch a boxset with my partner and/or kids.
Dr Jayne Kavanagh is a Principal Clinical Teaching Fellow at UCL Medical School, where she leads the Ethics and Law teaching programme. She also leads a number of student groups: Target Medicine, a project aimed at widening participation in applying to medical school and Viva la Vulva, a political action group on FGM and other sexual health issues. She is a prominent teaching figure for every Football, definitely. For an enthusiastic feminist I spend far too much year group in the medical school, and won the UCL SLMS Education time watching men kick a ball around. Award in 2015.
What are your guilty pleasures?
Tell us about your career: what did you study and where, what have been the highlights of your career, how did you get to UCL? I studied Medicine in Liverpool in the eighties and Politics, Philosophy and History in London in the nineties. I continued studying Philosophy into the noughties alongside education. I’ve been studying sexual and reproductive healthcare since Medical School - it’s a lifelong project. I got to UCL via a sexual health colleague who told me the MBBS ethics teaching (in 2005) needed some practical input. Every time a patient or student thanks me for helping them is a highlight.
Describe yourself in five words Doggedly determined to make a difference. Sorry, that’s six words.
What first sparked your interest in science and medicine?
What one piece of advice would you give to your students for their futures? Be true to yourself, find something you’re interested in and go for it.
My wonderful grandma who used to take me with her on visits to vulnerable people in hospital when I was a little girl.
What’s the best thing about working at UCL and in London? The diversity, the vibrancy and the political leaning to the left.
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Research is many things. Research is something medical students are expected to do and can be tedious. Equally, research can be fast paced and exciting. The great Hungarian physiologist Albert Szent-Györgyi described research as ‘Seeing what everyone else is doing but thinking what nobody has’. To me, research is all of these things but above all, research is fun and rewarding. In this, the first research feature of the RUMS Review, I will begin with an article dedicated to Cardiology. This decision was influenced, in part, by my particular interest in this field and, in part, by UCL’s forefront position at some of the most interesting cardiovascular developments of the 21st century. The Hatter Cardiovascular Institute
The Hatter Cardiovascular Institute is the University College Hospital (UCH)’s perennial Cardiovascular laboratory. It is directed by Professor Derek Yellon, who founded the Hatter Institute in 1990 with the aim of creating a laboratory that was truly translational between clinical and academic cardiology. The core research focus of the Hatter Cardiovascular Institute has remained unchanged for the past 25 years. It investigates the cardioprotective mechanisms and tools that can be used clinically against ischaemia-reperfusion injury. The story of how The Hatter Cardiovascular Institute was founded is an interesting one. Professor Yellon was approached to run a new academic cardiology lab - so long as the necessary funds could be raised. Initial financial support from a UK drug company and the sports company Reebok (whose slogan at the time was ‘At the heart of sport’) provided Professor Yellon with sufficient funds to turn his modest laboratory space into a functional laboratory (pictured above). This was the beginning of the first academic Cardiology laboratory within UCH, but it wasn’t until he was introduced to Morris Hatter, a colleague’s patient, that the full potential of the laboratory was realised. Later named after this generous patron, the Hatter Cardiovascular Institute has developed originally from a laboratory built in a hospital bathroom to a world-renowned Cardiology Institute, which has received over 20 years of British Heart Foundation (BHF) programme-specific support, as well as support from MRC and The Wellcome Trust. In 2000, the laboratory had outgrown its modest beginnings and moved into its new premises in Chenies Mews, with Tony Blair officially opening it in 2005. As Director of the Hatter Institute, Professor Yellon has supervised over 50 MD or PhD students - to which 5 are now full Professors in their own right - he has raised millions of pounds for the institute, published hundreds of academic papers and edited 23 books.
Why is Cardiology Important? Before we delve into the cutting-edge work at the Hatter Cardiovascular Institute, a perspective of the current problem is important. Chronic heart disease (CHD) is the leading cause of mortality and morbidity worldwide. Indeed CHD is estimated to account for 17.5 million deaths per annum. The clinical endpoint for CHD patients is usually a myocardial infarction, presenting either with or without ST elevation on electrocardiogram investigation. It is the patients with ST elevation, so called STEMI patients, that are known to have the worse prognosis.
The Ischaemic Paradox Myocardial damage associated with myocardial infarction is the direct result of ischaemia resulting from a lack of blood flow to the myocardium, however it is now understood that this only accounts for around 50% of the total necrotic tissue. There is an additional paradoxical tissue death that arises upon blood flow re-initiation; a so-called reperfusion injury occurs and has been suggested to contribute to up to 50% of the final infarct size. Exactly how this reperfusion injury occurs biochemically is not completely understood, but the important role that mitochondria play is appreciated and has been heavily investigated at the Hatter Cardiovascular Institute. Namely, it has been a unique mitochondrial pore which has been placed as a central mediator of this injury - the Mitochondrial Permeability Transition Pore (MPTP).
AC: How did you originally get into Mechanical MPTP Targeting research and, more specifically, in the The Hatter Cardiovascular Institute has also been involved in the defield of cardioprotection against velopment of a non-pharmacological treatment of ischaemia- reperischemia reperfusion fusion injury- called remote conditioning. This follows the idea that a series of short lived ischaemic events applied to a remote area, for injury? example the arm, either before a myocardial infarction (pre-conditionDY: From my undergraduate degree in Cape Town, SA, I knew that I would go into research - it is the feeling of discovery, like being a detective and learning new things, that fuelled my initial passion. From here I travelled to Bath University to undertake a PhD in Cardiovascular Pharmacology. I think that people have a natural tendency to stay in the field of their PhD so I was lucky that mine covered the cardiovascular sciences, otherwise my career may have been a lot different. If I had completed a PhD in Neurology, we may have had the ‘Hatter Neurology Institute’! In terms of deciding to focus on cardioprotection, that came from my post-doctoral post at St Thomas, where my main area of study was ischaemia-reperfusion and cardioprotection. Therefore, when I founded the Hatter Cardiovascular Institute, I thought it wise to stay in the field that I had been trained in.
The MPTP Trigger Hypothesis Physiologically, the MPTP controls the homeostatic regulation of calcium and reactive oxygen species across the inner mitochondrial membrane, however the pore requires strict formation requirements which, during ischaemia, become deregulated. Despite the presence of opening factors such as high oxidative stress, low adenine concentration and Ca2+ overload, MPTP opening is inhibited by the low pH. Reperfusion causes the washout of this acidosis, removing MPTP inhibition and causes mitochondria to become non-selectively permeable to molecules less than 1.5kDa. MPTP opening causes a number of effects, most of which disrupt the proton gradient resulting in ATP synthase reversing direction, and uncoupling oxidative phosphorylation. Associated with MPTP opening is an influx of water, causing mitochondrial matrix swelling and outer mitochondrial membrane rupturing. After enough mitochondria have collapsed, the cell is irreversibly committed to either necrotic death resulting from the loss of the mitochondrial trans-membrane potential, or apoptotic cell death resulting from the release of cytochrome-c. The exact molecular constitution of the MPTP still remains unknown, with many different proteins being suggested as physical pore components or regulators of its formation, however one of the most important proteins is cyclophilin-D. Generations of transgenic mice lacking the peptidylprolyl isomerase-f gene, which produces cyclophilin-D, confirmed its role as these mice were shown to be resistant to MPTP opening and displayed reduced damage induced by acute ischaemia- repurfusion injury (IRI). However, it is impossible for cyclophilin-D to be a structural part of the MPTP as it is purely a mitochondrial matrix protein and not found in the inner mitochondrial membrane (IMM). Furthermore, evidence from cyclophilin-D deficient mice showed MPTP can still form but with an increased threshold for calcium induced pore opening, suggesting cyclophilin-D acts as a regulator of other MPTP components, by possibly inducing conformational changes. The importance of this protein did not go unnoticed and it wasn’t long until this had been therapeutically targeted.
Pharmacological MPTP Targeting
Cyclosporin-A (CsA) has a high binding affinity for all cyclophilins, binding to which inhibits cyclophilin activity. Originally licensed as an immunosuppressant, CsA inhibits the regulatory cyclophilin-D component of the MPTP, thus preventing transient pore opening. Human ex vivo experiments investigated the in vitro success of CsA. Yellons’ group showed that slices of human atrial appendage tissue from coronary artery bypass graft patients were protected from IRI damage after pre-treatment with CsA, suggesting that CsA protection is translatable in a human model. In 2014, they showed protection in CABG patients in a small proof of concept study. Importantly, the largest randomised trial into the effectiveness of CsA (CIRCUS- Cyclosporine and Prognosis in Acute Myocardial Infarction (MI) Patients) was published a few weeks ago in the New England Journal of Medicine showing after 1 year of follow up, CsA had a neutral effect in PPCI patients. It is clear, therefore, that protection afforded by CsA is not perfect and might not be clinically translatable. Prof Yellon and Hausenloy wrote an editorial to this paper which explains the potential reasons why this study was neutral. The race is on at the Hatter Cardiovascular Institute and other institutes across the world to develop modified versions of CsA, which are more clinically translatable.
ing) or after it (post-conditioning), can promote a degree of protection from the ischaemia- reperfusion injury. The mechanism of ischaemic conditioning is not fully understood but involves the activation of either a neural or systemic component, which acts to reduce lethal reperfusion injury by reducing oxidative stress, improving endothelial function, attenuating apoptotic cardiomyocyte death, reducing neutrophil accumulation and delaying the restoration of neutral pH. Zhao et al. showed that after a 45-minute episode of sustained myocardial ischaemia, the interruption of myocardial reperfusion with three 30-second cycles of myocardial ischaemia and reperfusion could reduce the myocardial infarct size in dogs from 47% to 11%. Professor Yellon and others at the Hatter Cardiovascular Institute have spearheaded the largest multicentre randomised controlled clinical trial of remote ischaemic preconditioning, called the the ERRICA (Effect of Remote Ischaemic preConditioning on clinical outcomes in patients undergoing Coronary Artery Bypass Graft surgery) trial. Over 1600 patients were recruited and have been followed up for 1 year so far. Fully published results of the ERRICA trial will be published in the New England Journal of Medicine, however it is known that in terms of the primary endpoints, the use of pre-conditioning in CABG patients was neutral. The white in the tissue cross-sections is the necrotic tissue resulting after a myocardial infarction. Without any protection (top), the damage is severe. Reperfusing the heart (middle) still has significant damage. This is massively reduced using ischaemic conditioning (bottom).
AC: With the publication of your ERRICA trial and Prof Ovize CIRCUS trial both providing neutral results, is this field dead? DY: Not at all! This is why we undertake research and this is how science develops. We can say in the basic science arena that hearts can be protected from ischaemia-reperfusion damage both pharmacologically and interventionally, it is just a matter of translating this basic science result clinically which, after all, is the bottleneck that all scientific fields must overcome. The CIRCUS trial did indeed have very good pilot results, however the newly published 1 year follow up data shows no benefit at the primary mortality endpoint or any secondary endpoints either. As mentioned above, in the editorial we wrote, we questioned the validity of these results for a number of reasons- mostly as a different formulation of cyclosporine was used in the CIRCUS trial, different to the one used in the pilot. We now wait for the results of CYCLE (Cyclosporine A in Reperfused Acute Myocardial Infarction), a similar cyclosporine trial study as CIRCUS, but importantly uses cyclosporine with the same vehicle as used in previous past positive results. As for our ERRICA trial, this measured the ability of remote preconditioning in the surgical environment with CABG patients. We measured Troponin T levels, a marker for cardiac stress, and the levels were consistently lower than expected in the control group, suggesting perhaps that the overall stress on the heart was not sufficient to see an overall protective effect (Hausenloy& Yellon NEJM in press). The BHF have not lost faith in this concept and the Hatter Cardiovascular Institute have been awarded a £1.5 million grant to specifically investigate the clinical outcomes of remote preconditioning in protecting the hearts of patients presenting with STEMI. Having the ability to test the validity of this treatment in STEMI patients will allow us a more robust insight into the clinical application of preconditioning.
The Future of The Fight Against IRI The future of therapies against ischaemia- reperfusion injury currently rests on the results of a few clinical trials but, what is certain, is that massive advancements have been made within the pre-clinical application of therapies and the field eagerly awaits the inevitable clinical translation of these results. It remains to be seen as to whether CsA will be a valid treatment option, but it will certainly offer a solid base for future drug modification. As to the development of remote preconditioning, relatively little is understood about the science behind this principle, and rapid advancement would occur if the factor(s) for cardioprotection was known or if more was understood about the pathway of protection. Until this, remote preconditioning may remain a toy of scientists rather than a tool for clinicians.
AC: How would you recommend students to engage more in research? DY: Firstly I freely applaud any medical student that wishes to engage in research. Medicine is such a diverse area of study, performing research at this stage of training will provide students with the necessary transferrable skills to come back into academic medicine in the future if they so wish to. From that point of view, I think it is very important for students to be pro-active and get more involved. In terms of practicalities on how to do this, the most important thing for students is to be able to demonstrate perseverance and a passion for the subject area. I would suggest students contact Primary Investigators (PI) directly and organise meeting with them, the subject of which will serve two purposes: It will allow the PI to see if you are the right fit for the lab but, more importantly, it will provide students with the opportunity to discuss scientific topics with experts in the field and find out for themselves if that is a field that interests them and they feel passionate about. Research shouldnâ€™t be performed just for CV points but because of a deep seated enthusiasm. I know that UCL have a very established Research section within its medical society, who would be able to provide details of how UCL can support students looking for research exposure (Contact: firstname.lastname@example.org).
Andrew Cole, MBBS Year 4, Research Editor
For a full list of references, please visit http://myrums.com/rums-review/ Professor Derek Yellon Professor of Molecular & Cellular Cardiology Director of the Hatter Cardiovascular Institute UCL, Programme Director (Cardiometabolic), NIHR UCLH Biomedical Research Centre.
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An Hour With Dr Christian Jessen
Since graduating from UCL Medical School in 2000, Christian Jessen has enjoyed a highly successful career as a doctor and television guru, presenting popular Channel 4 programmes Supersize vs Superskinny and Embarrassing Bodies. In addition to his prolific achievements in medical media, Jessen holds an MSc in sexual health medicine and provides occupational health services for various organisations. In this interview, Jessen reveals the motives behind his career choices, discusses his areas of interest in the medical field and provides a wealth of invaluable advice for medical students and doctors alike. RR: Hello Dr. Jessen, we’re delighted to have the chance to speak with you. CJ: Aww, I’m very honoured! RR: Did you find UCL to be an enjoyable environment? CJ: I found UCL to be very warm and very relaxed, but absolutely thrusting and dangerous from an academic point of view, up there with the best of them. And of course superbly located in the heart of London to offer a wealth of life experience. What can I say? RR: And did you find that the course really stretched your abilities? CJ: To be honest, I think it will have changed an awful lot from when I did it to now. Our [course] was much less integrated; we didn’t see patients that much. I found it enjoyable and frustrating in equal parts, but I think medicine was a fairly natural thing for me to do. I saw it as less about being academic and more about communication. I think that 90% of successful medicine is communication and everything else you could look up, especially in this day and age. RR: Were you involved in lots of extra-curricular activities whilst at UCL? CJ: I dabbled in all sorts of things, including the theatre and the opera. Whatever was going on I was probably involved in. But being at UCL you are there in the middle of London. I would make absolutely sure I did a lot of London stuff, rather than just university related activities. I’d really recommend that to anybody, because suddenly you’re in your first job, and all the other stuff goes out the window. So make the most of it. RR: You did some research in HIV after finishing your degree. What attracted you to this area? CJ: It was 1995, and HIV was a new disease back then, with advances being made very rapidly. It was particularly interesting because you were literally learning as you went; the textbooks were being written as you were learning from them, and being written by the people who were teaching you. That was very exciting, and what you knew one day had changed the next day. There were also social and personal reasons for it: I’m gay, and a lot of the patients that were really suffering from HIV were also gay. I could actually relate to the HIV patients and the lifestyle, and therefore communicate with them a lot better. Also, in Africa HIV was a terrible problem, and still is. There was a lot of research going on there; that’s really why I ended up going there. RR: How did working in Kenya and Uganda shape your current expertise as a doctor? Did seeing the healthcare system there have any effect on you today? CJ: Obviously the important thing wasn’t honing your clinical skills because there’s a real lack of equipment, scanning and testing so you really learn to run on instinct and your own clinical judgement. But what transcended was just the vastness of the world and your very small place in it. I think that going to Africa you realise just what an insignificant little speck under a huge vast sky you really are. And that’s a very important feeling for a Doctor, I think – to be humbled and to be brought off his pedestal and back into the real world. There’s a real danger with medical students if you churn them out feeling like they are invincible. This creates a disjoint between doctors and patients and sometimes communication problems.
RR: Recently you tweeted your views about the need for more arts subjects to be incorporated into education, and you also mentioned that the arts have made you a better doctor. Could you elaborate on how they have helped your career? CJ: Well absolutely - I think that learning arts just makes you a more rounded person, with far better knowledge. If you study mankind as a whole you’re far more able to understand it, and therefore able to communicate with people from all walks of life. I remember going on ward rounds listening to some top of the class academics struggling to talk to a young heroin addict in Brixton – I think the expression is ‘facepalm’ these days! I can’t say the arts would ever have helped them, but I certainly think it gives you a wider perspective on life. Also it gives you a breather away from medicine, a sense of mindfulness, and a realisation that there are other things. RR: How did you go about pursuing a career in the medical media and was this a decision you made whilst at university? CJ: The media introduced itself to me, I didn’t seek it out. It was just a question of being in the right place at the right time. Someone asked me to go on the news to comment on a medical story, I was then asked to be the doctor overseeing a medical show for someone I knew, and from that it gradually built up. There came a point where I decided that there wasn’t just a place for medics in the media, there was a whacking great gulf – and a real need for medics to directly connect with the public. The only communication that existed really was within a consultation, or possibly a letter in a magazine. I saw that the only way the NHS, and medicine, could triumph was in public education. We needed to stop people getting ill in the first place, so to introduce preventative measures was the way forward. Doctor in Greek means ‘teacher’ and I think we forget that too often, that our role is to teach: not just each other, but our patients as well. So I took the media thing to heart and decided that I was going to pursue it. And yet it was a position that didn’t really exist; I just had to go against the grain, stick my head down rather stubbornly and just hope things would work out. RR: As medical students, we are always advised to take a lot of care with what we post publicly on social media. With this in mind, do you think that it is important that all doctors are accessible, or at least visible on social media, or do you think that this is just you and that some doctors may choose to be a lot more private? CJ: I actually think that doctors should be more accessible, should have more of a presence, and appear more human. I don’t just tweet about medicine: I tweet rude things, I tweet funny pictures, I tweet and I’m human. I think that’s so important. Everyone can have their own view but for me as a sort of ‘TV doctor’ as I became, and a familiar face, I was really striving to show that medics are just human beings too, with their own silliness and a sense of humour and weaknesses, and we do make mistakes and all the rest of it. As a medical student, I do think that you’ve got to get social media right. There is a danger of giving away medical information and breaching confidentiality, so there are certain standards that you need to meet. I never answer personal, diagnostic types of questions, only ever general enquiries, such as ‘is it true that you can do this or that?’ or ‘can you catch a cold doing this?’. Never ‘here’s a picture of a rash, what is it?’. I’d never once answer questions like that. Overall, it’s absolutely personal choice, but I do think that there’s a role for medics socially, yes. RR: Do you also encourage your colleagues to use more digital media as a method of aiding the treatment of patients, such as Skype calls? CJ: With Embarrassing bodies when we started out doing Skype consultations that was all very new, but now its very common for GPs to do Skype consultations – and certainly for therapists too. I do think medicine is very slow to embrace new technologies. We are suspicious of these sorts of advances, they don’t involve face-to-face contact, and all this old fashioned nonsense like the laying of a hand on a patient is worth more than anything else. Actually I don’t think so, I think relaying news can be just as important as the next bit. I think that younger medical students are getting the hang of that very well. We wont survive in medicine if we don’t embrace new technology, we need to do what all other professions and industries are already doing, we’re just a bit slow to follow.
RR: Many medical professionals call for some degree of distance between the doctor and the patient, but in your case patients are often up-to-date on the intricate aspects of your personal life. Do you feel that being a prolific TV presenter has an effect on your relationships and interactions with patients? CJ: The irony is, you probably know more about me than your own doctor. Should you know a bit more about your own doctor? You probably should – or you might as well go and visit a hole in the wall! They aren’t just a service machine. I think my patients like knowing about me, and they like chatting about what I’ve been doing, in the same I chat about what they’re doing. Its in the same way that the old fashioned village GPs would see the whole family, and would ask “how’s your son doing” – you’d know the family, and the family would know you! Often patients feel more comfortable with you if they feel like they know you, and this can only be a good thing. RR: What always strikes me about Embarrassing bodies is how open the patients are about their stigmatised conditions, particularly given that they’re on national television. As a doctor, what techniques do you find helpful in instilling such comfort and openness in the patients? CJ: From the point of view of telly, whichever one of the doctors the patients get to see, they’ve probably been watching us for the last five years or so. So there’s already this feeling of familiarity, that they know us, they know the way we talk and the sort of questions we ask, and the way that we ask them. This certainly allows them to feel more at ease. But for patients beyond the television, in a ten-minute GP consultation for instance, it’s very difficult to build a rapport quickly. I think the most important skill that’s not ever verbalised is how to read people. To be able to tell what sort of a consultation the patient wants: do they want to be taken by the hand and guided, do they want to-andfro debate on what’s going to happen, or have they already made up their mind and are they coming to tell you exactly what to do? You need to be able to read that and react to it accordingly. What so often happens when I observe consultations is that the doctor just applies his same old consulting technique to every single patient. And as we know one size doesn’t fit all, we have to personalise medicine in a way! And as soon as the patient understands that you are on the same wavelength as them, you’re halfway home. RR:Do you think that the availability of medical information online has changed the way patients view their own health, and the frequency with which they visit their GP? CJ: I’m a big fan of my patients looking stuff up; I know doctors often feel threatened by patients looking things up and then challenging them, but I think that’s a very important part of the doctor/patient relationship. A patient should know that they can
challenge you if they want to, say ‘I was online recently and I have seen that this treatment isn’t perhaps the best one.’ And I think that as a doctor you need to be big and confident enough to say ‘do you know what, that’s really interesting, I’ve never heard of that, but leave it with me and I’ll read into it, let’s talk more’. And that I think is what makes a good doctor. However, there’s a lot of misinformation and I know that. But what is there I do think is good. I think it’s bred a nation of hypochondriacs as well. But I think the important thing is that even if they go online and scare the crap out of themselves, as long as that drives them in to see the doctor then it’s done the job. Even if they think they have a brain tumour as a result of their headache at least it’s got them into the doctors.
RR: Television programmes such as Supersize vs Superskinny are sending really strong health messages to the public in regards to maintaining a healthy diet and weight. But even with shows like this, obesity rates are still very high and on the rise. So what do you think can be done to raise awareness and to try and reduce these rates? CJ: There are four words that can provide a pretty robust attack on obesity: education, legislation, advertising, and surgery. We need to educate kids from an early age about healthy dieting and health, and normalise it, make it unexceptional. Society has changed so much that we see a 70 year old who still runs as exceptional rather than normal. And I think that shows how deep the infection runs. It really is a massive problem, but we’ve got to change that perception, that stereotype, and I think that starts right at the bottom with the youngest of kids. I think in terms of legislation, the government has to step in; not via taxation of the people, but via the food manufacturers. So if companies are making sugary, salty, fatty, foods of the worst type, then they should be penalised for it. And if they’re making much more healthier foods, they are less penalised, or even rewarded for doing so. I think that there needs to be really hard-hitting advertising campaigns about the dangers of obesity, just like with the smoking ads – there are some really graphic dramatic smoking ads which have seen success. We need an advertising campaign that hammers the message home. The government just hasn’t done that. We’ve got that sort of anaemic, very British Change For Life programme which is all very well and nice with little coloured cartoon-y characters, but my god, it’s advertising light. It’s blink and you miss it. The anti-obesity ad campaign needs to grab your attention, and make you really think about your life and what you’re doing. And finally surgery – we need to be doing more bariatric surgery. We need to get off our issues about bariatric surgery being wrong, or immoral, this idea of ‘I’m not spending my tax money on fat people’. Surgery saves lives and it saves money, and it will save the NHS. Those are my Big Four – my four-word solution to obesity!
RR: In your talk at the Inspire Medicine conference at UCL earlier this year, you explored the issue of non-communicable diseases dominating medicine, and you suggested that the modern man is not currently adapted for the lives we lead. So what changes in healthcare do you believe need to be made to account for that? CJ: Well the environments we live in are not the environments we are evolved to live in. I think as long as you bear that in mind always, you will understand the basis of the diseases you’re treating as well as understanding that preventative medicine really is your job. It is persuad-
ing people to fight against their own environment, which pushes them towards an unhealthier way of being. You’ll have heard the term ‘obesogenic ‘ society – we live in a world that is trying to make us fat, and we have evolved to be fat in many ways. That’s essentially what you are fighting. You need to be educating your patients more than treating your patients, I would say. And if you’re doing that, then we’re on the road to success.
RR: Speaking of your specialty, what do you find most enjoyable about working in sexual health medicine? CJ: As a specialty it’s enormously satisfying, because first of all it’s clinic based, and I love working in clinics – I like the environment of one-on-one consultations and find them a lot more productive for patients than hospital ward rounds. There are also very few clinics really where patients walk in absolutely terrified and can walk out completely reassured or completely cured, or, well on their way to being cured.
RR: Considering it is quite a heavily debated subject, as a private practice doctor, what are your thoughts towards doctors working in this sector? CJ: A doctor needs to make a living sometimes, and has family issues which just make private practice a more attractive and practical option than working nights in a hospital, which really can overwhelm you, and take away most of your life for a very long time. I don’t think anyone needs to feel like they’ve ‘sold out’ if they decide that actually they value their own life over their work – all of us should value our life over our work. Many of us also have no option – I couldn’t do what I do if I didn’t have the flexibility of private practice.
RR: Do you have any advice for medical students who are interested in a career in the medical media – of course it all happened quite spontaneously for you, but are there any specific actions that can be taken? CJ: You can certainly start with writing – there are probably more jobs as a writer than on the TV, such as university newspapers, local newspapers, community magazines and things. Write health articles, comment on latest news stories, and write letters – that’s a really good place to start. To do the telly thing you have to be extremely thick-skinned, I learned, because people are brutal. Initially, I was quite shocked at the nastiness of comments that came back. I was probably naïve, but I thought that all I was trying to do was be a doctor on telly and somehow it was made out that I was spawn of Satan for doing so – it was quite dark! I think its just being in the right place at the right time, being persistent, and lets face it, if you’ve got into medical school and got through medical school, you know all about being persistent. You know that carrying on until you’ve got what you want is doable.
RR: Just for the very last question – what do you, Christian Jessen, think makes a good doctor? CJ: The ability to communicate. You need to be able to reach out and inspire absolutely everyone, whether it be a limited-English-speaking mother from Bangladesh, a man from Ghana with HIV, a little kid who’s terrified of injections, a frantic Chelsea mother who’s convinced that the vaccine is full of mercury: all of those different cases you need to be able to handle smoothly and effectively. And the only way you can do that is to develop an utterly fluid consulting style, that’s instantly adaptable to the person you’re talking to. If you can win those people over and convince them, you’re most of the way there.
The Neuroscience of Navigation Dr. Caswell Barry writes on the importance of various cells types found in the hippocampus and entorhinal cortex, including place cells, grid cells and head direction cells that are vital for spatial memory formation, and the implications when these cells are absent or do not function. Black cabs are an iconic image of London. Before the advent of GPS, cabbies were daily moving passengers from A to Z, across an area that includes tens of thousands of different roads. Indeed, to become fully licensed each driver must pass the ‘Knowledge’; a test in which they are required to recall the route between any two places within six miles of Charing Cross. How does the brain achieve this? How is the information required to navigate represented and manipulated at the level of the individual neuron? In the 1950s, neuroscientists discovered that the hippocampus, a seahorse shaped brain region, is intimately involved with memory formation and retrieval. A widely known case study analysed Henry Molaison, aka patient ‘H.M.’, who suffered dense amnesia after sustaining surgical damage to both hippocampi. He was unable to remember events that happened after the surgery, such as meeting someone for the first time, and was not able to learn his way around new places. In addition, more recent work conducted at UCL using MRI found that in cabbies, the hippocampus is enlarged relative to non-taxis drivers; an effect that was more pronounced in the most experienced drivers. Electrophysiological investigations of the hippocampus and related brain regions in rats and mice have revealed the neural basis of these effects: several different types of neuron that appear to function as components of a neural map. The first element of the map to be discovered was the place cell. Working in the 1970s, John O’Keefe recorded the activity of hippocampal neurons as rats walked around an enclosure. He noticed that some cells were only active when animals were in specific places. The behaviour of these place cells was largely unaffected by what the animal was doing, for example whether it was standing or walking, the direction it was facing, or how hungry it was. In other words, because different place cells respond in different locations, even a relatively small population provide a raw indication of the animal’s position. We now know that place cells are found in humans, bats, and rodents; as such they seem to be a fundamental component of the mammalian brain.
Electrophysiological recordings made from the hippocampus and associated brain regions. A place cell recorded from a rat. Left-hand figure shows the raw data: The black line is the animal’s path as it moves around a 1m^2 arena for 20 minutes. The superimposed green dots indicate the animal’s location each time the place cell fires an action potential. Right-hand figure: the same data showing firing rate (number of spikes per second). Red indicates regions with a high firing rate and blue indicates a low firing rate. White bins are the unvisited regions, and peak firing rate is shown above the map.
Although place cells clearly look like part of a spatial memory system, on their own they are insufficient to support efficient navigation. This is because they lack a strong directional signal and do not signal the distance between locations. Two further cell types, head direction cells and grid cells, appear to fulfil these roles respectively. As their name suggests, head direction cells signal an animal’s direction of facing; each cell responds strongly when the animal faces in a particular direction. Most recently, grid cells were discovered in 2005, earning May-Brit and Edvard Moser the 2014 Nobel Prize in Physiology. Like place cells, grid cells signal an animal’s location. Yet they do so with multiple firing fields, distributed in a remarkably close-packed triangular pattern that covers the entirety of the enclosure. A tempting analogy to make, and one which isn’t entirely wrong, is to see grid cells as the grid lines on a neural map, with place cells providing the details and head direction cells the compass.
Raw data and corresponding rate map for a single grid cell recorded from the entorhinal cortex. This is showing the multiple firing fields arranged in a triangular lattice.
But do we really know if taxi drivers are using these cells when they navigate around London? While it is not yet possible to directly record the activity of neurons from people in real world situations, it has been possible to infer the activity of these populations of cells using fMRI brain imaging. For example, in a fMRI study conducted at UCL, subjects lay in the brain scanner whilst navigating around a simple virtual reality world; their task was to move objects back to specific remembered locations. Subjects with the strongest grid cell signal performed most accurately on the task, strongly suggesting that grid cells are necessary for planning routes through the world. Interestingly preliminary work suggests that this same grid cell signature is absent in people who are heterozygous for a mutation that predisposes them to developing Alzheimer’s disease; a dementia associate with memory loss and impairments in spatial navigation. Future challenges will be to find ways to support the activity of grid cells that have been degraded by disease. It would also be interesting to understand whether these cell types are important for navigating more abstract spaces, such as social networks or the arrangement of ideas needed to write an essay. Dr Caswell Barry, Cell & Developmental Biology, Div of Biosciences, Faculty of Life Sciences
Grid cells of different scales are found in the entorhinal cortex. Two grid cells recorded from the same animal are shown, with the approximate recording locations in the entorhinal cortex also indicated. The more ventral cell exhibits a considerably larger size of firing fields and distance between firing fields than the dorsal cell.
Transgender Healthcare: Educating Tomorrow’s Doctors
Christen Van Den Berghe writes on the importance of educating medical students and healthcare professionals on transgenderism, gender dysphoria and disorders of sexual development. The transgender community has received increased media attention in recent years with the rise of Laverne Cox, who plays Sophia in Netflix’s Orange is the New Black, and the transition of Caitlyn Jenner, a gold-medal-winning Olympic athlete and member of the ubiquitous Kardashian family. This has brought the issues of transgenderism to the forefront of the public mind, along with the complex concepts of identity politics. These issues are often difficult to discuss, with people treading carefully for fear of offending anyone involved. It has led us to question our perception of gender, our ideas of womanhood, manhood and self-identification. Most of all, it has brought the struggles of this long-isolated community into the mainstream. As explained by Laverne Cox, transgender “very basically means that the gender you identify with is different than the one you are assigned at birth”. The presentation of this is a spectrum. People may dress differently, or not feel as though they are any gender, or may express their gender in a multitude of different ways. Those who decide on surgery and “fully transition” between the sexes are known as transsexual. Transgenderism has been medicalised as gender dysphoria; the condition of feeling one’s emotional and psychological identity as male or female to be different to the biological sex assigned at birth. The politics surrounding transgenderism can be discussed for days but, working in the health service, it is an inescapable fact that doctors and other health professionals will come into contact with people experiencing these issues. It’s been estimated by the Gender Identity Research and Education Society (GIRES) that 1% of the British population are gender non-conforming to some degree, and that around 20% of these will seek treatment. The number of people seeking treatment for gender fluidity of some degree has been estimated at 128,200, which is more than the number of people diagnosed with Parkinson’s (127,000). With this many people affected, surely it’s a part of the medical school curriculum nationwide? Apparently not. At this year’s BMA annual representatives meeting, there was a call to improve transgender healthcare by ensuring medical students are educated about the issues. However UCL has, for 2 years, been ahead of the field in this. “We think UCL is a first here”, says Professor Gary Butler, who was involved in the implementation of a module on transgender care in the year 5 MBBS course, “but it’s something that clearly needs to be part of the curriculum and part of the training for doctors everywhere”. Currently included in the year 5 paediatrics and child health module, teaching on transgender care at UCL Medical School introduces “The issues of biological sex and gender development”, and is currently looking at being extended further. So far the training seems to be working and “There are many doctors and staff that are not happy dealing with people with gender issues and there is a lot of prejudice. However we did a survey of UCL medical students, and the majority of students are accepting of these situations”. The training for year 5 students in the paediatrics module covers gender assignment and development of sex in two lights- how gender is assigned relative to biological sex at birth, including the development of disorders of sexual development (DSDs), and gender dysphoria
“As explained by Laverne Cox, transgender “very basically means that the gender you identify with is different than the one you are assigned at birth”
in children and adolescents. These “Are almost completely different areas”. In the UK, parents and guardians have 6 weeks to register a child with a particular gender. In situations where the infant has been diagnosed with a DSD, there is perhaps an extension, but the doctor plays a large role in defining the gender of the baby. “It is quite political”, says Professor Butler, “because it involves a lot of human rights issues… it is a combination of factors involving family, culture, and the best prospects of a child living in an assigned gender. It also requires careful counselling of the child as they get older, so that they understand what’s happened to them”. Children with DSDs can be treated with gender reassignment surgery or hormones - extreme measures which, sometimes, may be reversed later on in the child’s life.
The treatment of those with gender dysphoria is also introduced to UCL medical students. It can happen to anybody of any age but Professor Butler, as a paediatrician, deals primarily with children and adolescents experiencing “A reaction against themselves, their gender and their body”. Body changing treatments cannot be prescribed until the age of 16 (or 18 in the case of surgery), so after detailed psychological assessments, children with gender dysphoria are prescribed hormones to block any further pubertal development. This is, of course, different to how adults with gender dysphoria are treated. “[Treating children] is much more cautious, and the focus is very much on what is called gender identity development… it’s not such a primary focus on body changing treatment, such as surgery and hormones”. Professor Butler says that while there are 50-100 cases of children with DSDs at University College Hospital (UCH (the South’s main referral centre)) each year, the numbers of new cases presenting with gender dysphoria are much higher and in the region of 200-300 - “Something in the region of about a 400-500% increase in the number of children and young people presenting with unhappiness about birth gender”, in the last 5 years. While there is no doubt that it is highly beneficial for students to be educated on issues of gender assignment in clinical practice, it is important to remember that those who are transgender are not solely defined by that. They, like everyone else, have health issues unrelated to their gender identity, and so it is vital that medical students learn about the issues which may permeate through every speciality and every aspect of medicine. As of this academic year, this will also be the case at UCL. Dr Jayne Kavanagh leads the Ethics & Law teaching programme within the medical school, and was instrumental in setting up this education, along with Dr Jessica Salkind and Dr Emily Van Blankenstein, recent UCLMS graduates. They say: “Year 5 medical students will receive a half-day session on the health and social issues relevant to LGBT+ people... we will be inviting transgender and LGBT patient visitors to talk about their experiences of healthcare. The session will aim to give students a fundamental understanding of gender identity and insight into how transphobia can negatively impact health outcomes. Students will be encouraged to reflect on the importance of open, inclusive language to create an NHS which is welcoming to everyone”. The aim of this education is summarised in the final remark: the creation of an all-inclusive health service, free of prejudice. UCL, renowned for its long history of inclusivity, was the first university in the UK to admit women on equal terms with men, and the first to admit students of any race, religion or belief. By tackling multiple aspects of gender identity in healthcare, from how gender is assigned to how those whose gender and biological sex do not match are treated, and how those who have been treated are then treated further as patients and human beings within the NHS, the hope is that the LGBT+ community are not commodities, or tokens, or anomalies, but an everyday part of medical practice. Christen Van Den Berghe MBBS Year 2 Professor Gary Butler is a Consultant in Paediatric and Adolescent Endocrinology at UCH and Honorary Professor in Paediatric Endocrinology, UCL Institute of Child Health.
Radical or Ethical? How Far Should We Go to Improve Quality of Life?
Dr Nicholas Herodotou writes on the importance of considering the patient’s wishes when working in palliative medicine – in spite of the ethical implications. Introduction Throughout their education, medical students are taught about diagnosing and treating disease. However, what about patients who are not treatable or unlikely to benefit from any pharmacological or surgical intervention? Indeed, chronic health issues such as heart and lung disease are never really ‘cured’, but are frequent attenders to the emergency department for symptom control. What about palliative patients? Palliative relates to any patient who has a progressive, non-treatable, irreversible illness that will take their life prematurely. This encompasses not just cancer patients but also those with neurodegenerative conditions such as MS or MND and end stage heart and lung disease. In fact, even advanced dementia is now seen as a palliative diagnosis. Palliative is a spectrum which, in cancer terms, implies that the cancer has metastasised to other areas of the body. This could often cover a time span of several months to weeks (commonly termed End of Life Care). When a patient appears to be ‘dying’, then this is often implied to be the last hours to last days of life. In this timescale, it is appropriate to call this the terminal phase. This is an ethical medical case involving a palliative cancer patient who had metastatic bowel cancer with a prognosis of weeks to live, but also suffered from chronic insomnia, and had done so for about fifty years. I was asked to review whether to treat his insomnia in order to enhance his quality of life. He had requested anaesthesia in order to regain the energy needed to complete the churchyard garden before he died. Insomnia is the inability to have adequate restful sleep. This may be acute, over a few days or chronic if more than one month. 30-40% of the population may be affected with higher incidences seen with increasing age and among females, and it is deemed an important public health problem. Case Presentation: Mr BW is a 73 year old who was initially diagnosed with Dukes C carcinoma of the colon in 2007. He initially underwent surgical resection of the tumour and later received chemo-radiotherapy for metastatic spread to both the lungs and liver. With regard to his insomnia, he has undergone every investigation and treatment option, all to no avail. On average, he sleeps about 2-3 hours a night. A referral was made by the Macmillan nurse to myself to treat him for his chronic insomnia. The patient stated that the only drug that initially worked was a barbiturate, back in the 1960s. Currently, he was taking Temazepam 20mg, Lorazepam 2.5mg & Promethazine 25mg, with no real benefit. Despite having a prognosis of weeks, Mr BW insisted on working on average four hours a day maintaining the church gardens, which he has been doing for the last ten years. However, he felt that the chronic insomnia compounded his fatigue, impeding his ability to work longer. He was determined to complete the church gardens by Christmas 2012, after which, he would then be ready to die. During consultations, Mr BW frequently requested anaesthetic sedation in order to enable a full night’s sleep. This, he believed would ‘re-vitalise’ him, as he described feeling refreshed on two previous occasions following general anaesthesia prior to surgery. His request was initially resisted, as it was not deemed a reasonable option. Instead, a barbiturate, Phenobarbitone 30mg, was commenced orally along with dexamethasone (steroid) 6mg for daytime energy, which did help. The patient was non-compliant, insisting that he didn’t want any medication that would sedate him during the day. The next option was to switch to a short acting barbiturate, Amibarbital 120mg, but again, he disliked it. Because the patient was desperate to regain some sleep in order to fulfil his dying wish, it was eventually agreed that an anaesthetic opinion would be sought for a one-off non-repeatable sedation. The anaesthetic
“Deciding whether any treatment is beneficial is determined by the good being greater than the harm.”
consultant agreed to sedate him for one night only and his admission was arranged when the anaesthetist was also on call at the hospital. He was sedated with an infusion of propofol, with cardiac monitoring for six hours. He awoke, initially feeling a bit drowsy, but in the afternoon, he was back at the church ground mowing the lawn and saying he felt ‘refreshed’. The hospital communications officer became aware of this planned admission and obtained the patients consent for Anglia TV news to tell his story. He was filmed both prior and after his sedation which was then broadcasted that evening. Remarkably, post-anaesthesia, he lived for a further five months and died peacefully at the local hospice in March 2013. Discussion Propofol is the most widely used intravenous anaesthetic agent, being ultrafast and associated with rapid recovery and less hangover effect than other anaesthetics. It can be used for both induction and maintenance of anaesthesia in adults and children. It is rapidly metabolised by the liver and excreted in the urine. It is occasionally used in palliative medicine for terminal agitated delirium and for severe intractable vomiting. The recent death of the singer Michael Jackson from propofol (administered for chronic insomnia by his cardiology physician Dr Conrad Murray) brought biased media attention regarding the safety of this anaesthetic. Although propofol is not recommended as a treatment option for chronic insomnia, a recent randomised, double-blind, placebo-controlled study on 103 adults with chronic insomnia, receiving either propofol or saline infusion, resulted in an improvement in the sleep pattern of 64 patients who received propofol, which persisted for six months afterwards with no adverse effects. The risk argument against the use of this drug for the long-term treatment of chronic insomnia is unknown, as few studies have been undertaken. Current evidence for managing chronic insomnia involves the use of Zolpidem and benzodiazepines and non-pharmacological methods such as cognitive behavioural therapy (CBT) and progressive muscle relaxation techniques. A new class of drug Ramelteon (Rozerem®) is licenced in the USA for chronic insomnia and acts as a selective M-L1 melatonin receptor agonist within the suprachiasmatic nucleus of the hypothalamus, but was withdrawn in the UK and Europe in 2008 due to lack of convincing evidence of its efficacy. However, a recent systematic review seems to show some clinical benefit for chronic insomniac sufferers with this drug. Ethics The four principles of ethics, Autonomy (right to self determine), Beneficence (do good), Non-maleficence (no harm) and Justice (equal treatment for all), underpins the way we practice medicine. Deciding whether any treatment is beneficial is determined by the good being greater than the harm. Discussion The patient’s quality of life, which is not an easy quantifiable marker because it is heterogeneous and subjective, was the principal driving factor which prompted the final decision to anaesthetise him. For him, his dying wish was for the pleasure of a few hours sleep under anaesthesia. Due to his previous experiences post-anaesthesia, he knew it would re-energise him and allow him to work longer hours to complete the church garden before becoming too unwell. There was considerable disagreement with some members of the Macmillan nursing team who felt the patient was manipulative. Another objection raised was the negative impact it could have on the palliative care service, as well as setting a precedent for chronic insomniac sufferers who could demand the same treatment. Lastly, there was the risk to my professional career if the patient died under anaesthesia. As there is no clear guidance or precedent for anaesthetic sedation in this niche patient group, there was an element of medical risk. However, despite the many objections, the overriding objective was the safety, dignity and quality of life for this patient, thus the utilisation of a highly skilled consultant anaesthetist was employed. A few weeks post-procedure, this case was discussed by the hospital clinical Ethics Committee (CEC) because of the uniqueness of this procedure. Ironically, they voted against this procedure being ethical as it was felt the potential for harm of anaesthesia outweighed the good, that it could set a precedent and that it may not be the best use of limited resources (the Justice argument). However, it was pointed out by another consultant anaesthetist on the ethics committee, that the use of propofol by a skilled anaesthetist and under controlled conditions was a very safe drug. Had the ethics committee given a consensus before the procedure, it is probable that the patient would not have received his wish to be anaesthetised for his chronic insomnia. What impact this may have had on his morale and wellbeing is speculative. Summary We seem to have lost a fundamental skill in modern medical training, and that is the art of medicine, which was very much an attribute of the old apprentice medical training of bygone years, whereby you learnt, were inspired and motivated by your clinical teachers. Is this something that perhaps needs to be reintroduced in modern clinical training? We have lost the skill to think outside the box, to innovate, to inspire, and to be willing to take risks for our patients providing of course the benefit outweighs the harm. It is not solely medical knowledge that makes good doctors. It is also your communication, compassion and empathy, which are harder to measure. Patients aren’t just interested in how much you know, but also how much you care. If this were your patient, would you have anesthetised him? Dr Nicholas Herodotou BSc(Med.Sci.Hons), MB,BS, DGM, DRCOG, Dip.Pall.Med., MRCGP, FRCP (Lon) proMacmillan Consultant Palliative Medicine (Cambridge Community Services) L&D University Hospital, Luton Honorary Clinical Lecturer, UCLMS President, MNDA (Luton & S.Beds Branch) July 2015 No funding was received for this case report No conflict of interest by author For a full list of references, please visit www.myrums.com/rums-review/
An Elective in Nepal: The Day of the Earthquake
Chapagaun is a rural town south of the capital in the Kathmandu valley of Nepal. The Primary Health Care and Resource Centre there provides a small ward, birthing centre and outpatient clinics for the 60,000 people living in the surrounding area. Chapagaun was hit hard by the earthquake on April 25th; much of the town was reduced to rubble in a matter of seconds. We are in a place called Boudhanath, North-East of Kathmandu. It is a cool grey day with a strong wind. Not a day for admiring views, but still we are in a rooftop cafe looking down on the enormous Buddhist shrine when the ground starts shaking. We haven’t long arrived, and have only just placed our lunch order. I know what is happening straight away as I have experienced an earthquake once before in Corfu in 2003 - the floor vibrates and everything around you rattles and sways. If you have never felt one before you look for other explanations – my friend thinks maybe the restaurant has switched on their generator. We dive under one of the tables to stop anything falling on our heads. It feels like the earthquake lasts a long time although it can only be seconds. We are lucky the 3 storey building we are in doesn’t collapse. So many buildings collapse that day. As the ground steadies everybody immediately flees downstairs, customers and staff alike, and the whole place empties. Shutters are being pulled down over the doors and windows of neighboring businesses. Outside people are standing dumbfounded in the courtyard surrounding the stupa. Piles of rubble now stand in place of some of the smaller shrines and statues. No one seems to know what to do next - are there more tremors to come? Is this a warning shot for something bigger? Do I stay inside in a building that might collapse? Do I stay outside where I could be struck by rubble? Nowhere looks safe. Neither of us knows what to do and we head for the nearest taxi. The driver refuses us. The road is gridlocked, nothing is moving. We hear screams and turn round to see a bloodied man being carried through the traffic towards us. There are police and a paramedic ready to receive him. We try another taxi and find a driver who is willing. It takes a long time to move out of the area. People are standing in the road like rabbits caught in the glare of headlights, afraid to move, unsure where to go - there are no open spaces here. My heart is in my mouth as people start shrieking again - a small aftershock is making the shop shutters shake violently. It takes a long time for the traffic to get moving again. We pass wooden temples reduced to piles of sticks, old brick houses whose walls have caved in, and the shattered windows of modern office blocks - files, documents and bookshelves are lying on the road. We are lucky there are no complete road blockages until we reach the edges of Patan. The driver needs to ask for alternative directions to Chapagaun where we are staying and we pick up a man who tells us he is a local and knows the way. Many people are desperate for a lift out of the chaos.
gaun are old. They looked old and crumbling even before the earthquake. As we approach the town the traffic slows again; the taxi cannot take us any further as the road is blocked with debris. We get out of the car and hurry through what can only be described as a scene of devastation - collapsed buildings, torn-down house fronts, kitchens, bedrooms, a lifetime of possessions exposed for the world to see. At least half the buildings here have been damaged beyond repair. Our focus is on getting to the health centre, a 5 minute walk outside the town. On the way we pass the Buddhist monastery, the finest building in Chapagaun. The pagoda style roof lies toppled over on its side like a giant hand from the sky has reached down and knocked it over. The activities of the monks are no longer concealed behind high garden walls. Past the piles of bricks we see them sat in the grounds in a wooden pergola, their normally serene faces filled with worry. It comes as a major relief to find the buildings of the health centre still standing. It has taken us around an hour and a half to get here from Boudhnath and emergency operations are well under way. There are around 25 casualties lying on mats in the quadrangle around which the health centre is built. Some are yelling in pain as the paramedics suture their wounds, some are connected to oxygen and being pumped with fluids, some are lying still with eyes closed; their relatives crying next to them. Every casualty has a tag around their neck describing the injury they came in with - head injury seems by far the most common. As much as we want to help it is hard to find a useful role to play - we don’t speak the language, we don’t know where the equipment is, we don’t have a lot of experience in wound management. We settle with helping distribute equipment and clearing up medical waste. As we are doing this, a man in his 50s is brought in on a stretcher. The doctor checks for signs of life. Seconds later he begins CPR. For 5 minutes the team try everything at their disposal to revive him (oxygen, fluids, adrenaline) as the doctor continues chest compressions. The one thing that might save his life, a defibrillator for shocking the heart, they don’t have. At 5 minutes, a unanimous decision is made to stop resuscitation. The man’s face is covered and he is carried inside.
As we drive further out into the rural villages we begin to feel safer. People are gathered in their fields a safe distance from any buildings and there are fewer signs of major structural damage (most homes on the outskirts of Patan are modern builds).
Witnessing the resuscitation attempt was deeply affecting. Unfortunately it was not the only one that day. It never occurred to us that the health centre would be lacking in this basic, life-saving resource. The health centre cannot afford to provide a single defibrillator to the 60,000 people that it serves. Since returning to the UK we have been raising money towards the purchase of this life-saving equipment. These 60,000 people, who live in an area at such risk of natural disaster, should not be without a defibrillator again.
Unfortunately this trend does not continue. The buildings in Chapa-
Dr Laura Williamson, Former RUMS Student
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Stroke in the 21st Century National Clinical Director for Stroke, Professor Anthony Rudd, describes some of the most dramatic progressions in the field of stroke medicine to date, which he himself has witnessed during his career. You don’t have to go very far back in time to see that, already, there has been a major change in the way that stroke patients are managed. When I first qualified as a doctor in 1978, stroke was regarded as a largely untreatable disease of old people. Patients, if they got into hospital at all, were admitted under general physicians. They would have been subject to few investigations and little in the way of active treatment, either acutely, or later in the illness. Even when I was appointed as a consultant geriatrician at St. Thomas’ Hospital ten years later, little had changed. To illustrate the negative view of stroke patients, I recall wanting to arrange a CT scan on a man with a stroke who was presenting in an atypical way. The request form was sent down to radiology and returned a couple of days later with the words ‘scan not indicated’ scrawled across it. The registrar went down at my request to give some further details to the consultant radiologist to persuade him to change his mind- though to no avail. When I went down to his office at the end of the ward round to have a man-to-man discussion, he got up from his chair, looked angry, and hit me in the face. He said ‘I have already told your registrar that this patient is not having a scan. Now get out’. I have not been hit by a radiologist for over 25 years so I know that services are improving. Research has driven much of the change. Demonstrating that stroke units save lives and reduce disability, and showing that thrombolysis for some patients with acute ischaemic stroke can dramatically change the course of the illness, has meant that we have had to develop specialist services for stroke patients that are able to respond quickly; treating stroke as a medical emergency. About 10 years ago, stroke became an area that doctors could take an additional year to train in and we now have a speciality that offers a fantastic career spanning acute care, brain imaging, general medicine, rehabilitation, community care and cardiovascular disease. Furthermore, it is a disease where there are some exciting developments in prospect. Over the last 6 months, five trials have shown that intra-arterial clot retrieval for patients who have occlusion of their middle or anterior cerebral arteries is a highly effective treatment. This requires patients to present quickly to a place where there are interventional neuro-radiologists capable of catheterising arteries in the brain, inserting a clot retrieval device (a bit like a corkscrew), ensnaring the thrombus and pulling it out through the groin puncture site. At the moment, there are only 100 consultants in the country capable of performing the procedure. This means that either we have to train and employ a lot more people in this, or build in to stroke physicians’ training the necessary skills for them to take on the role (as interventional cardiologists have done). One of the big problems in stroke is that we have still not found an effective way of consistently preserving the ischaemic penumbra; the area around the central infarct that is ischaemic, but not yet dead. Many drugs have been developed and tested for their neuroprotective properties, but all the trials have thus far failed. One option that is now being tested in trials in Europe is using induced hypothermia for the first few days after cerebral infarction. The idea: allowing time for the cerebral perfusion to improve. The treatment requires the patient to be managed in intensive care and to receive muscle relaxants to stop unpleasant shivering. Certainly in animal studies, it has shown great promise as a treatment to reduce the size of infarction. Despite improving acute stroke treatment, it is likely that there will be some patients left with long-term neurological deficits. Early phase studies in man are looking to see whether putting stem cells into areas of infarcted brain will enhance neurological recovery. There are also trials being run of drugs that might enhance rehabilitation either by encouraging greater connectivity between neurones, or by stimulating stem cell activity within the brain.
However, even without new technology, we could be doing a lot better with our rehabilitation. Patients frequently don’t receive enough therapy. There are often unacceptable delays starting treatment and it is then stopped too early. Shifting care and resources out of hospital, into the community and investing in more therapists is essential if we are to reduce the huge burden of stroke on society. It is estimated that stroke costs the English economy £7bn per year. Spending more on acute treatment and rehabilitation has the potential to save huge amounts of money currently being used to support people with long term disability in the community, and in care homes.
“I have not been hit by a radiologist for over 25 years so I know that services are improving. ”
It is clear that we are entering a period of major financial difficulty within the NHS. Whilst the health budget is not going to be cut, the fact is, health inflation runs considerably higher than the national rate of inflation. So even though the total pot of money won’t fall, there will in effect be a need for massive savings – an estimated £20bn before 2020. The way services are currently delivered will have to change. We are spending about 90% of the budget on hospital-based care, and only 10% of the budget in primary care - despite the majority of patients being treated in the community. The burden on hospitals is increasing, partly as a result of an ageing population, but also because of greater difficulty getting complex patients home due to cuts in the social service budget. This means that some of the ideas coming out of NHS England about new ways of delivering care must be tested. Seven day working has received a bad press because, of course, doctors have always provided weekend and night time cover, and we resent suggestions in some parts of the press that we are not willing to work unsocial hours. However, we do need to ensure that the quality of care a patient receives after their stroke is the same, regardless of when in the week they present. In London, reconfiguration of stroke care to limit hyperacute care to just eight hospitals for the 8 million population of the city has meant that there are always expert doctors and nurses available around the clock. As a result, we have seen mortality rates in London fall significantly lower than the rest of the country. We need to see similar reforms everywhere. We need to make sure that patients continue to receive therapy every day of the week and not left to fester just because it’s a weekend. We need to be able to safely send people home if they are ready at weekends, knowing that social services will be able to start their services immediately. Shifting care into the community earlier than we currently do by developing early supported discharge teams capable of caring for more severely disabled people might be one option. Getting specialists to start working in the community to support primary care colleagues, and not just in hospitals, will also be necessary. There is no doubt that life is going to be difficult in the health service, but it remains far and away the best universal health system in the world. Medicine, in my view, remains the best job in the world. It is only going to get more exciting and stroke, in particular, has a great future as a specialty. Anthony Rudd CBE Professor of Stroke Medicine, Kings College, London National Clinical Director for Stroke
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Don’t Forget... Medicine is Brilliant Professor Jane Dacre, President of the Royal College of Physicians and former Director of UCL Medical School, reminds us why, though tough at times, medicine really is a fantastic career. When you first applied to Medical School, do you remember how exciting it was to be selected to come to UCL? Do you remember how scary it felt to begin to understand what you had taken on? I certainly remember giving you all a lecture in the first week of the first year. You all seemed so enthusiastic, and altruistic, and keen to get going with learning about your future career.
You are amongst this country’s highest A Level achievers, and are all capable of extraordinary things. You have been through a tough selection process, and have been successful. You are clever, creative, potential leaders, high-level communicators. You are going into a profession that is consistently at the top in opinion polls which ask about trustworthiness - the same polls that tend to put politicians and journalists at the bottom. So why does it seem so hard sometimes? The course is tough. The patients you see are becoming increasingly complex, with a vast range of different illnesses, often all at the same time. The patient with diabetes may also have had a stroke, and been admitted with a hip fracture, for example. The Royal College of Physicians recognised this problem in 2012, and published a piece called Hospitals on the Edge. It was followed up with the Future Hospitals Commission, which made several recommendations for change. These have recently been reflected in the 5 Year Forward View, from NHS England.
You will witness events on the wards and in practice that don’t seem right and you will feel out of your depth. To quote Sir Cyril Chantler, founding Chair of UCL Partners: “Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective and potentially dangerous.” Such daily problems risk making you forget that medicine is brilliant. So what can we do as a profession, to remind us of this and to make medicine better for us all?
We need to remember that the NHS is an extraordinary organisation, frequently quoted as being the envy of the world. However it doesn’t always seem like that for those of us that work in it. It sometimes feels a difficult, demoralising place to work in and this is not helped by the trickle of negativity that comes through the media.
I assume that most medical students went into medicine and decided on becoming a doctor following considerable thought. You recognised that you were able enough academically, you were a pretty good communicator, and you wanted to help people. You had a vocation. You wanted to be a professional.
Remember that those original attributes are still there and that means you are perfectly equipped to do the job, but you need to adapt to be able to provide the service that our patients need in the future. You also need to look after yourself and develop resilience so that you are able to do the job as well as you can. We, as a professional group need to value ourselves, value our medical colleagues, and to feel valued by them. That way, we remember that medicine is brilliant.
“Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective and potentially dangerous.” “You will be challenged intellectually. You can work anywhere in the world. You can genuinely help people.” Leadership
One of the potential attributes you all have is to be a leader. There is much written these days about how we doctors need to be better at clinical leadership. Several medical schools, ours included, are working on how to make sure that you have the opportunity to learn about leadership and how to develop the necessary skills. It is very interesting to reflect how well the skills of being a good clinical leader mirror those of being a good doctor: communication; team work and understanding the needs of others, be they patients or colleagues. So, value your own observation and opinion. If you look around you, and find things that could be done better, even as a student, and certainly as a trainee doctor, suggest how. Get involved in changing the system, and you will feel empowered and be valued. Anything you can do to help the patient in front of you is worthwhile. If you can contribute, even in a small way, to changing the system, then you can help even more patients than the one sitting in front of you. As a doctor, that feels brilliant.
Wellbeing Being a medical student and working in the NHS can be stressful. It is worth thinking how you can build your resilience so the stress gets to you less. When you see something which troubles you, make sure you find someone you can trust and talk it over with them. It may be a family member, a friend or a fellow student. It doesn’t matter who, but make sure you do so in a non-attributable and confidential way. If you are unwell, or get into some kind of trouble, it is a good idea to seek help early. There are some silly rumours about which make some students feel reluctant to come forward. Although all medical schools are obliged to have fitness to practice procedures to protect patients, they are also designed to help students. Medical Schools have a duty of care to their students. There is a lot of support around, so don’t be reluctant to use it.
Medicine is brilliant Now you are here at UCLMS, all you need to do to get through medical school is to turn up, pass your exams, and be nice to everyone. If you do that, you will find that it is a rewarding and fulfilling career. When you qualify, you will be paid to do a job you love. You will be challenged intellectually. You can work anywhere in the world. You can genuinely help people. You can work in some fantastic teams and form lasting relationships with colleagues with whom you share your core values. There is an area of interest for everyone because there are so many specialties to choose from. Medicine is brilliant.
My own career trajectory I started as a student at UCLMS more than 30 years ago. I turned up, passed my exams and tried to be nice. Since then, I have had what feels like a charmed career. Yes, I have worked hard. Yes, there have been challenges. But it has been brilliant. I have met some amazing patients, seen some spectacular scientific advances which have made huge changes to patient care, such as biological and gene therapies. I have also had a family life and three children along the way. I have now ended up as the President of the Royal College of Physicians. I see myself as a pretty normal, jobbing doctor, with an academic interest in your education. Medicine has been, and still is, a brilliant career for me and it can be for you too. So don’t forget… Medicine is Brilliant! Professor Jane Dacre President of the Royal College of Physicians Former Director UCL Medical School
Unfair and Unsafe A new contract is imposed on junior doctors.
On the 15th September, the government announced a new contract for junior doctors working in England, four weeks after the Junior Doctors’ Committee voted against re-entering contract negotiations. Talks between the British Medical Association (BMA) and National Health Service Employers (NHSE) stalled in October 2014 over claims that the changes would threaten the welfare of doctors and the safety of patients. This led to the appointment of an external review body, however they accepted many of NHSE’s arguments. In July 2015, Health secretary Jeremy Hunt announced that the BMA had until mid-September to agree to all recommendations without question. As of August 2016, junior doctors will see basic working hours per week increase from 60 to 90 hours. Safeguards that protect them from dangerously long hours will be removed, as will the progression of pay with every year of experience gained. I caught up with Amy, a Foundation Year 2 (FY2) doctor at the North Central Thames Foundation School. What were your reactions to the contract? My position as a junior doctor has given me insight into the pressures already on NHS staff as a result of government-led reforms. No matter how necessary a change is, the practicality of enforcing it without compromising patient care is what people struggle with. It definitely impacts upon your role as a junior doctor: your job is to do medicine, but you get caught up in countless logistical, administrative issues that arise due to the governmental agendas. It’s tough for us - this is not what we were prepared for at medical school. Under the new contract, standard working hours will be extended to include late evenings and Saturdays. Is this reasonable? Saying that working until 10pm on a Saturday night is the same as working in the middle of a weekday is simply wrong. We all have commitments outside of work, including making time for friends, partners and children. By working nights and weekends, you’re foregoing precious time that could be spent with loved ones. By refusing to compensate junior doctors for this sacrifice, the new contract disregards the importance of maintaining a healthy work-life balance. If junior doctors are demoralised and stressed, it will undoubtedly have an impact on their team and compromise their patients’ care. The new contract abolishes automatic pay rises trainees receive as they progress. Does a new pay system, based purely on the responsibility of the job, undermine the value of experience in medicine? This is quite a complicated, situation-based issue. At my hospital, many doctors have come from abroad. I have a colleague who is an FY1, although he has two years’ experience as a junior doctor in Greece. So in experience terms, he is more like a core trainee. However, the service that he is providing is an FY1-designated service and, though the quality of his work is probably better, he will be paid as an FY1. Things change; doctors develop skills and expertise through training. But before that level, when you’re a junior doctor, it is very much a service provision and this dictates what you will be paid. It has been suggested that the new contract financially punishes trainees for switching specialties or taking time out of their training. What advice do you have for young doctors? Switching specialties inevitably means dropping down the hierarchy in terms of your specialist level and your pay grade. Changing specialties is difficult and it is very important that junior doctors thoroughly explore their options. I’m planning to take a year out to improve my portfolio so that I’ll be competitive for an application the year after. There are many options, including studying for a master’s degree, doing locum work, undertaking research, or even practicing abroad. However, with the current plans to abolish pay protection, junior doctors might be reluctant to delay their specialty training. Thus, we are likely to see further bottlenecks in the system as more applicants compete for training posts. How might these changes impact current and prospective medical students? There will always be people who want to be doctors. However, I think that many more are being discouraged from pursuing it, or are choosing to practice overseas, to avoid the unnecessary demands that this country imposes. It’s a real shame as it means that our patients will lose a lot of talented doctors. Do you advocate industrial action in making a stand against the reforms? Industrial action might be considered as a last resort once all other reasonable methods have been exhausted. The fear of junior doctors striking is that hospitals will lose an important workforce, which could have consequences for patients under our care. But I don’t think it should be ruled out completely. A strike can happen without harming patients; it just needs thorough planning. While the BMA continues to fight on behalf of its members, doctors and medical students are being urged to campaign against the contract. Whether via social networks, signing e-petitions, writing to newspapers, or writing to members of parliament, we encourage you to join the debate. We must make a unified stance to guarantee patient safety, protect doctors and secure the future of the NHS. Please send in your responses to our comments piece, issues surrounding Junior Doctor contracts or any of our contents to email@example.com. We will endevour to publish as many emails as possible in our second edition.
Paris Hosseini, MBBS Year 5, Comments Editor
On first yearLIVE. WORK. PLAY. Live
‘Have fun and make the most of it, but remember to look after yourself,’ says the classic family member. Too true. The first transition to medical school throws all sorts of curve balls. For some, a new city. For all, a new course and a fresh start. There’s no time like freshers - in the first few weeks you’ll meet hundreds of people whether they be hall mates or course fellows, or even just random people you’ll (probably) never see again. Don’t hesitate to introduce yourself to anyone and everyone - you’re all in the same boat. You’ll start your degree, and at some point you’ll look around LT1 and think, ‘I’ve finally made it to medical school’.
RUMS has a vast array of resources and contacts available to help medical students through any issues they may face during their 6 years at medical school. Though many students pass through medical school without needing support, the RUMS Welfare team is on hand to help you with any questions you may have - no matter how big or small. My job as RUMS Welfare VP is to to draw on our own experiences and training to listen, help, and advise you on any problems you might be experiencing, whatever they are. We form a support system within RUMS, liaising with the Medical School to provide pastoral care, and using student-run services to provide peer support.
With this in mind, it is important to get the basics right- making sure you have a bed, some decent method to wash (sounds obvious, but this is especially important after dissections!), and a source of hot nourishing calories (particular after those endless diet and nutrition lectures). Before university all these commodities have probably, quite literally, been handed to you on a plate. With great independence comes great responsibility - so make sure to look after yourself ! Just remember that whilst you’re running around getting caught up in the uni fever, it is worth keeping family updated. Even if it is just to tell them that you are doing the washing (occasionally) and not always relying on late night fast food…
We all know the huge test that is getting into medical school. Amongst all the playing sports and going out, we still have a degree to study for! The timetable is pretty intense with more hours than most other courses, but usually less than school. This gives more independence, freedom and flexibility. Most teaching is in the form of lectures, which may be more impersonal and overwhelming than the classroom environment, but you’ll benefit from hearing world-leading academics and clinicians talk about their specialist fields. Experiment with note-taking to find what is best for you - do you want to take notes on a computer/tablet, or print them out and write around slides? Discover where you study best by trying different locations and working with various groups of people - this is a slow process, and is one of the hardest things to manage in the transition to life at medical school! You will learn how to tackle new concepts and participate in self-directed learning with the aid of the Moodle site and libraries. It can be difficult to gauge your progress, without the existence of regular assignments or past papers. Make the most of tutorials and smaller group work to clarify any misunderstandings. A piece of advice about getting advice from others: do not get blinded by people who dumb down first year. Everyone has to work for it, and part of the difficulty is in finding your own way to manage the medical degree. Make the most of mentor schemes, peer tutorials and medic parents!
‘Freshers is a blur… the nights out were great,’ says the classic second year. On arrival you are immediately hit by a multitude of clubs and societies vying for your membership. Medical school teams and societies are a great way to meet people in all years of medical school, and throw some of the most memorable (or not) socials. Make the most of London. Rest and play are both equally important, so channel your interests beyond the university scene. Go to the theatre or watch a rugby match. Invest in your life away from the books and in return your study will benefit. In a flash, first year will be over - so make sure you enjoy it. You will meet the best people and have some great times. So I would say, ‘Work hard, play hard and look out for yourself.’ Your university years are the best - luckily for us we have many of them! Elle Wilson, MBBS Year 2
On Second Year
Going into second year is less daunting in some respects - you have your social group, you’ve worked hard to pass first year and are now familiar with the teaching style - but this does not take away from its reputation for being tough. You’ve inevitably heard from your friends in the year above complaining about how insane the amount you have to learn is - but second year is a pretty crazy step up in terms of content (there are twenty muscles in the forearm...TWENTY). Teaching begins with Movement & Musculoskeletal Biology, which is basically mostly anatomy. The Anatomy Department put up lots of resources such as Moodle quizzes and SDL worksheets, but similar to first year, most of the learning is based on D&P and it is advisable to find a good atlas to go through as you learn. Second year is relentless, so before you’ve really had time to recover from MMB you’ll be going into Neuroscience & Behaviour, which comes with the entire anatomy of the head & neck...covered in under two weeks. Definitely try to keep up with the anatomy and read before dissection sessions! You’ll also be taught neuroanatomy in this module, and one useful textbook is Crossman & Neary’s ‘Neuroanatomy’ (although all the Cruciform copies are gone by the end of the first week of N&B - try getting them from other hospital libraries). All I can say is to try and use the Christmas holidays to review some of the content of the first 2 modules, because they’re pretty hefty and it’ll be invaluable come the end of the year. Endocrine Systems & Reproduction is possibly the most organised module - try and keep up with ESR because if you learn it well at the time, you’ll retain quite a bit of it before the Easter revision begins. Genetics, Development & Cancer will round off second year. And then there’s Pharmacology. There isn’t really anything I can say to properly prepare you - pharm is tough, even without it being scheduled for a Thursday morning. Looking back, I wish I’d made the effort to learn a few drugs every week - instead, I got to Easter with a list of 300+ drugs. You can use the course material, make flashcards or use the handy table of all the drugs/their mechanisms/contra-indications etc. etc. that gets passed down year on year. The early pharmacology lectures are key for learning the rest, and I can promise you’ll have revelations as you come to understand the difference between Gs, Gq and Gi. I also found the textbook ‘Pharmacology at a Glance’ really useful- it takes each lecture and compresses the information to a double page (#notsponsored). In terms of life outside of work - moving out of halls into private accommodation was such a great experience. It does come with new responsibilities of paying bills (potentially learning how to read a gas meter?...maybe even learning gas meters exist?), applying for council tax exemption (this is a good thing to do), and discovering there are no longer UCL cleaners to clean up after pre’s. You still have a lot of time to carry on with the clubs and societies you joined in first year, and maybe even try something new! This year, you will also pick your IBSc degree and write a personal statement. Whether you definitely know what you would like to study or are still deciding, it’s good to start preparing for the application. Your statement is not just the same as your UCAS one - you need to show you’ve been active at uni and that you have an interest in the subject you’re applying for - try and attend some of the many MedSoc lectures, or read around the subject. If you’re feeling lost, then ask someone in the year above on the course for guidance. Overall - good luck, work hard and remember to enjoy yourself ! Aayushi Gupta, MBBS Year 3
On Starting Clinics
Clinics are a massive change from any of the experiences you have had in your pre-clinical years. There are an overwhelming amount of things to take in in your first few weeks but DON’T PANIC! Everyone will be feeling the same and it does not take long to get used to the day-to-day hospital madness. However, to reduce the first day panic a little, here are the “Big five to stay alive” and key things to be equipped with before you start your first day at big school:
1. A stethoscope – Littman are the ones most people go for (mainly to look the part), and whilst you won’t use it for the vast majority of term one, you will use it successfully at some point I promise! n.b. Your stethoscope goes in your ears with ear-pieces facing forwards (this was a panic moment I frequently had at the bedside in my first few weeks!).
2. An Oxford Handbook of Clinical Medicine - despite the mumblings of many other books, this gives you all of the essentials whilst on the wards where you can speedily look things up in your first few weeks whilst the consultant’s back is turned! It also fits in most bags/large hands.
3. A good pair of smart shoes - I CANNOT stress enough the importance of a decent pair of shoes as after spending three hours walking around a ward round, your feet can hurt like hell in a pair of £5 ballet pumps.
4. An analogue watch - any cheap watch will do as long as you can reliably count 30 seconds on it. It is essential for examinations that you will be practicing from day one. You will look like a bit of a moron taking a pulse counting with absolutely nothing!
5. A small pocket notepad - essential to note down the huge amount of terms thrown at you throughout the day that you will need to look up when you get home and are too scared to ask the consultant for.
Throughout the year, you will encounter some excellent attachments, and those that frankly make you wish you’d stayed in bed. But unlike preclins, clinics are very much what you make of it. Making friends with one of the FY1s and asking to just follow them around for a day reaps a huge amount of benefits - both in getting signed off for procedures that they are more than happy to do if you are showing a little interest, and learning the actual useful things that you need as an FY! You may worry about OSCEs, DGH placements, revision techniques and balancing societies with clinic hours. Again, don’t panic and I will hopefully cover these in detail in future issues! Overall - good luck, work hard and remember to enjoy the experience! Robyn Brown, MBBS Year 6, Welfare Editor
Inside Mums and Dads We run various events throughout the year, from pre- and post-exam talks, to regular peer-support meetings for those in need of advice. Our first event, Mum’s and Dad’s, is in fresher’s week - as is medical school tradition, every first year will be assigned a ‘Mum’ or ‘Dad’ from year 2 to welcome and introduce you to university life. In addition to your transition mentor, parents are an invaluable source of academic information and wisdom. After all, who better to ask for advice than someone who has just been through it? It’s a great way to meet people in other years, with some families having the whole 6 generations of students. It just remains for me to say - enjoy your time here and welcome to our RUMS family! Vignesh Gopalan, MBBS Year 3, Welfare VP, Welfare Editor
(Go to http://myrums.com/welfare/ for more information about the team, and for tips/contact information)
The Royal Societey of Medicine A little piece of gold that not many people know about. Situated in London’s West End, just behind John Lewis and House of Fraser and away from busy Oxford Street, you will find the Royal Society of Medicine – one of the UK’s largest providers of medical education and home to one of the largest and most up-to-date medical libraries in Europe. Derar Seyoum, a recent UCL medical student explains why he joined the RSM and how his membership benefited his career development. “I was first introduced to the Royal Society of Medicine and its facilities in 2012 by a friend at medical school. One of the major reasons I decided to join the RSM was because of its library which is open 24/7 and is always quiet with lots of space available to study. As a medical student in London I found having this on my doorstep extremely useful. RSM members can use the printers and photocopiers free of charge - great for those occasions when I was rushing to print the last pieces of paperwork for a deadline when the university facilities closed at 8 or 9pm! In addition, the RSM also has a large collection of ejournals and ebooks which you can access free as a member. The RSM runs hundreds of events and lectures each year which I found to be very inspiring and helpful for students. You can attend the events related to the specialties you are interested in at discounted rates. They also provide great opportunities to hear and meet the leaders and prominent people in medicine. For example, Professor Parveen Kumar gave lectures in gastroenterology in the RSM’s Student Revision lecture series. In 2014, I was fortunate enough to join the RSM Student Section, which organises events to support students’ studies along with events of general medical interest. This provided me with the opportunity to work closely with other RSM Student Members from universities across the UK. Up to four representatives from each medical school can join the RSM Student Section for which there are currently vacancies for UCL students. If this sounds like something you would like to get involved in or would like to find out more about then contact: firstname.lastname@example.org The RSM also has club facilities, including a bar and restaurant. A fascinating aspect of using these facilities is the wide variety of medics you come across; everyone is friendly and has a lot of experience to draw from and share. I highly recommend joining the RSM – it feels like a little piece of gold that not many people know about.” About RSM Student Membership RSM membership starts at just £40 per year but substantial savings can be made if taking out membership for multiple years. Benefits include: - 24/7 access to the RSM’s library: over 600,000 books and journals, free printing and photocopying, free access to private study rooms and group working space with 65 inch interactive touch screen PC and glass boards. - RSM meetings – free or discounted rates: over 400 each year spanning over 60 specialties and areas of interest. Events include annual Specialty careers fair, revision series and OSCE practical days. - Extensive online resources: over 5,000 full text ejournals, 1,500+ ebooks and major medical databases - Prizes and awards: Enter over 30 prizes and awards specifically for students worth over £12,000 - Members’ only club facilities: Café, bar, lounges, restaurant and onsite hotel. - Save money from well-respected companies: Discounts on Apple products, Austin Reed and TM Lewin clothing, cinema tickets and gym membership. See the RSM for yourself If you would like to have a tour of the RSM before joining then please do contact the RSM membership team who can arrange this: email@example.com or 020 7290 2991. Special RSM Joining offer for UCL Medical Students Join the Royal Society of Medicine before Friday 27 November and receive a free NUS EXTRA CARD* – worth £12. To take advantage of this offer apply online: www.rsm.ac.uk/join quoting “UCLMM” *subject to availability
SPORTS & SOCIETIES
RUMS Review brings you the latest reports, news and updates from all RUMS sports and societies. As we start the new acadmic year, our clubs turn a new page - setting out their aspirations for the future and evaluating their previous form. If you can’t choose which new club or society to join this year then read carefully, as each club also informs us on what they can offer new members. We also focus on the MDs, and their recent foray to the Endinburgh Fringe Festival, while Andy Webb introduces himself and his plans for RUMS sport 2015/16 - watch this space! Andy Webb on RUMS Sports and Societies 2015/16 Hello RUMS! I’m Andy Webb and I’m your Sports & Societies VP this year. The RUMS sports and societies are one of the clear strengths of the Medical School. We have a huge range of sports and societies on offer and, despite an intake 1/15th of the size of UCLU’s, all of our sports clubs compete at the highest level and our societies are some of the strongest in the university. Within the sports clubs, there are always enough teams to cater for any ability – from national and county levels to the complete novice – and the societies allow students to also engage in other areas. Not only do the sports and societies perform well, but they also provide continuous support for their members. Many provide tutorials led by older years and the social side of things is just on another level, epitomised by the weekly sports night. They are a credit to the participation and commitment of the numerous students involved. What is unique about the RUMS sports and societies is that they are catered specifically to medical students. They allow you to work, compete and perform on a par with six years worth of students. Not only do they have a wealth of experience, but they are also always willing to share the tips and tricks you need to make a success of your time at university. There is also a greater understanding of the time constraints you may come under as you progress through the course. Despite these busy schedules however, RUMS students are constantly coming up with new ideas and schemes targeting more and more aspects of student life. As the Sports and Societies VP, my role is to support all aspects regarding these RUMS sports and societies. As well as making sure everyone slowly comes round to the RUMS mentality and to really push an awareness of RUMS, I’m here to help the heads of societies throughout the year and to maintain our brilliant traditions. On top of this, I’ll be organising the legendary RUMS Sports Ball and building on our involvement in the annual varsity competition – or just setting up our very own grudge match against GKT. Most importantly however, I’m here to improve anything you think needs improving. So if you have any problems throughout the year or if you want to set up something new then please do get in touch. To those considering whether to join a RUMS sport or society, my advice would be to go for it and get stuck in. First hand, through my time in RUMS FC, I have seen that the RUMS sports and societies can really make your university experience and I can’t recommend getting involved highly enough. You’ve made it into one of the world’s best medical schools so now that you’re here why not make the most of your experience by joining one of the incredible RUMS sports or societies. Regardless of which sport or society you’re involved with or decide to join though, here are just some of the highlights to look out for in the year ahead: - Weekly sports nights - Just come and see! - MDs Show – November. This is the main MDs event of the year. Full of hilarity and heckling – it’s a classic in the RUMS calendar. - Bill Smith’s – December. Rugby’s annual first years vs second years grudge match in Regent’s Park. Steeped in tradition and always a large one! - Varsity – March. UCL vs Kings – hopefully with the largest RUMS involvement yet! - Lumsden Cup – March. The annual Netball charity extravaganza – come and see the chaos of their inter-sport netball competition. - John’s Cup – March. The first years look to make their mark and embarrass the second years in the annual Football grudge match. - Annual General Meetings – March. Each society holds its AGM to select the new committee to take them forward in the upcoming year. - Sports Ball – March. The perfect way to top off the second term and celebrate the success of our teams and stand out individuals – an amazing event! - UH Bumps – May. The highlight of the Rowing calendar and a great spectacle out on the Thames. I wish you all a fantastic year within RUMS and hope that the RUMS sports and societies continue to enhance your medical school experience. Please feel free to get in touch with me, or any of the RUMS exec, with any questions, comments or suggestions and I hope to see you at some of the many events this year. Andy Webb, MBBS Year 5, Sports and Societies VP
My name is Kevin and I am the proud president of RUMS Badminton. With more than 115 members last year and even our alumni still getting involved, we pride ourselves on being an inclusive and welcoming club offering the chance for both competitive and social badminton. Last season was very successful for the club. We continued to compete at a high level and saw our women’s team, led by Karen Erskine, make it to the South Eastern BUCS Final. They successfully returned with the cup after a tight match against Queen Mary University. Next year, we are hopeful that both the men’s and women’s teams, captained by Tom Ngan and Sowmya Garikipati, will be just as successful. The year also saw the introduction of BADucation – a series of student-led tutorials for first and second year students. Under our publicity officer Orla Gillman, we plan to expand BADucation to include more tutorials and IBSc sessions as well. We have also continued to hold our social training for less experienced players every Wednesday and Saturday. The social side of badminton continues to hook members. Wednesday evening sports nights at the Huntley continue to be a staple of RUMS Badminton as well as several social events, including club meals, a trip to see the All England Championships and our infamous Christmas Party. Our friendly social secretaries, Aayushi Gupta and Ava Zamani, will soon become familiar faces to all our new members. It doesn’t matter whether you are a fresher or a seasoned 6th year, born with a racket in your hand or a complete novice, you are more than welcome at RUMS Badminton. If you have any questions, please feel free to contact me at firstname.lastname@example.org, or alternatively, follow us on twitter @RUMSBadminton.
Cricket Recently proclaimed by Carlsberg as “Probably the Best Cricket Club in the World”, times have never been better for RUMS Cricket. Fresh from a year that brought silverware to the trophy cabinet and 15 fine young men to Singapore and Malaysia, the club looks forward to much more of the same in 2015/2016. Our cricketing year begins at Lord’s Cricket Ground, where we run net sessions throughout the first and second terms. In the summer, we field 1st and 2nd XI sides and these compete in LUSL and BUCS leagues as well as the famed UH Cup. Off the field, the club offers ample opportunity to get away from the world of enzymes and action potentials, thanks to Wednesday’s sports night and a wide array of social events. 2015 saw the most successful season in RUMS CC’s illustrious history. Led by 1st XI Captain Jimmy Oldman, RUMS beat GKT by 157 runs to pick up the UH Plate and then a mere week later defeated a well-fancied Bart’s side to win the UH T20 Cup. Such achievements are a testament to the club’s wealth of talent and exciting brand of cricket. With the dawn of a new season now near, new members are warmly welcomed. RUMS Cricket is a flourishing club and offers an inclusive and friendly environment for getting to know fellow medics of all ages. We embrace both the playing and social aspects of the game and new members of all abilities are encouraged to join, whether a seasoned cricketer or a genuine beginner. So whether you’re looking for highly competitive university cricket, or just to meet some new people and have a laugh, RUMS CC is the club for you. Please feel free to message email@example.com (RUMS Cricket President) with any questions or follow us on Twitter @RUMSCC. James Groves.
Women’s Football Hi everyone! My name’s Becki Clark and I am president of the RUMS Women’s Football Club. We are a club with a wide variety of experience, ranging from those who have never kicked a ball before to those that have played for most of their lives, and we have three teams to cater for all ability levels. Our first team had an incredibly successful season last year. They only lost one game, won the league and gained promotion to the premier division. The team is going from strength to strength and we would love to gain some fresh faces to help us face the challenges that this higher level of football will throw at us. Likewise, the second team continued to improve and this year saw two new members scoring goals for them. The year ended on a high with the best result of the season – a draw against UCL 3rds! We welcome players of any ability to come join the seconds, never refusing anyone the option of game time. On Wednesdays our BUCS (mixed) team competes. This is made up of players from both the first and second teams, which we do to keep the whole club united. Many will agree that these are incredibly fun games to be a part of, getting to try new things out and playing alongside different people. We continuously have an active social scene; we meet every Wednesday for sports night, have a fresher’s meal, a Christmas meal, mixed socials and much more! So if you’re a budding footballer or just want to try something new with a great group of girls we would love you to join RUMS WFC (especially any goalkeepers!). For more information check out our website (http://www.pitchero.com/clubs/rumswfc), the RUMS WFC Facebook page or email me at firstname.lastname@example.org.
The club had a very successful season last year. Our Women’s 1st XI had a great intake, including 5 freshers, and went on to have a strong BUCS season in the South-Eastern League 2B. This resulted in a promotion to League 1B and so we look forward to both a challenging and exciting upcoming season. Our 2’s maintained a strong position in their league this year after a double promotion and the 3’s will also be entering BUCS this year after a successful year in the Sunday LUSL league. We closed the season with our massive annual varsity match against GKT. This was played in the great atmosphere of the Olympic pitches and was watched by hundreds of supporters. Alongside our fiercely competitive hockey, we also have a number of socials. Every week we have sports nights at the Huntley bar and throughout the year we have regular curries with the rest of the women’s club and mixed socials with the men’s club including pub-crawls, the annual End of Season Dinner and several incredible annual tours. Our training is held on a Thursday night at Paddington Rec, with additional fitness as a team on weekdays. We welcome members of all abilities, whether you are an advanced player or complete beginner. So, if you have any questions please feel free to contact our president, Charlotte Griffiths, at email@example.com or follow us on Twitter @RUMSWHC.
RUMS Hockey is one of the biggest clubs within RUMS and we have three teams, allowing the club to cater for all levels of ability. The 1st XI play competitive fixtures against other university first teams, the 2nd XI is a development team and the 3rd XI, our ‘team of the year’, is suitable for those with less experience. For first team players there is also the additional incentive of playing for the United Hospitals, a prestigious invitational team. Last season was a big success for the club. We had a record-breaking intake of freshers and it was particularly pleasing for our 3rd XI to have their most successful season ever. The greatest highlight of the year was our Varsity match with GKT Hockey Club. This was part of the London Varsity Series and we are proud to be the only club in RUMS to hold a place in the series, which is played at the Olympic park. The United Hospitals side saw yet another strong year for RUMS’ contribution, with six of our members representing the side and Hamish Miller being elected captain. Off the pitch, the club continues to embrace a vibrant social scene from weekly sports night socials to mixed events and tours with the Women’s club. A recent highlight was our preseason tour to Exeter where a development squad spent three days training and then played a match against Ashmoor Hockey club. The success of this recent trip, in conjunction with our new internationally experienced coach, bodes for an exciting upcoming season. We are looking forward to welcoming new members to the club and it really does offer something for everyone. Please contact firstname.lastname@example.org or follow @RUMSHC on Twitter. Harry Bamber, Interim President.
My name is Anna Mullan and I’m the new RUMS Netball President. We are a thriving club consisting of more than 80 fun, friendly medics from freshers right the way up to 6th years. We have 6 teams catering for all abilities and hold weekly training and fitness sessions. In addition, we have a packed social calendar and an annual tour, providing so many opportunities to get to know new people, both within the netball club and from other RUMS sports clubs. At the beginning of last year, we were thrilled to welcome an unprecedented number of new members to the club. They gelled quickly within the teams and we saw our numbers at sports night increase rapidly. There was great play on court with 4 of our teams competing in both a LUSL and BUCS league and all 6 teams playing regular matches. All teams held onto their current league positions, which was a great achievement. Throughout the year our ongoing volunteering scheme with KEEN continued running with great success. Our annual events such as the Alumni cup and tour also took place; this was a fantastic weekend away in Brighton that was enjoyed by many members. We also organised the Lumsden Cup, an inter-club netball tournament for all RUMS Sports Clubs, raising £579.26 for KEEN. We are hopeful that this coming season will be as enjoyable and successful as the last. We look forward to welcoming even more new members and to more fun and games both on and off court. If you are looking for a friendly and fun sports club, then RUMS netball is for you! If you have any questions please do not hesitate to contact me at email@example.com, or there is also our website and Facebook page, just search RUMS Netball.
To introduce myself, I’m Tom Western, the RUMS Squash president for this year. We are a small and tight-knit group of 40 members, ranging from very beginners to seasoned members, and I’m very much looking forward to meeting all our new members this year! We have two men’s teams and a women’s team and they all regularly play in two different leagues against other universities, BUCS and LUSL. Last year the men’s first team performed highly in BUCS and was promoted back into the Premier Division in LUSL. The women’s team has gone from strength to strength of late, reaching the semi-finals of their BUCS cup and maintaining solid positions in both leagues. Along with our matches, we continue to have regular professional-led training sessions and the highlight of the season was as always the National Association of Medical Schools (NAMS) tour. It is always a fantastic weekend, giving the chance to meet and play against many other teams. Of course, it’s not just about what’s on court. We have regular socials, including sports night every week, visits to local pubs after training or matches, and this year we are also hoping to organise a second tour - this time abroad! We attend a number of professional matches throughout the year, allowing the opportunity to meet with the pros and talk over some squash. So if you are looking for a fast-paced, exciting game, requiring strength, fitness and skill and want to join a club with great people, then RUMS Squash is for you. The friends you will make in RUMS squash will support you throughout medical school and you are welcome to attend as much or as little as you want. If you have any questions, please don’t hesitate to email me at firstname.lastname@example.org.
RUMS Tennis is a mixed club, welcoming everyone from avid players to complete beginners. We have two men’s teams and one women’s team representing our club. We play in a number of competitions including the BUCS Leagues and as part of the United Hospitals (UH) competitions. Last year in BUCS, all teams held their leagues and we had huge success in the UH competitions. RUMS won the UH League Cup Men’s Doubles, a competition dating back to 1887 and the second oldest of its kind in the world, and we came runners up in the equivalent Mixed Doubles competition. With the majority of our members playing tennis just for fun, our Social Tennis on Wednesday afternoons continued to be popular this year. Everyone is always welcome and you don’t need to have played before or even own your own racquet to join in. In this upcoming year, we’re hoping to build on our success in BUCS and UH as well as continue winning trophies and securing promotion for our teams. Off court, we’re looking at more ways we can be involved in the community and engage with sponsors in order to push the club further. As a club, we provide our members with a fantastic social atmosphere, the opportunity to develop their tennis skills and push themselves further. Everyone is welcome and as a member you can be sure that we will provide you with the support you need to make the most of your time in RUMS. If you want to find out more then don’t hesitate to contact us. Check us out on Facebook or email Jon Funnell (club president) at email@example.com.
RUMS Boat Club is one of the biggest sports clubs in RUMS, averaging 100 members of all abilities each year. Our history dates back 150 years, with many of our events being internationally renowned such as the men and women’s Head of the River Races on the Thames. We take on complete beginners to the sport, who benefit from coaching from their Novice Captains (who for the first time this year will have British Rowing level 2 Coaching Awards), and we also welcome schoolboy and schoolgirl rowers and transfers from Oxbridge into our senior squads. Last year was very successful for the club. Most crews won medals and we continued to show well at BUCS events. Without a doubt, the biggest achievement for RUMSBC was against our United Hospitals competition. After gaining the most points overall from our many successes in UH events, we were crowned the inaugural UH Champions - a title which we will not be letting go any time soon. This year we will be looking to enter more races than ever and have as much or even more success than last year. Whilst we are a serious rowing club, our club social life is not to be underestimated. As a mixed-gender club all of our events are mixed and continue to be attended in large numbers. We have weekly sports nights, two formal dinners and many special events throughout the year. This coming year RUMSBC are also the United Hospitals captains and so will be organising events with the other clubs including Imperial, St George’s and King’s College. If you want to find out more then please check out our website: www.rumsbc.co.uk, Twitter: rumsbc or Facebook: RUMSBC. Tom Morgan, RUMSBC President 2015-16
Welcome to RUMS RFC, the RUMS rugby club. We are an active club, welcoming players of all skill levels. Our 1st XV are the highest ranked RUMS sports team and one of the highest ranked sports teams in the whole of UCL! Last season, the 1st XV once again came 2nd in the BUCS league South Eastern 1A. The Boars (The 2nd XV) also compete in the BUCS leagues and had a strong finish to the year, reaching two finals in both the UH Cup and the BUCS Cup. The Piglets (our 3rd XV) continued to be a great side to be involved with, especially for those new to rugby, and competed in various merit league festivals. The highlight of the year was our success in the United Hospitals Challenge Cup – the oldest rugby cup competition in the world. After a spectacular match under floodlights and spurred on by an amazing crowd at Ealing Trailfinders, our 1st XV won the UH Challenge Cup, for the first time in 128 years! Off the pitch, we are a very sociable club. Not only do we have Sports Night every week and various socials, we also tour to Oktoberfest every year where we compete as ‘plate specialists’ in the Munich Oktoberfest 7s tournament. We also travel to Paris to play Paris Sciences et Lettres Research University (PSL) and this is always a great weekend away! We train Saturday mornings and Monday evenings and welcome players of all abilities, including those who haven’t played before. If you are interested then please get in touch with this year’s Club Captain, Sam Cullen at: firstname.lastname@example.org.
Welcome to RUMS FC, the men’s football club of RUMS. We have five 11-a-side squads that compete in both BUCS and LUSL leagues and provide opportunities for players of all abilities. RUMS FC had another strong year in 2014/15. We started the year off well with a large intake of keen freshers. Key highlights were the 1st XI becoming champions of the LUSL 1st Division and the 2nd XI managing to beat the 3rd XI in the RUMS FC derby and going on to gain promotion at the end of the season. This season saw the first ever for RUMS FC’s 5th XI and provided a great chance for more members to get involved in 11-a-side football. Off the pitch, RUMS FC continues to have an exciting social scene. With weekly sports nights and various socials throughout the year, we have a busy social calendar. We also have annual tours. Last year our fresher tour was to Birmingham and at the end of the season we went on tour to Manchester to take part in the annual NAMS tournament where we won for the 182nd time in a row! We also strengthened our alumni connections this year with our inaugural Alumni Sports Night. This was a glorious success with dozens of doctors returning for the night. In addition, our volunteering scheme got underway, allowing our members to help coach children at a local school. With an exciting bunch of new captains and a new committee keen to provide even more for our members, we cannot wait for another great season within RUMS FC. We look forward to welcoming even more members and if you have any questions please feel free to message email@example.com or follow us on Twitter @FCRUMS. Harry Mitchell, RUMS FC President 2015/16.
We are RUMS Music, a friendly bunch of people sharing a passion for all things musical! We have a strings group made up of six people, a chamber choir of about fifteen and the original thirty-strong RUMS Music choir. This year, we are also hoping to set up an orchestra and would love to hear if you’d like to be part of it! Each individual group meets once a week at UCL to rehearse. They all cover a wide repertoire of music and are always open to new suggestions. Last year was very busy for the society. At Christmas we all came together to perform carols at the Whittington Hospital and we also sang at several church services in St Pancras in collaboration with the Royal Veterinary College. Later in the year, we held our annual Spring Concert at UCL. This year we really want to build on the success of last year. We hope to expand our volunteering section to perform in more hospitals and retirement homes. Also, we hope to integrate with more of the university’s arts societies and perform in other events at UCL. RUMS Music really allows its members to continue and develop their love for music during their time at UCL, and to do so in a relaxed, fun way within RUMS. So if you are interested in taking part then please get in contact with us and join RUMS Music. We are always looking for new members to participate and to take on leadership roles. For more information, including on our taster sessions, have a look at the ‘RUMS Music’ Facebook page. Or, if if you have any queries please drop us an email at firstname.lastname@example.org. Looking forward to seeing you! Pollyanna Cohen, RUMS Music President 2015-2016
RAG My name is Kaitlin Wong and I’m the President of the UCLU and RUMS Raise And Give (RAG) Society. We are a student-run society and
the purpose of RAG is to make fundraising a fun and rewarding activity. Last year was hugely successful for us. Our most popular event was Jailbreak. This saw many teams endeavour to travel as far away from UCL as possible within 36 hours, without spending any money and as always it led to many crazy and memorable experiences. Also, we had a fantastic trip abroad to climb Mt. Kilimanjaro for charity and this proved to be a once in a lifetime experience for all those who took part! Overall, we managed to raise a total of £45,000 for charity – a huge achievement for the society. This year, we hope to raise even more for our four charities: Hope For Children, The Cure Parkinson’s Trust, Teenage Cancer Trust and Pump Aid. Apart from events, we also continue to engage with our society through social activities, taking part in Varsity - where we put our fundraising ability to the test against Kings - and a special RAG Week to celebrate and raise awareness of a chosen topic. As one of the few societies that includes RUMS and UCL students, we provide an opportunity to make friends from a variety of backgrounds. It continues to bring students from everywhere together, creating a network of people who enjoy having fun whilst fundraising for some very worthwhile charities.
Our society began 117 years ago when a few medical students decided to perform on the wards of the Middlesex Hospital to cheer up patients around Christmas time. Since then the MDs have been performing countless sketches and shows to entertain medical students. The highlight of the MDs calendar is our annual Christmas show and last year it was a singing and (somewhat questionable) dancing extravaganza. In April, we took part in the UH Comedy Revue. Here we competed against the other UH medical schools for the Moira Stuart Cup and, for the second year in a row, we won! Also, it was our first year at the Edinburgh Fringe Festival, where the MDs had a sell-out run. We have socials every Thursday and every year we have a legendary weekend away at a secret location. You’re guaranteed a great time and if you don’t drink don’t hesitate to join! Our society has a strong cohort of “hydrators” and we always make sure everyone is having a blast on nights out. If you feel sufficiently hooked after our freshers’ show, join us! Keep an eye out for our audition dates. Not a fan of the spotlight? Our shows can’t happen without our amazing tech team, so if you’re eager to learn or even know a thing or two yourself, we’d love to have you on board! Is that a musical instrument I see in your pocket? Well why not join our band, who provide incredible music for our musical and pop parodies. If you love the sound of what we do and want to join in, keep an eye on on our Facebook page and Twitter (@MDsComedyRevue), or if you have any questions please get in touch at email@example.com.
Welcome to the RUMS Islamic Society. We are a society open to all medics and our aim is to help you make the most of the new and exciting social, academic and spiritual experiences on offer at university. We provide the opportunity to meet some amazing people from all over the world, learn about many different things and perhaps most importantly, learn about yourself. Our calendar is always packed with academic and social events. Academic support ranges from small group tutorials throughout the year to personal mentors for freshers. Our regular socials provide opportunities to have fun and get to know students from across all years. They include activities such as football, go-karting and Boris Biking. We are also involved in several outreach programs. Every summer we hold our AspireMed event, with the Social Mobility Foundation. This is aimed at helping sixth formers from low-income backgrounds with their application to medical school. We also host a thought-provoking medical ethics conference, looking at contemporary ethical issues all doctors will face from an Islamic point of view and our most recent event addressed the ethical issues of Life and Death. Our biggest week of the year is Charity Week. Last year, RUMS ISoc and its members hosted the annual Charity Week dinner. This contributed significantly to the total of over £77,000 that the UCL Charity Week team raised for Orphans In Need all over the world. We’re sure that it’s going to be a busy year ahead for you but RUMS ISoc is here to help you make the most of it. We really hope to welcome new members to the society and if you have any questions please message firstname.lastname@example.org, or have a look at our Facebook page or Twitter (@RumsIslamicSoc). Sabeeh Syed, RUMS ISoc President.
In Focus: The MDs’ Quest to the Edinburgh Fringe Festival
When the days were short and the nights were cold (sometime in January) a council of medical students came together to discuss a matter of great importance. A question that had not been answered for over a century. It was a calling from the North, a whispering in the wind, getting louder with each passing week - the infamous Edinburgh Fringe Festival. Dare they do it? Dare they make the treacherous journey to face the public, with no medical school loyalty to keep the audience from leaving? Could they possibly come away unscathed by such monsters as the treacherous critics, the villainous early morning flyering, and the elusive theatre schedulers? But so brave were this council of MDs that they embarked on this epic quest which began with the forging of the show, eventually titled ‘A Jam-Maker’s Guide to Self-Preservation’. Fast forward roughly eight months, and a brave band of 12 arrived at the footsteps of Edinburgh Waverely train station. But what is the Edinburgh Fringe I hear some of you cry? It began over 60 years ago when theatre companies not selected to perform in the official Edinburgh International Festival decided to set up their own private performances in smaller venues. They created an ethos of zero vetting of shows and this was officially written into the Fringe Festival’s constitution when a formal organisation, the Festival Fringe Society, was subsequently set up. Since then, the Edinburgh Fringe Festival has grown to become the largest arts festival in the world. It showcases anything from cabarets to children’s shows, operas to circus acts and of course, the most popular genre, comedy - being a well known launchpad for stand up comedians such as Lee Evans and Jack Whitehall. For groups of student performers, the Edinburgh Fringe is a real test of talent, with no student paper to create false pretence and audience of friends to crank up the forced laughter when needed. If the show is good, people stick around. If not, well there’s a reason audience numbers often only reach single digits. It provided the perfect testing ground for us to see if people really do laugh at us when they’re not drunk. Or medics. After a quick run-through at ‘theSpace on the Mile’, the home of our show for the next week, and a few hours of sleep at our accommodation,
our first show day was upon us. From midday onwards, we flyered to passers-by, using every trick in the book to get the public into our show - never before has the phrase “Trust me, I’m a medical student,” been used and abused so much. Eventually, with less than an hour before the show, the nerves started to creep up on us. Sure, we had done a preview performance in Camden to a full house, sure we got a five star review from it (many thanks Carnstheatrepassion.com), but this was the Edinburgh Fringe. Would our clinical years (Beth Brockbank, our Director, Xander Gurnee, our Stage Manager and Greg Dewar, our veteran fifth year) feel the pressure of performing less than a week after their exams? Would the audience laugh at our freshly written jokes? Would the cast remember their lines? As the cliché goes, anything could happen… Fifty minutes later however and the whole team were taking to the stage in front of rapturous applause for our final bows. It couldn’t have gone better and, except for a couple of minor things that needed tweaking, the cast and crew felt on top of the world. As the days went by, each performance became more polished and refined. Backstage became a smooth-running command centre run by our ever-present Stage Manager Xander, and the tech was absolutely flawless thanks to our wizard (yes, we are convinced he may be a real wizard), Jonathan Au. Throughout it all, our Director Beth kept us on our toes and in fine form. Even flyering became a real treat as audience members from previous shows came up to us, telling us how much they had loved our show. As for our reviews, they were largely positive, citing a “sharp and well written” script that managed to “demonstrate the flaws of the NHS in a way that mocks but is not aggressive, and is perceptive rather than over-the-top”. That’s right RUMS. Someone who saw our show said we weren’t over the top. One even went as far as to say that there were “Moments of sheer genius”. There were of course some minor criticisms mentioned in some of the reviews, but we were being compared to the big guns - the professional sketch groups who were veterans of the Royal Mile in Edinburgh. It’s safe to say we were more than happy! Our free time was spent watching others perform. One of the highlights was our group trip to see Pajama Men, a world renowned sketch duo, where we learnt a new way to start a sword fight (avant garde!). Different performances varied in how captivating they were but we all gained a huge insight into just how good comedy can be. Unknown names bringing the house down with hilarious sketches certainly smashed buckets of humble pie into the faces of our cast and set the standard. We became determined to, at the very least, dream of reaching it one day. With our final performance came a bittersweet farewell to the team at theSpace on the Mile who had been absolutely incredible in helping us with every little thing. Along with a strong contingency of MDs alumni doctors, we toasted to the end of our sellout (yes we sold out!) Fringe run and naturally we had an epic circle to end what had been an unforgettable 10 days in Edinburgh. Typically, the biggest stumbling block with Edinburgh shows is financing the whole thing. However, from the very beginning a small fundraising team comprising of Benji Rosen, Nathan Waldie, Jenny Budden and Jessica Howes were determined to knock on every metaphorical door possible to find who would help finance this brand new MDs venture and their hard work certainly paid off. We would like to thank the Heller foundation and Wesleyan for their contributions to the show and a special mention must also go to Tiptree Jam Company. When the team joked about being sponsored by jam to match the title of the show (‘A Jam-Maker’s Guide to Self-Preservation’), little did we know Benji was determined to make this a reality. Sure enough, five weeks later we entered rehearsals to be greeted by a mountain of over seven hundred little pots of conserve displaying our show’s title. Along with some further help from the union, we were able to make this dream a reality. The generosity of those that contributed to the MDs’ first Edinburgh Fringe performance, in its one-hundred-and-seventeen year history, will always be remembered. Undoubtedly, our trip to the biggest arts festival in the world was incredible and we are determined to not let it be our last. We learnt a great deal about ourselves and the calibre of our society. Over the course of the week, we felt the buzz of new ideas bouncing around our heads, inspired by the things we’d seen, and we couldn’t wait to start writing new material. But what does this all mean? Essentially, it means one hell of an MDs Christmas show is just around the corner. With more sketches poised for YouTube fame (or infamy) on our brand spanking new channel as well, it’s all kicking off for the MDs Comedy Revue. So keep your eyes peeled for our next venture - we promise you, it’ll be worth a watch! Ankit Bhatt, MBBS Year 3, MDs Comedy Revue President 2015/16
Lucy Porter, MBBS Year 2, Sports and Societies Editor
BOOKS & EVENTS
Books BAD PHARMA by Ben Goldacre It’s BRILLIANT. Ben Goldacre neatly and succinctly sums up the problems with the pharmaceutical industry today, turning what should be a dry book full of statistics and evidence skills no one likes into a book that will make you furious. Bad Pharma covers how industry frequently puts big money into clinical trials that really do very little, because the results are then hidden, changed or biased to give the result that the company wants. The trials are poorly designed and performed on hopelessly unrepresentative patients, and then the confused results are peddled to doctors hidden beneath a façade of free lunches and pens. Results that don’t coincide with the intent of the drug are hidden and their existence ignored, putting patients’ lives at risk and requiring yet more money in more trials to discover exactly the same poor results. Goldacre fills the book with interesting stories, showing us just how clearly statistics and clinical practice are intertwined. At nearly 450 pages, it’s a struggle to get through at times, but each chapter can be read independently. This book is perfect for those interested in pharmacology, statistics and ethics.
EUREKA: PHYSIOLOGY by Jake Mann and David Marples RUMS Review was sent the Eureka series to review and my verdict is that they are wonderful. Physiology is packed full of helpful diagrams, clinical scenarios and question packs and cover the pre-clinical physiology course almost entirely, making things simple and easy to understand. It starts with the basic information needed for FHMP, recapping A level in that little bit more detail that UCL expects. What makes it different to any other textbook is that clinical cases and their relevance to the information being taught are mentioned straight away. The first year DNA and cell lectures are covered easily and quickly in the first ten pages, making this book perfect for quick revision or getting ahead. After the initial chapters, the book becomes systems based, so it is laid out perfectly to overlap with modules in both first and second year. Later on it goes into more detail, meaning in-depth revision is also possible, with SBAs to review. It reads like a condensed, more clinically orientated Human Physiology and is perfect for the UCL course.
BLOOD MATTERS: A JOURNEY ALONG THE GENETIC FRONTEIR by Masha Gessen Masha Gessen found out she had the gene that predisposed her to breast and ovarian cancer in 2004. Blood Matters is her account of what happened after- working out what the information meant for her, and what genetic testing meant for others who had family histories of diseases that could tear their worlds apart. This is a great book for anyone wanting a more relaxed approach to medicine, covering the more ethical sides of genetic testing and what it means for the patients and clinicians involved. RUMS Review is looking for suggestions! If you have a book you think we should review, please get in contact with the Review Editor, Katie Hodgkinson, at email@example.com
Events Women In Surgery Conference Aspiring female surgeons rejoice - Sam Scott finds out that there is more to life than just the operating theatre… yes, really!
The 2015 Women in Surgery Conference was held in Birmingham at the impressive Repertory Theatre. WinS is a supportive network organisation for any females working, training, or interested in surgery. This year the focus at the annual meeting was on the incredibly diverse lives of female surgeons - both in and out of the operating theatre. The day began with complimentary breakfast, which was welcomed after a 5.30am start, and a 3-hour commute. This was followed by an address from the president of the Royal College of Surgeons England, Clare Marx. The morning session consisted of talks from surgeons at various stages of training about their passions, interests and careers. Following a networking lunch break, the group split into various seminars and Q&A sessions aimed at different levels. My personal highlight was hearing neurosurgery consultant Helen Fernandes talk about her life outside of work. Who knew it was possible to have three businesses in the hospitality industry and to bring up three children whilst also casually being a neurosurgeon? A career in surgery is often talked about as being a difficult option. It’s assumed that this will mean having to sacrifice other areas of life in order to be successful, and this can sometimes be off-putting (especially for females). At the 2015 WinS conference we heard from many female surgeons who had children; who might work part-time; who had a keen interest in sports; who worked tirelessly for charities and who generally had very enriched lives. It was a great opportunity to meet and talk with people further along in their careers, many of whom were attending with the specific aim of encouraging women to choose surgery. There was also time to discuss less-than-full-time working options, and to ask questions in a relaxed and supportive atmosphere. The conference is open to women at any level in surgical training. The range of attendees - from medical students to eminent consultants - was refreshing, and very inspiring for the more junior trainees. Throughout the day I managed to speak to consultants and
registrars from neuro, plastics, orthopaedics, breast, urology and vascular surgical departments, and surgeons working in the army – and I’m the worst networker I know! The 2016 conference is set for 30th September – a little way off, but definitely a date for your diaries. It’s at the Royal College of Surgeons in London this time, which is much easier for aspiring RUMS girls to get to. Even if you aren’t certain about a career in surgery this day could help you make the decision, plus the food was great! Sorry boys… Sam Scott, MBBS Year 6
Up and Coming...
Join MedSoc every Monday for a fascinating series of events; discover exciting career opportunities, hear medical tales from across the globe and be inspired by cutting edge research...
BMJ Careers Fair: 23-24 October A Taster Course for Respiratory Medicine: 12 October – 5:30pm RSM Digital Orthopaedics: 15 October – 2:00pm
RSM and UKMSA conference: Equipping MedSoc Battles: The Specialties Sports and Exercise Medicine: a whistle-stop tomorrow’s clinical leaders: 17 October – 9:00am tour Paediatrics and Global Health: Stories from The 2015 Darwin lecture: transforming medical practice - from population health Sierra Leone to precision medicine: 19 October – 6:00pm Global Health: Electives Fair Ellison-cliffe lecture 2015: life is what you make it: 20 October - 6:00pm Ebola Epidemic: The Aftermath Oncology: The Promise of Immunotherapy
Global Health Film Festival: 30-31 October – 8:30am
GP and Debating: Counting on Candour
Future Ortopaedic Surgeons Conference: 7 3D Printing in Orthopaedics: past, present November – 8:15am and future RSM Specialty Careers Fair: 13 November – 6:00pm Paeds and Protons: the power of the beam To find out more like our Facebook page: Global health alert - europe and the refugee crisis: 25 November – 5:30pm UCLU Medical Society and follow us on Twitter: @UCLUMedSoc Dilemmas, date rape and death: an introduction to forensic and legal medicine for students and trainees: 26 November – 6:00pm UPRAS 2016 (undergraduate plastic reconstructive aesthetic surgery): 28 November 8:30am
A career in urology: undergraduate and junior doctor foundation course in urology: 9 January – Day (Time TBC)
Cardiothoracic Surgery - The Overlap of Cardiothoracic Surgery and Interventional Cardiology: 16 October - time TBC Medics for Medics: Peer Support Group Meeting: 19 October – 6:00pm Introduction to Surgical Society and How to Make the Most of Medical School: 19 Octo- Medics for Medics: Peer Support Group ber - 6.00pm Meeting: 2 November – 6:00pm General Surgery: Making the most of your Medics for Medics: Peer Support Group time in theatre: 27 October - time TBC Meeting: 16 November – 6:00pm Ophthalmology: Introduction to Ophthalmology: 4 November - time TBC Medics for Medics: Peer Support Group Virtual Reality Workshop, Medical Simula- Meeting: 30 November – 6:00pm tion Centre, Royal Free Hospital: 18 NovemMedics for Medics: Peer Support Group ber - 1.00-6.00pm Meeting: 14 December – 6:00pm Medics for Medics: Peer Support Group Meeting: 28 December – 6:00pm
Royal Colleges Royal College of Ophthalmologists - Medical Students Taster Day: 27 November – 8:30am Royal College of Pathologists - International Pathology Day Conference: 18 November – Time TBC Royal College of Paediatrics and Child Health - Patients and Families as the New Educators: 20 October – 9:00am Royal College of Physicians - Hands-on with London Museums of Health and Medicine: 28 October – 2:00pm Faculty of Public Health - Growing Up Happy in England: Evidence-based approaches to wellbeing and implications for policy: 4 November – 9:15am Faculty of Public Health - Health Through Peace: 13-14 November - 10:00am Royal College of Surgeons – Student Saturdays Tutor-Led Anatomy Study Session for Clinical Years 4 & 5: 7 November – 10:00am Royal College of Surgeons – Student Saturdays Tutor-Led Anatomy Study Session for Clinical Years 4 & 5: 28 November – 10:00am Royal College of Surgeons – Careers Afternoon: 9 October – Time TBA
UCL Memory Matters: The Art and Science of the Brain: 30 October – 7:00pm Lunch Hour Lectures: “It’s so unfair!”: stress in adolescence: 3 November – 1:15pm Lunch Hour Lectures: Why early life matters: insights from longitudinal studies: 5 November – 1:15pm UCL Prize Lecture in Clinical Science: 10 November – 5:30pm CLOSER Conference: The Importance of Early Years, Childhood and Adolescence: 30 November – 9:00am Lunch Hour Lectures: Cannabis: pleasure, madness and medicine: 8 December – 1:15pm Lunch Hour Lectures: Truth and lies: medicine in the media: 10 December – 1:15pm
Various Medic Footprints - Alternative Careers and Wellbeing for Doctors: 31 October – 9:00am
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