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RUMS REVIEW UCL MEDICAL SCHOOL STUDENT MAGAZINE

SPRING TERM 2016


01 29 REC ENT

DEV EL O P M ENTS What’s happened in the

UCL MEDIC AL SC HOO L MAG A Z I N E SPRING TERM 2016, Vol. 1 No. 2 E:

rums-review@ucl.ac.uk

W:

www.rumsreview.co.uk

junior doctor contract dispute so far.

RUMS REVIEW TEAM E D I TO R S-IN -C HIEF Rebecca Mackenzie, MBBS Year 2 Sophie Bracke, MBBS Year 2 S U B E DI TO RS Rebecca Kells, BA English Year 2 Tara Carlin, BA English Year 2 N EW S E DITO RS Emma Lewin, MBBS Year 2 Rebecca Kells, BA English Year 2 Anamika Kunnumpurath, MBBS Year 3 O U T O F HO URS EDITO R Christen Van Den Berghe, MBBS Year 2

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R E S E A RCH EDITO RS Andrew Cole, MBBS Year 4 Richard Bartlett, MBPhD MBBS Year 5 Eng O-charoenrat, MBBS Year 2

RUM S RO U N D U P

A L U M N U S IN TERVIEW EDITOR S Adesh Sundaresan, MBBS Year 3 Charlotte Leigh, MBBS Year 2

After a busy term of

Bill Boucher, MBBS Year 2

sport and activities, clubs tell us about their highlights.

A RT I CL E EDITO RS Rebecca Fisher, MBBS Year 3 Lucy Refell, MBBS Year 2 Otso Pelkonen, MBBS Year 2 Melika Moghim, MBBS Year 1 S PO RT S AN D SO C IETIES EDITOR Lucy Porter, MBBS Year 2 BO O K R EVIEW EDITO R Katie Hodgkinson, MBBS Year 3 EV E N T REVIEW EDITO R Yul Kahn Pascual, MBBS Year 1 A RT WO R K Kate Alice Mackenzie D E S I G N AN D LAYO UT EDITOR Vinzenz Leuenberger, IMB Year 1

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AM YL O ID O SIS UCL’s Sir Mark Pepys introduces us to his break through

O N L I N E EDITO R

research.

Joe Hearle, MBBS Year 2

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CONTENTS CONTENTS — PAGE 4

Page 4-6 RUMS RUMSWELCOME NEWS

BE DPAN S & B RO O MSTIC KS

Page 4-6 PAGE 5-8

MDs deliver in annual Christmas show.

RUMS NEWSFLASH RUMS NEWSFLASH —

MD’s in circus themed christmas show.

Page 4-6

RUMS PAGE 8-9 MEDICAL SCHOOL NEWS —

RUMS MEDICAL SCHOOL NEWS Page 4-6 RUMS OUT OF HOURS PAGE 10-11 —

Page 4-6

RUMS OF HOURS RUMSOUT RESEARCH —

Page 4-6 PAGE 12-15

RUMS ARTICLES RUMS RESEARCH Page 4-6

RUMS NEWS

PAGE 16-31 —

24 17 D EP RESSI O N Where are we going wrong? It’s time to talk about our minds.

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RUMS ARTICLES Page 4-6 RUMS COMMENT & CORRESPONDENCE —

PAGE 32-37 Page 4-6

RUMS SOCIETIES RUMSSPORTS SPORTS &&SOCIETIES —

Page 4-6

PAGE 38-39 RUMS BOOK REVIEWS — RUMS IN FOCUS

Page 4-6

RUMS EVENT REVIEWS

PAGE — 40-41

RUMS COMMENT & CORRESPONDENCE PAGE 43

RUMS BOOK REVIEWS

PO LITIC S

PAGE 44-46

What role does it have in

RUMS EVENT REVIEWS

the medical profession?

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B IL L SM I TH ’S

RU MS MA GA ZI N E

Second years make

Disclaimer: The views and opinions expressed

it into the history

in this magazine are those of the authors, and

books by becoming

do not reflect those of the editors, UCL Medical

‘double winners’.

School or RUMS Medical Students’ Association.

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ED ITO RS-IN-C H IEF Rebecca Mackenzie, MBBS Year 2 Sophie Bracke, MBBS Year 2

EDITORS-IN-CHIEF

Rebecca Mackenzie, MBBS Year 2 Sophie Bracke, MBBS Year 2

WELCOME

Our second RUMS REVIEW issue. Delivered. — Welcome back! The New Year is all about fresh starts, from cold January 9ams to working off those Christmas mince pies, and RUMS Review is no exception to this ritual. Having listened to your feedback from our pilot issue, we present to you the second issue with a fresh new look, a brand new website (check it out at www. rumsreview.co.uk) and plenty of pictures for a more medical student ‘friendly’ format – yes, we know after reading a couple of pages of D&P no one has the capacity for much more.

THANKS TO EVERYONE WHO MADE MADE RUMS REVIEW HAPPEN THIS TERM! We have been overwhelmed by the standard and range of material we have received, reflecting how engaged so many of you are with issues both within and outside the curriculum. With junior doctors taking to picket lines and the feasibility of a 7 day NHS on everyone’s’ mind, it seemed only fitting to examine the relationship our profession has with politics and how it can be improved: giving rise to our theme of medical policy and quality improvement.

There have been many highlights throughout the term, but Bill Smiths certainly took centre stage; our match report covers all the thrills and spills which led to the second years becoming historic double winners. Sir Mark Pepys gives us an exclusive insight into his cutting edge research on amyloidosis and advises students on how to make the most of research opportunities. We have the latest on junior doctor contracts and UCLMS news from Professor Deborah Gill which includes external changes that have implications for us all.

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- RUMS GENERAL NEWS -

GEneral NEWS Be informed.

MBPHD STUDENT AWARDED PRIZE FOR VOLUNTEERING UCLMS student Callum Donaldson was awarded a prestigious Team London Award in the Under 25s “Mentoring and Coaching” category. This is in recognition of his unfaltering dedication to volunteering with Spectrum, a UCL student-led charity that links student volunteers to children with disabilities or special needs.

LUC IN DA C O N DER Best ATC cadet in the UK!

LUCINDA CONDER AWARDED DACRE BROOCH Selected out of over 60,000 other cadets, Second-year Medical student Lucinda Conder was recently awarded the Dacre Brooch for the Best ATC cadet in the UK for 2015. The award recognises exceptional service, and is reflective of Lucinda’s impressive 7-year involvement in the Air Cadets. While the differences between cadets and medicine are evident, Lucinda‘s experience as a cadet has perhaps equipped her with invaluable skills for medicine. “Fitting all this around a medical degree can be hard, but if you really have a passion for something then you always make time for it. In many ways, I think everything I’ve done will in some way benefit me in the medical profession. From good communication and presentation skills, to resilience and determination and, when things aren’t going as planned, being adaptable and ready for the unexpected.”

The overlapping experiences, such as building trust within a team and remaining calm and in control, will no doubt make Lucinda successful, both personally and professionally. We wish her all the best. by Becky Kells

Established in 1982, Spectrum is a service in the truest sense of the word and its longstanding success is built on the hard work of its volunteers who support the activities run by the charity. They provide essential support and respite to parents and carers of these young children in Camden, a role that offers volunteers many rewarding opportunities in return. Callum has spent over five years working with the charity and has expanded on his “communication techniques (including some basic Makaton)” as well as his skill in “adapting to difficult situations”. Callum feels incredibly privileged to be a volunteer and recognises the impact that volunteering has on the lives of these young people. “I have been linked to a young child with autism for 5 years”, said Callum, “during which time I have watched him develop and flourish”. Callum was motivated to get involved by “the enthusiasm and affability of the incumbent Spectrum committee” in his first year of Medical school. Callum’s previous experience volunteering with young children fuelled an impressive longstanding commitment to Spectrum. His strong ties with this fantastic charity mean that he is a vital team player in the committee, even serving as Chairperson from 2014-2015. Now in the midst of his MBPhD at the Crick Institute, Callum’s devotion to volunteering remains an integral part of his UCL experience and he continues to be a presence on the committee as their Honorary Chairperson. For a volunteer who showcases such passion and commitment, Callum’s award demonstrates the personal and long-standing relationship between Spectrum and its volunteers. Callum hopes that “it will continue to provide an important support service for children in Camden for many years to come.” We would like to commend Callum’s wonderful achievement and applaud the work of Spectrum’s dedicated team of volunteers. by ANAMIKA KUNNUMUPURATH

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TEAM AWARDED £2.5MILLION FOR RESEARCH

UCL AT THE FOREFRONT OF DEMENTIA RESEARCH AND

INTO PNEUMONIA DIAGNOSIS

CAMPAIGNS

The National Institute for Health Research (NIHR) has awarded £2.5 million to research teams at three different sites in an attempt to develop and assess new molecular diagnostic tests in order to detect bacteria and their sensitivity to antibiotics. The team, led by Dr Vanya Gant at UCLH, Dr Vicky Enne at UCL and Dr Justin O’Grady and Prof David Livermore at UEA, received one of sixteen awards awarded by the NIHR for their project, INHALE: Potential of Molecular Diagnostics for Hospital-Acquired and Ventilator-Associated Pneumonia in UK Critical Care. This will be particularly beneficial for the treatment of hospital-acquired pneumonia.

In a study carried out at UCL, researchers found that changes in sense of humour could be an early sign of dementia. This brings to attention an area not commonly associated with dementia, which could lead to improved diagnosis of the condition. The study specifically focused on change of sense of humour in Alzheimer’s disease and frontotemporal dementia (FTD). The latter condition does not commonly manifest itself in memory loss early on, but rather symptoms include behavioural and personality changes. Significantly, the study discovered that people with FTD found events that are not typically deemed as humorous, such as a badly parked car, to be amusing. It was also discovered that both FTD patients and Alzheimer’s patients preferred slapstick humour, departing from a sense of absurdist humour or satirical humour at times 9 years before their diagnosis.

Currently, the primary method of diagnosis is to grow the bacteria found in a patient’s lungs and use this culture to diagnose the causative agent. However, this has a number of disadvantages. It takes at least two days, therefore a ‘broadspectrum’ antibiotic is given to treat the infection until the bacterium is identified and a more specific antibiotic can be used. This can lead to ‘over-treatment’ of the infection, causing undesirable side effects and even encouraging antibiotic resistance. Some pneumonia infections are caused by highly resistant bacteria, while others are not caused by bacteria at all. Therefore the ‘broad-spectrum’ antibiotic treatment may be ineffective, doubling the risk of death.

The study was led by Dr Camilla Clark, and was funded by Alzheimer’s Research UK, the Wellcome Trust, Medical Research Council and the NIHR Queen Square Dementia Biomedical Research Unit. It reflects increased interest and success at UCL in dementia research – UCL Professor John Hardy (UCL Institute of Neurology) was awarded a $3M Breakthrough Prize in Life Sciences in recognition of his research into the genetic causes of dementia and Parkinson’s disease. Professor Hardy’s work on neurodegenerative diseases has been of paramount importance to Alzheimer’s disease research and treatment breakthroughs over the past 20 years. £50,000 of this prize money has generously been given by Professor Hardy in order to match donations towards the construction of the new Dementia Research Institute at UCL.

With bacterial resistance to antibiotics becoming an increasingly strong concern, this research could not come at a better time. The team will study three new molecular diagnostic tests, which provide results much more quickly - within 1 to 4 hours. They will be tested for accuracy, ease of use and value for money, amongst other things. The best of these will then be selected for clinical trial, where it will be compared to conventional treatment. If this test proves effective it will facilitate a more specific treatment as well as a quicker diagnosis, facilitating both improved patient care and the fight against antibiotic resistance.

These developments coincide with the construction of the Dementia Research Institute at UCL, which will hopefully be at the forefront of national and international efforts into dementia research. by Becky Kells

by EMMA LEWIN

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- RUMS NEWSFLASH -

MONDAY MIXERS Monday 19th October 2015 saw the first of a number of informal sessions on Mondays, which allow first year students to meet Faculty members and give feedback on the course so far- with drinks and snacks provided of course! Unlike in previous years, the whole year group has been invited to these events, split over 4 or 5 sessions. This first session was a perfect opportunity for First Year students to get to know Faculty members, ask for advice and ask any questions about the course. We are sure the next sessions will prove just as useful for students!

NATIONAL HEALTH SINGERS RELEASE SINGLE “YOURS” choir foundedbybytwo two UCLMedical MedicalSchool SchoolGraduates, Graduates, AA choir founded UCL the National Health Singers have just released their single the National Health Singers have just released their “Yours”, a celebration of the public’s NHS. Their aim, single “Yours”, a celebration of the public’s NHS. Theiras their states,states, is to “empower EVERYONE to fight aim, as website their website is to “empower EVERYONE their We aimWe to aim raisetoawareness of the current to for fight forNHS… their NHS… raise awareness of threats to the NHS,towhilst at the sameattime mothe current threats the NHS, whilst theboosting same time rale, increasing positivity and ultimately boosting morale, increasing positivity and protecting ultimately our National our Health Service!” TheyService!” have gained protecting National Health Theycelebratory have support from the likes of Michael Sheen, Amanda Holdgained celebratory support from the likes of Michael en, Amanda Abbington and Rufus Hound to and nameRufus a few. Sheen, Amanda Holden, Amanda Abbington Their to single download now from iTunes, Hound nameisaavailable few. Theto single, with some promotion Amazon music and Google play. For more information from Justin Bieber himself, reached Christmas No.1. on the choir, single andtoopportunities to join, see Their singlethe is available download now fromplease iTunes, www.nationalhealthsingers.co.uk Amazon music and Google play. For .more information on the choir, the single and opportunities to join, please see www.nationalhealthsingers.co.uk.

UCL MOVES UP IN THE RANKINGS UCL has stormed through the 2015-16 Times Higher Education World University Rankings, climbing from number 22 to number 14 this year.UCL is ranked as 9th in the world for research and stands at an impressive 4th place out of 78 institutions in the UK.

GET PUBLISHED IN BMJ CASE REPORTS BMJ case reports is an award-winning journal that publishes clinical case reports in all disciplines. If you are interested in submitting an article for this well established journal, library staff at the Cruciform, Royal Free or Whittington will be able to provide you with the UCL Fellowship Code. Head to http://casereports.bmj.com/ for more information.

CONGRATULATIONS TO UCLMS ALUMNUS DR JASON REDDY On the 20th November, UCL alumnus Dr Jason Reddy was awarded the Fellowship of the Royal College of General Practitioners. According to the RCGP, ‘RCGP Fellowship is awarded in recognition of a significant contribution to Medicine in general and General Practice in particular’. Fellows are ambassadors for RCGP, exemplifying our motto: ‘cum scientia caritas’ (scientific knowledge applied with compassion). We would like to offer our huge congratulations to Dr Reddy for such a marvellous achievement.

Who was Donald Currie? In 2015 there were a row of stone busts located outside the librarian’s office in the Cruciform Hub, four of which were 19th century alumni and staff of UCL. The fifth, without a head, was the bust of Sir Donald Currie, a shipping magnate who endowed the new Medical School and Nursing Home (now the Rockefeller Building) in the early 1900s. Currently under the care of the Institute of Archaeology, Currie’s head will be reattached to his torso and returned to the Cruciform in summer 2016.

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Prostate Cancer Team Win Health Service Journal Award The UCLH Prostate Cancer Team has won an award in the acute sector innovation category of the HSJ awards. Their work includes pioneering more effective treatments and using methods requiring fewer but more accurate biopsies. Congratulations to all involved!

Research Clinic Launched to Revolutionise Ovarian and Breast Cancer Prevention The clinic, launched in November, is investigating why women with the BRCA mutation are especially susceptible to developing breast and ovarian cancer. The clinic will be based at the NIHR/Wellcome UCLH Clinical Research Facility.

RUMS Alumni Association Award for Extracurricular Achievement The RUMS Alumni Association has awarded a prize of £250 to four students, including both chief editors of RUMS Review, in years 2 and 3 for the year 2014/15. It celebrates the huge amount of effort it takes to succeed both academically and in the extracurricular. Congratulations to the winners- Abdel Mahmoud, Sophie Bracke and Rebecca Mackenzie (year 2 prize) and Ankit Bhatt (year 3 prize) - and all those who were commended.

- RUMS MEDICAL SCHOOL NEWS -

MEDICAL SCHOOL NEWS — Welcome to what I hope will be a regular feature in the RUMS Review. The medical school is a large and complex organisation and it is difficult to ensure that staff and students get to hear about what matters to them within the medical school. There are lots of communication channels available, but as your RUMS President always reminds me, never enough!

SCANNING THE HORIZON

18/12/2015

The medical education and healthcare field is buzzing with new activity and announcements at the moment. The recent government Green Paper on Higher Education has the potential to have far reaching impacts on universities: some positive, some less so. Most worrying for medical students is likely to be the loss of student bursaries to be replaced by student loans. We understand that this will be phased in with students currently registered on MBBS courses still receiving the bursary. This suggested change in funding is in the same document that encourages us to work harder on our widening participation agenda. You can be sure that we will be highlighting this anomaly in our feedback on the Green Paper and the likely impacts of extending the size of medical student loans on how some potential applicants may view studying medicine – particularly in London. The GMC has recently made some assessment announcements that will affect all medical students. Firstly it has been confirmed that a national assessment for doctors joining the UK register will be introduced: forming a common route for all doctors entering the UK Foundation Programme. This is likely to begin no sooner than 2019. The GMC is in the very early stages of developing this assessment and is working with individual schools and the Medical Schools Council to ensure the assessment is proportionate, robust and reliable.

RU MS MA GA Z I N E

D EB O RAH G I L L DIRECTOR of UCLMS

More immediately, UCLMS is now subject to the now mandatory national prescribing skills assessment (PSA). Healthcare officials representing the four UK countries have recently announced that from 1 August 2016 all new F1 doctors will be required to pass the PSA. Any F1 entrant who is unable to pass the PSA at this stage will be expected to undergo a programme of remediation prior to retaking the PSA. The GMC has been asked if it would take forward passing PSA as part of the evidence of using medicines safely and effectively in order to be eligible to apply for full registration with the GMC, and is working this through. This decision is unexpected and we are discussing the impact of the decision with MSC. We are concerned that if any student does not pass on the first sitting, we only have one date for a resit. This date is when half of you are on elective which is obviously not ideal. We are trying to secure alternative dates so no student is disadvantaged. - 8 -

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The medical school The MBBS programme underwent a formal five-year review last week. Known as the Internal Quality Review (IQR) at UCL this robust assessment helps us to identify strengths, weaknesses and development priorities. Thanks to all the students who worked with the medical school team to contribute to the self-assessment, commented on our written submission and priorities list and who came along last week to give their feedback about the programme. We were delighted that the visiting team found a well-run programme, enthusiastic and able students and a culture of cooperation between students and staff. Our feedback fully concurred with the priorities we had set in the self-assessment and even before the IQR we had a number of projects on the go or about to begin all with the same focus of improving the student experience. These include a ‘Changemakers’ project on making use of feedback, an ‘Outlook calendars’ pilot looking at adopting real time updated e-timetables for year 4 and 5 modules and a Task and Finish Group Working looking at assessment and feedback which are the two areas that the national Student Survey highlight as needing more attention. You are great at telling us what works and what doesn’t and helping us to try to improve things. Keep it up. On that note a word about ‘Name and Proclaim’, a new initiative from the Quality Assurance team that can be found at: http://www.ucl.ac.uk/medicalschool/quality/name-proclaim and the Quality Matters – ‘You Said, We Listened’ Moodle site: https://moodle.ucl.ac.uk/course/view.php?id=21821. Name and Proclaim is a new opportunity to tell us about outstanding people who have impressed and inspired you during your time at UCL Medical School. It acknowledges that showing gratitude to people is not only a way of thanking them but encouraging them to carry on doing what they do so well. You Said, We Listened is an excellent source of up to date information about what we have done in response to your feedback.

Staff and student update Finally, many of you will know that both Nikki Mathastein in the Clinical Skills Team and Chloe Marshall, the lead for years 4-6, have been off on maternity leave. Nikki welcomed a 6lb 14oz daughter named Sophie Bowen on 29th May and Chloe’s daughter Evelyn Rose Cunningham arrived on 14th July weighing a sturdy 8lb 2oz. Both Mums and daughters are doing well and send their regards to all of the students. Pictures of said young ladies, who will no doubt one day be UCL MMBS students, are below!

by Deborah Gill, Director UCLMS FOLLOW ON TWITTER: @doctordeborah @UCL_MBBS

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- OUT

of

HOURS -

DR Sandra martelli — Dr Sandra Martelli is a Senior Teaching Fellow for Anatomy. She is the convenor for the Movement and Musculoskeletal Biology module in the 2nd year of the MBBS course, and co-responsible for anatomy and imaging teaching in MBBS years 1-5. Besides teaching lectures to years 1 and 2, she has taught practical anatomy classes for multiple years.

TELL US ABOUT YOUR CAREER: WHAT DID YOU STUDY AND WHERE, WHAT HAVE BEEN THE HIGHLIGHTS OF YOUR CAREER AND HOW DID YOU GET TO UCL?

DESCRIBE YOURSELF IN FIVE WORDS. Curious, patient, stubborn, loyal, nerdy. WHAT FIRST SPARKED YOUR INTEREST IN SCIENCE AND MEDICINE?

I started my academic career at the University of Zurich, Switzerland, where I’m originally from. For my BSc, I chose biology because it was one of the most diverse degrees one could study at the time. My MSc focused my interests in human anatomy/ biology and primatology, and I graduated in palaeoanthropology, human anatomy and early history and prehistory. Through my master’s thesis work I came in contact with Paul O’Higgins (then reader at UCL) and I transferred to UCL for my PhD in comparative evolutionary anatomy, supervised by him and Christopher Dean (Professor of Anatomy at UCL).

I used to follow my grandfather around and watch him whilst he worked. He was a professional gardener at an estate and I was always asking a ton of questions and making observations about the plant and animal lives we encountered onthese outings. It was always a given that I would go to university to find more answers to all of my questions.

Teaching has always been an integral part of my academic career and ever since I was a master’s student, I taught practicals in biology, worked for museums and took up anatomy teaching during my PhD. In 2010, I was appointed teaching fellow for anatomy at my old home Department of Cell and Developmental Biology. This position so far has proved to be the perfect combination for both my continued research in comparative evolutionary anatomy and my passion for teaching and interacting with students.

D R SAND RA M A RTEL L I

Highlights are always difficult to identify, as they usually appear with hindsight and I don’t think that I have reached the end of the road yet where it is worth looking back. However, having completed an MA in clinical education this year could probably serve as a bit of a personal highlight and a good example of my dedication to life-long learning. RU M S MA GA ZIN E

Senior Teaching Fellow Anatomy

WHAT ONE PIECE OF ADVICE WOULD YOU GIVE TO YOUR STUDENTS FOR THEIR FUTURES? Keep an open mind, stay curious and do both with a smile on your face! - 10 -

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WHAT’S THE BEST THING ABOUT WORKING AT UCL AND IN LONDON? I deeply appreciate the academic community here at UCL and in London. There is always somebody with whom you can discuss your ideas and get fantastic feedback and input from. London and UCL also attract many visitors, so there are good chances that the great minds of your field pass through and visit here. There is no place like London; I feel very at home here and could not imagine living and working anywhere else. WHAT ARE THE BEST AND WORST THINGS ABOUT TEACHING MEDICAL STUDENTS? UCL’s medical students are the most amazing students: at their best (and they are mostly at their best), they are boundless in their thirst for knowledge and it is a joy to work with such smart and enthusiastic people. At their worst, they can show an alarming tendency of only being focused on what to know for the end of year exam. WHICH ONE PERSON HAS MOST CHANGED THE WAY YOU THINK ABOUT MEDICINE AND SCIENCE? I can’t really attribute it to only one person but I was fortunate enough to have studied with some outstanding talents in my field. Early influences at University of Zurich were Robert D. Martin (currently Emeritus Curator, The Field Museum Chicago) and Peter Schmid (Associate Professor at the Evolutionary Science Institute, University of the Witwatersrand) who inspired a lifelong passion for careful, critical thinking and considering the bigger picture into which any given research I undertake should fit. For example, they were great advocates that any good academic should be equally passionate about their research as well as about their teaching, and that both are just two sides of the same coin. WHAT ARE YOUR GREATEST AMBITIONS THAT YOU HAVE LEFT TO FULFIL? With regards to my research: writing a textbook on comparative primate and human anatomy and doing the research that would enable me to do so. WHAT IS YOUR FAVOURITE WAY TO RELAX AFTER A LONG DAY AT WORK? Season and weather permitting, I love working in my garden. I am also an avid Sci-fi reader.

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- RUMS RESEARCH -

AMYLOIDOSIS — For the second edition of RUMS Review, we shift our focus from cardiology to a mysterious group of diseases that do not easily fit into any of the organ-based specialties: amyloidosis. Amyloidosis occurs when there is a disruption at the microscopic level, specifically in the processes of protein synthesis and folding.

University College London is home to the Centre for Amyloidosis and Acute Phase Proteins, a key institute in researching the mechanisms and pathogenesis of diseases such as amyloidosis. The Centre was founded by Professor Sir Mark Pepys FRS in 1999 when he was appointed Head of Medicine at UCL’s Royal Free Campus. The Centre comprises the UK NHS National Amyloidosis Centre, also established by Professor Pepys in 1999 with Professor Philip Hawkins FMedSci as clinical director, and the Wolfson Drug Discovery Unit directed by Sir Mark himself. The Centre is internationally recognised for amyloidosis research and outstanding clinical practice. In 2011, Professor Pepys retired as Head of Medicine to become the first Director of the new UCL Wolfson Drug Discovery Unit within the Centre for Amyloidosis and Acute Phase Proteins. The Unit was created with Wolfson Foundation support and is supported by core funding from the National Institute for Health Research via the UCLH/ UCL Biomedical Research Centre. The research is also funded by grants from the Medical Research Council, which Pepys has received continuously since 1969, as well as grants from The Wellcome Trust, the British Heart Foundation and other medical charities. The UCL Amyloidosis Research Fund, a charity under the umbrella of the UCL Development Fund, also provides key support. During the course of his career, Professor Pepys has published over 350 academic articles. His contributions have also been widely recognised by the academic community, including election to Fellowship of the Royal Society, Founder Fellowship of the Academy of Medical Sciences, Honorary Fellowship of Trinity College Cambridge and awards include the Royal College of Physicians Harveian Oratorship 2007, the Royal Society GlaxoSmithKline Prize 2007, and the Ernst Chain Prize for Medical Discovery 2008. In 2012, Professor Pepys was knighted in the New Year Honours list for his services to biomedicine.

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WHAT IS AMYLOIDOSIS ? In order to function, proteins must fold correctly in a process that is determined almost entirely by their sequences. Major breakthroughs in understanding the pathogenesis and pathology of several important diseases have been made due to a further understanding of the impact that protein misfolding can have on physiology: not only are misfolded proteins usually non-functional, they may also acquire new, abnormal, and tissue damaging properties. Amyloidosis is the disease caused by amyloid deposition in the extracellular space in the tissues. Amyloid is an abnormal insoluble fibrillar protein material which is always rich in proteoglycans and glycosaminoglycans, and is composed mainly of characteristic fibres, the amyloid fibrils. Although about 30 different unrelated proteins are known to form amyloid fibrils in vivo in humans, in different types of amyloidosis, the ultrastructural morphology and core protein protein structure of all amyloid fibrils is very similar. They are rigid, unbranching structures of indeterminate length, about 10 nM in diameter and composed of several twisted protofibrils. SP R I N G T E R M 2 0 1 6


The core structure is a cross-β sheet running perpendicular to the fibril long axis. All human amyloid deposits also contain another protein, the invariant plasma glycoprotein called serum amyloid P component (SAP). In 1976, Professor Pepys discovered that SAP is a calcium dependent ligand binding protein and went on to show that its avid specific binding to all types of amyloid fibrils explains the universal presence of SAP in amyloid deposits.

kidneys, liver, spleen, peripheral and autonomic nerves, and blood vessel walls throughout the body. Clinical problems related to any one or more of these areas can predominate and the symptom and signs are thus protean. As a result of this, as well as the fact that most doctors may have never seen a case of amyloidosis, the appropriate investigations to diagnose amyloidosis may be long delayed or never undertaken. Biopsy and appropriate histological staining with Congo red and examination under strong cross polarised light are essential for diagnosis. This is often long delayed, leading to poor prognosis. About 25% of patients still die within 6 months of diagnosis despite improvements in treatment over the past 20 years.

All amyloid fibrils are formed by the aggregation of misfolded precursor proteins. The normal, wild type plasma protein transthyretin (TTR), forms amyloid in most people who live long enough, simply because it has an inherent propensity to misfold and aggregate in this way. Another normal plasma protein, serum amyloid A protein (SAA), also has a propensity to form amyloid. However, SAA only forms amyloid when it is overproduced for a long period of time. SAA is an acute phase protein and its production is hugely increased in response to tissue injury and inflammation. Patients with chronic infections and inflammatory diseases can therefore sometimes develop amyloid derived from SAA. Variant proteins, with abnormal sequences due to either inheritance of mutated genes or acquired somatic mutation, form amyloid because their abnormal amino acid residues destabilise the normal folded structures so that they easily misfold and aggregate. The hereditary forms of amyloidosis are extremely rare but have been informative for understanding the molecular mechanisms of amyloidogenesis.

Despite being composed of just autologous proteins and glycans, amyloid deposits are almost entirely ignored by the normal phagocytic mechanisms for removal of extracellular debris. Coupled with the continuous production of the amyloid fibril precursor proteins, amyloid deposits therefore persist and usually inexorably accumulate. They disrupt the normal tissue architecture leading to functional damage and disease. Treatment is thus aimed at reducing the production and abundance of the fibril precursor and, if this can be achieved, amyloid deposition can be halted leading to clinical stabilisation. In some patients there may even be slow regression of the deposits but this does not always happen and, in many forms of amyloidosis, there are no interventions available to reduce production of the fibril protein. Treatment is needed which promotes removal of amyloid deposits.

In contrast, acquired amyloidosis, the most common form of systemic amyloidosis, is caused by variant immunoglobulin light chains (L) encoded by somatically mutated genes. AL amyloidosis comprises at least 70% of all cases of systemic amyloidosis and causes about one per thousand deaths in developed countries. It is a very serious and usually fatal condition, which can affect any tissue or organ, but typically involves the heart,

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He also showed that SAP contributes to persistence of amyloid in the tissues and validated it as a therapeutic target. He developed a new drug, (R)-1-[6-[(R)-2-carboxy-pyrrolidin-1-yl]-6-oxo-hexanoyl]pyrrolidine-2-carboxylic acid (CPHPC), which was intended to remove all SAP from amyloid deposits in vivo. This was safe, well-tolerated, and seemed to stabilise patients clinically. However it did not promote amyloid regression, probably because it did not remove all SAP from the deposits. In contrast, CPHPC almost completely depletes all circulating SAP. In a novel pharmacological mechanism, SAP binds the drug, forming complexes which are instantly removed from the plasma by the liver and destroyed. This discovery led Professor Pepys to invent a new treatment in which CPHPC is used first to clear SAP from the blood so that antibodies to SAP can then be infused to target the residual SAP in the amyloid deposits. Binding of the antibody to amyloid activates complement, attracting and engaging macrophages which fuse into multinucleated giant cells, and are specifically adapted to engulf and destroy large complement coated objects. After proof of concept in experimental models, this treatment has been shown to be effective in patients and is being developed by GlaxoSmithKline. by ANDREW COLE

ASK THE EXPERT HOW DID YOU DECIDE TO GET INVOLVED IN RESEARCH ALONGSIDE YOUR CLINICAL CAREER ?

WHAT ADVICE WOULD YOU GIVE TO MEDICAL STUDENTS ON HOW TO GET INVOLVED IN RESEARCH?

I was very lucky to have a father [Professor Jack Pepys] who was a very eminent clinician scientist and an outstanding role model. I never considered any career other than medicine and medical research. When I was doing A-level zoology I got very interested in physiology and suggested to my father that perhaps I would go straight for that and not do clinical medicine. It took him only 5 minutes to convince me that doing medicine first was the right way. I greatly enjoyed both biomedical science and clinical studies and was determined to do both. My father was the first Professor of Clinical Immunology in the UK and the world’s leading expert in respiratory allergic disease, and I therefore chose to do my PhD in immunology. I was very fortunate to come up with my own original idea for my thesis work and made an important discovery in basic immunology. The thrill of such creative activity is highly addictive, especially because it is so rare. I also greatly enjoyed clinical medicine and was profoundly influenced by my father’s teaching that most biomedical research achieves its impact when it influences patient management. I therefore was determined to be fully clinically trained and competent as well as a research scientist. However it is very difficult to practice clinical medicine at the most desirable and highest possible level. Too many different people and processes are involved and it is impossible to achieve and maintain optimal control of all the variables. Experimental laboratory research usually enables one to be in greater control and, if the experiment fails, you can usually repeat it. In contrast, in clinical situations if things are not done properly the patient suffers or worse! Nevertheless if one’s work is to have clinical impact, one must eventually, and preferably sooner, bring it into the clinical sphere and then confront the complexity and extreme challenges of all clinical work. Optimal chances of success in any such endeavour demands involvement of individuals who are at least well trained, and preferably who are experts, in both fields: basic scientific research and clinical medicine.

If you are interested in doing research, there are many opportunities during the undergraduate course, most notably in a project for the intercalated BSc, but also at other times if you are keen. UCL has an enormously wide and varied choice of such activities. Even if no project is available in an area of interest for you, you can become better informed, indeed expert, on any aspect of biomedicine just by applying yourself to the literature, lectures, meetings, etc. in that field. To be successful and to enjoy research you must be passionate about the subject. Robust and exciting new results are hard to achieve. Just doing research because you think it is necessary for your CV is not the way to go. But if you have an interesting and potentially important question that you wish to answer, or that is presented to you by an encouraging or impressive mentor or supervisor, then research can be a most exciting, creative and eventually rewarding activity.

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WHAT IS THE NEXT STEP HAVING OBTAINED THE RECENT PHASE I CLINICAL TRIAL RESULTS AND HOW LONG DO YOU THINK IT WILL BE UNTIL ANTI-SAP IS USED CLINICALLY? The latest results in the second part of the Phase I study have shown that repeat dosing with antiSAP antibody produces progressive reduction in visceral amyloid load with clinical benefit and it seems likely that the treatment will be applicable to all forms of systemic amyloidosis. The next step is a Phase II trial, which is being planned for 2016 and will focus on cardiac amyloidosis, as this is the most common cause of morbidity and mortality. Drug development is highly regulated, very slow and extremely costly, so it is impossible to predict timelines. But GlaxoSmithKline, who have licensed the patents and are performing the development, are very enthusiastic and supportive. Provided safety and efficacy continue to be demonstrated, it should eventually become a medicine.

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UCL RESEARCH DEPARTMENT OF LIVER AND DIGESTIVE HEALTH

by Eng O-charoenrat, MBBS Year 2

by Eng O-charoenrat

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UCL WOLFSON INSTITUTE FOR BIOMEDICAL RESEARCH

UCL RESEARCH DEPARTMENT OF RESPIRATORY MEDICINE

UCL RESEARCH DEPARTMENT OF NEPHROLOGY

UCL RESEARCH DEPARTMENT OF METABOLISM & EXPERIMENTAL THERAPEUTICS

UCL RESEARCH DEPARTMENT OF INTERNAL MEDICINE UCL RESEARCH UCL ACADEMIC CENDEPARTMENT OF TRE FOR MEDICAL INFLAMMATION EDUCATION


- RUMS ARTICLES -

FUTURE HOSPITAL: FROM PRINCIPLES TO PRACTICE WITH PATIENTS AND PROFESSIONALS — AInspired by the Future Hospital Commission, the Future Hospital Programme (FHP) at the Royal College of Physicians (RCP) seeks to address growing concerns about the standards of care seen in hospitals, and strives to ensure patients receive the safe, high-quality and sustainable care they deserve. Here, FHP officers and consultant physicians Mark Temple and Frank Joseph describe the ongoing aims and achievements of this innovative and ambitious programme.

Principles, visions and recommendations When the Future Hospital Commission report for the RCP was published in 2013, The Lancet described the report as ‘the most important statement about the future of British medicine for a generation’. Two years later, the principles and focus areas remain as relevant as ever; particularly as the NHS faces unprecedented demand on acute services and financial constraints.

“THE LANCET DESCRIBED THE REPORT AS ‘THE MOST IMPORTANT STATEMENT ABOUT THE FUTURE OF BRITISH MEDICINE FOR A GENERATION’.” The Commission distils its vision for high-quality and compassionate patient care into 11 core principles. At its heart, the report emphasises the need for the responsibilities to patients to extend beyond the traditional hospital site. The Future Hospital encompasses the delivery of care to patients in the community or close to their home. The Future Hospital Programme at RCP is committed to embedding the recommendations of the Commission’s report in clinical practice. The programme entails the development, implementation and testing of new models of integrated, person-centred care across its partners and projects. Further to this, we continue to be guided by the Commission’s 11 core principles as shown. Person-centredness The first four FHP development sites were selected in September 2014. All four sites – Betsi Cadwaladr University Health Board in Wales, Mid Yorkshire Hospitals, East Lancashire Hospital, and Worthing Hospital – have a common theme of implementing new ways of delivering care to frail and elderly patients, and the focus of these projects span hospital and community settings.

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Fundamental standards of care must always be met (e.g. patients must be treated with compassion, respect and dignity). Patient experience is valued as much as clinical effectiveness.

Responsibility for each patient’s care is clear and communicated.

Patients have effective and timely access to care.

Patients do not move wards unless this is necessary for their clinical care.

Robust arrangements for transferring of care are in place.

Good communication with and about patients is the norm.

Care is designed to facilitate self-care and health promotion. Services are tailored to meet the needs of individual patients, including vulnerable patients. All patients have a care plan that reflects their specific clinical and support needs. Staff are supported to deliver safe, compassionate care and are committed to improving quality.

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Person-centredness The first four FHP development sites were selected in September 2014. All four sites – Betsi Cadwaladr University Health Board in Wales, Mid Yorkshire Hospitals, East Lancashire Hospital, and Worthing Hospital – have a common theme of implementing new ways of delivering care to frail and elderly patients, and the focus of these projects span hospital and community settings. At the beginning of December 2015 the FHP team and representatives from the four development sites gathered at Worthing for the final FHP learning event of the year. This was the third time in 2015 that these development sites met together to share their experience and learning in implementing new ways of working in hospitals and communities; the focus of the Worthing meeting was on the analysis of clinical data. A theme common to all three events was the need to bring about a cultural change in healthcare and social services staff, with an emphasis on partnerships built around the needs of patients.

M A RK TEM P L E Future Hospital Officer and

Data to drive improvement

Consultant Physician

This year we have also concentrated on the best ways of collecting and using data regarding patient experience. Through our Tell us your story initiative, a collection of case studies for innovative healthcare, we heard from Annie Laverty, director of patient experience at Northumbria Healthcare NHS Foundation Trust. She reported the successes they had experienced from a simple patient experience data capture exercise. The trust created and conducted a ‘Two minutes of your time’ exit survey, deliberately sent to patients in the two weeks after discharge – to coincide with the time patients are statistically least satisfied with their experience. Feedback was given to staff within 24 hours and shared with patients, families and the public. The clinical team found they scored highly in domains such as respect and dignity and were able to set the bar at 90%. In the annual NHS staff survey, the trust performs exceptionally well, with 94% feeling that their work makes a real difference. The learning from Northumbria is being used to support local quality improvement in line with the Future Hospital vision of patientcentred care. The RCP continues to support the development sites by helping them implement new ways of working, providing access to quality improvement expertise, and assisting in evaluating their individual programmes of work. The lessons learned by the FHP team and each development site will be collated and shared widely to stimulate

debate, spread good practice and foster system-wide improvement. We are currently in the process of recruiting our second phase development sites, with the aim of adding four more healthcare sites in March 2016 to our innovative learning community. Shared decision making Patients who are more involved in decision making have better outcomes and quality of life than those less involved as shown by the 2012 report ‘Helping people share decision making’ by The Health Foundation. Further to our commitment to influence and shape medical policy, the FHP seeks to help the RCP train physicians to work in partnership with patients by raising the profile of shared decision making (SDM) and support for self-management (SSM); a set of attitudes and skills which helps make patients and carers full partners on equal terms with healthcare staff in all clinical interactions. It is only by making changes at grassroots, as well as to existing systems and organisational processes, that new communication skills can be properly nurtured. Our SDM & SMM programme has worked with clinicians involved in the MRCP (UK) PACES examination to explore how the practical examination can encourage candidates to learn about and adopt SDM approaches. The programme team also made suggestions to the PACES team for changes to the template instructions given to candidates at the history taking station – using the language of what ‘matters to them’ rather than ‘differential diagnosis’ and ‘discuss assessment and options’ rather than ‘explain...and answer questions’. These proposed changes were accepted by the MRCP (UK) Clinical Examinations Board in October 2015, and the new wording should come into use in 2016. The role of chief registrar The FHC report also recommended the creation of a chief registrar post with structured off-site training in management, leadership and quality improvement. This post would be taken up by specialist registrars close to completing their training and help improve the profile and value of the contribution made by junior doctors. In 2016, in partnership with the RCP’s Education and Training Department, and the Faculty for Medical Leadership and Management, the FHP plan to launch a Chief Registrar programme. This pilot programme will evaluate the benefits to patient care, identify the management and leadership skills required, and help support the professional development of junior doctors in order to develop a chief registrar training model suitable for NHS hospital trusts to adopt nationally.

FRAN K JOS EPH Future Hospital Officer and Consultant Physician

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A PRESCRIPTION FOR POLITICS Should the medical profession care about politics? Patrick Senior demonstrates the professions long standing and complex relationship with politics, and the opportunities it provides.

Recent weeks have seen scrub tops and stethoscopes pour onto the streets and into our newspapers. The junior doctors have organised effectively, exercising political clout in order to oppose changes to their contract. The government has hit back, attempting to paint medics as unreasonable and unreasoned. At its core, this story is one of industrial relations, but much of the campaign’s message referred to the welfare of the Health Service as a whole and its patients. Doctors have vigorously challenged the government over its health policy. In doing so, and in a manner unseen by most of us, doctors have become political.

“MARMOT IS CALLING ON MEDICS TO EXAMINE THE SOCIETAL CONTEXT OF THEIR PATIENTS. HE IS ALSO THE ONLY MBBS LECTURER I CAN EVER RECALL RECEIVING A STANDING OVATION.” But what is the role of doctors in politics? Is it even legitimate for them to have one, and on which issues might they hope to become involved with? The NHS itself is a mountain on the British political landscape – voters consistently rank it as their priority (although, at the general election most viewed Labour as the party which priorities the NHS, while the Conservatives claimed the most votes) – but how far should the medical profession go to influence its future? In its past, the NHS hasn’t always found its greatest ally in us. When Nye Bevan sought to bring about healthcare for all in the 1940s, some of the biggest opposition came from doctors: he was compared to a fascist, and described in the BMJ as a ‘complete and uncontrolled dictator’.

Doctors feared loss of private income, and so to ensure cooperation with his project, Bevan was forced to ‘stuff their mouths with gold’. More recently, reactions to the restructuring of the Health Service have been mixed: while the BMA opposes the Health and Social Care act (2011); the Royal College of Physicians was not as forthright (although the vast majority of its members wanted the bill withdrawn); the Royal College of Surgeons was complicit in the coalition’s restructuring. The vast majority of doctors in the UK are employed and trained by the NHS, but perhaps it is important to understand it as more than an external body through which to practice medicine and hone our technical skill. Since its creation, it has become integral to the vocation of medicine in this country and should be a source of pride. So, when the health service is so unstable, it is crucial that clinicians take steps to protect it, and bear some responsibility for ensuring its survival. They are best placed to point out the constraints that government policy may impose: for example, the intrinsic link between pressures in secondary care and deep cuts in social care is recognised by many clinicians (last winter, 1 in 3 patients awaiting discharge were having to do so because of lack of social care). Frontline staff need to be instrumental in shaping the politics of healthcare, not its passive bystanders. Health is the objective of medicine, but the Health Service can only go a small way towards achieving that goal. Looking beyond it, what space is there for the profession to affect national politics more generally?


It has been consistently shown that the social environment - and therefore the political environment - profoundly affects the human body. Professor Sir Michael Marmot and his department at UCL are just one group that make plain the innate links between the social conditions in which we live and and the disease processes that affect us. By making these connections, Marmot is calling on medics to examine the societal context of their patients. He is also the only MBBS lecturer I can ever recall receiving a standing ovation. We must ask that healthy lives be a key objective of any government (the highest attainable level of health is a human right, after all), and indeed it is one of the jobs of public health doctors to advise government on which policy instruments can be used to improve health. However, all doctors must make healthy societies a key concern and must push for health to be prioritised – be it on matters of education, economics or the enviroment. As experts in the appraisal of evidence, and boosted by longstanding public trust, they can legitimately and effectively challenge those in the seat of power when there is a failure to do so.

“AS EXPERTS IN THE APPRAISAL OF EVIDENCE, AND BOOSTED BY LONGSTANDING PUBLIC TRUST, THEY CAN LEGITIMATELY AND EFFECTIVELY CHALLENGE THOSE IN THE SEAT OF POWER WHEN THERE IS A FAILURE TO DO SO.”

International Physicians for the Prevention of Nuclear War are another group of medics who were awarded the Nobel Peace Prize (1985). As an organisation, constituted by doctors on both sides of the Iron Curtain, they successfully framed nuclear arms proliferation as a public health issue. Through its medicalisation, an emotive issue is afforded some objectivity; nuclear war is seen as a disease like any other, and a disease needs a medicine. In his acceptance speech, Dr Eugueni Chazov spoke of the privileged position of doctors: ‘People are heedful of the voice of physicians who warn them of the danger and recommend the means of prevention’. Whilst there are differences between the contemporary NHS and soviet healthcare (are patients ever heedful?), it may still be that sufficient trust in doctors remains for their collective opinion to lend weight to a political cause. Consideration must be given to the best method of action. Is it trade unions (i.e. the BMA), professional colleges or direct engagement with government or the media that offers the best opportunities for activism? As an independent institution within democracy, the medical profession should not feel under pressure to accept the status quo, whilst acknowledging that explicit party-political alliances could be damaging. After all, the principal concern of the doctor is their patient. Nothing can dilute this attention, least of all questions of politics. Action needs to be carefully balanced against the risk of interference with that duty. Nonetheless, doctors should not deny themselves the opportunity to appreciate the bigger picture and increase the scope of what they hope to affect. If they do, a deep regard for human life combined with a well-developed array of skills, both practical and intellectual, could bring about real positive change. by Patrick Senior

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Medics have, at moments, also become prominent on the international political stage. When the then president of Médecins Sans Frontières (MSF), Dr James Orbinski, accepted the 1999 Nobel Peace Prize on behalf of his organisation, he addressed Boris Yeltsin directly and condemned Russian violence against Chechens. It is a central tenant of MSF’s work to speak out for those it treats. In itself this is a political act, although MSF aims to remain neutral. Examples in recent years include Rwanda, Srebrenica and Ethiopia. Others in the humanitarian community, such as the Red Cross, view silence on controversial topics a key pillar of their operations, in the hope that this affords them greater ‘humanitarian space’ in which to operate. Ultimately though, humanitarianism is a complex endeavour fraught with moral and practical pitfalls, and probably we benefit from both an MSF and a Red Cross at different times. Aside from conflict, the global medical community can also ‘bear witness’ to, for example, the under-access to medicines for so many, or the misalignment of global disease burden with research. To bring these issues to the fore is to insist on political responsibility for them – something Dr Orbinski deemed intrinsic to the humanitarian act.


PRECARIOUS PRACTICE

ON THEabroad ISLES AMEDICINE GP Placement —

Final year medical student Peter Woodward-Court explains why his placement on the remote Isles of Scilly provided an interesting eye opener. a privately owned island, has a corner shop that stocks caviar and champagne as it is the chosen island for wealthy individuals to visit for an ‘R&R weekend’).

If you need your bloods taken you have to come on a Tuesday or a Thursday. The radiographer flies in on Wednesdays so that’s the only time we can do your chest x-ray. If it’s the physiotherapist you need, she’s here every two weeks and that ultrasound will happen in a month. If you live outside St Mary’s, the GP will only visit you for a clinic one afternoon a week. This was the state of play where I spent my final year GP placement, on The Isles of Scilly.

“IT PAINS ME TO PAINT A DARK CLOUD OVER THEM, BUT NOT DOING SO WOULD MISREPRESENT THE FACT, AND SKIM OVER THE VERY REAL DANGERS CAUSED BY THEIR ISOLATION FROM IMMEDIATE MEDICAL SUPPORT.” This four-week block of primary care needs to be spent ‘outside’ London. While UCL offers locations at Enfield, Wembley and Uxbridge, I decided to be a little more adventurous and found myself in the archipelago off the southwest corner of Penzance. This happy little melange of islands is home to just over 2,500 people. The main island is St Mary’s, which contains by far the most populous location, Hugh Town, though I regard ‘town’ as a misnomer in this case; many villages in England have a larger population than the mere 1,000 residents here. That said, not many ‘towns’ can claim to have their own airport, council and hospital. Beyond these unique features, it’s a sleepy place, with one supermarket, one ATM, and a handful of shops and cafes. Each GP is assigned to visit one other island, once a week, and I tooled along each time; so three times a week my afternoon was spent sojourning on the medical boat to a place even more remote than St Mary’s. Most of these off-islands have one car; a couple of tractors; and a single shop to buy essentials (Tresco, RU M S MA GA Z I N E

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St Mary’s has a small hospital for acute admissions. During my first two weeks, there was a grand total of two patients and in my third week there were none. The daily multidisciplinary team meetings lasted around 20 minutes, with 15 minutes of the time devoted to discussing one patient. To have even a cottage hospital up and running, receptionists, a day- and night- nursing team, health care assistants, cleaners, and administrators are needed - all of which must make the St Mary’s hospital pro rata one of the most expensive in the country. There’s so little investigative power on the islands; the GP has to rely almost solely on his clinical acumen – ‘is this patient having an MI?’ ‘How can I tell without an immediate ECG?’ If there’s an emergency the hospital can’t handle, a GP has to decide whether to call for the air ambulance or not. It costs the NHS £3,500 each time the Cornish Air Ambulance is called out. If it’s the weekend or the weather’s poor, it isn’t an option at all. Instead the Royal Navy fly in with a Sea King at a cost of £7,000. Even though there are only 2,500 people within a 30mile radius (compared to 11 million within the same radius in London), it didn’t feel as remote as one might expect. Indeed, there were times when I lost this sense of remoteness – or indeed that it was normalised for me. Hugh Town is very closely packed; when I looked out of my window I saw plenty of houses, cars driving through regularly, and a busy high street. I could go down to the supermarket and pick up the same goods that I could anywhere else. In that sense it felt like the typical UK village. But when things didn’t sail quite as smoothly, I began to realise that Scilly merely teeters on the edge of ‘normality’. If the weather is overcast with a bit of rain, the planes won’t fly. That means there won’t be any post delivered that day, the shops won’t get stocked and the shelves become empty. From a medical standpoint, the medicines won’t be delivered: There was a terminally ill patient who wasn’t tolerating morphine well. They had much better pain management on alfentanil, but it had to be stopped because there was a five-day flight disruption and the practice ran out of the drug. Patients who came in for blood test results were turned away as the vacutainers hadn’t been flown out. At 5am one morning the GP got a call - a woman was going into labour prematurely. The GP hadn’t done a delivery in 20 years and he ended up doing it on his own because the air ambulance didn’t arrive in time. There was no midwife and no consultant obstetrician to fall back on if things went wrong.

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they want to. In London, despite how squeezed services are, we are still able to offer a vast array of care to mental health patients. Not being able to do so made me feel very helpless.

“IT IS EASY TO SEE THE ISLES AS IDYLLIC. THE PRACTICE PARTNER KEEPS SHEEP AND THE SALARIED GP HAS CHICKENS. MY ‘COMMUTE’ WAS A TEN-MINUTE WALK ALONG THE BEACH AND MY SURGERIES WOULD FINISH AT AROUND 3PM.” Having a visitor from somewhere as metropolitan as London was interesting for some of the islanders. I was invited to do an interview on Radio Scilly to talk about my experience. The next morning when I came into the practice, the first thing said to me was “Heard you on the radio this morning!” and more patients mentioned it when I saw them in clinic. In other words, when something happens here, the whole island seems to know about it pretty quickly. This is both a blessing and a drawback. I would repeatedly see patients in the Co-op, and recognise people every day on the high street despite having been there for just four weeks. I think many people find GP appealing for the sense of community it brings and to be known as ‘the village doctor’. The GP said he knew ‘practically everybody’ and actually, it was difficult to escape the work environment. In contrast, the London practice I had been at has a list that changes by 25% each year. It is easy to see the isles as idyllic. The practice partner keeps sheep and the salaried GP has chickens. My ‘commute’ was a ten-minute walk along the beach and my surgeries would finish at around 3pm. There are no traffic lights and the practice staff have an annual marmalade making competition. In many ways the islands are blissful. It pains me to paint a dark cloud over them, but not doing so would misrepresent the fact, and skim over the very real dangers caused by their isolation from immediate medical support. “She’ll probably ask you to leave” I was forewarned as the GP went to call the patient in. But I’d met her before and she didn’t mind. She shuffled into the consulting room chair with her head bowed and legs pointing inwards. “How are you?” the GP said. Her reply was quiet and listless: “Not so good”. “Physical pain is much easier to manage than mental pain” she said, as she showed us her burn marks. “I was ironing the clothes and I thought, I wonder what that feels like?”. All the red flags: active thoughts of self-harm, suicide plan, no appetite, worthlessness, “I’m crazy”, “I’m wasting your time”, “I’m better off dead”. A patient who clearly needs immediate help. But what support was there? A compassionate GP and a community psychiatric nurse that flies in once every two weeks. No crisis team, no psychotherapist, and no psychiatrist.

One afternoon clinic on Tresco had a grand total of two patients to see. The doctor kindly said I was free to leave and explore before we got the boat back. I walked past the quaint village houses, the old Church, through the pastureland and marram grass, and then onto the beach. Tresco has miles of white sand, and on a sunny day you could be forgiven for mistaking a photo of the place for the Bahamas. Even the overcast sky on a November day seemed to only add to the raw, earthy beauty. I was the only soul on the shore and all I could see in front of me was a distant collection of uninhabited islands. I was completely alone, and surrounded by nature: the crash of sea waves; the glass-like clarity of the water; the emerald-green hues seamlessly blending to dark navy blues. I looked down at my shoes, the same ones I’d worn countless times on the wards, the ones I wore when lost in the mindless rush of day-to-day work only a month before on a busy Acute Medical Unit. Now they trod the white sands of Scilly. I thought of the first- and second-years, stuck in an underground lecture theatre learning about the Krebs’ cycle, the third-years pipetting cells in the Rayne building, the fourth- and fifth-years hovering on the wards hoping to get the attention of the least busy looking doctor to ask “Is there a patient we could clerk?”. I thought of the endless drone of Euston Road. I thought of the FY1s, just twelve months my senior, and of the eight a.m. ward rounds, the crash calls, even the junior doctors’ contract. It all seemed so distant. Yet at this moment I was away from all of that, and this serenity would be here, and has been here, all along. Going to Scilly gives you an opportunity to see a completely different side of medicine, to take a step back from a frenetic pace of life, and to experience something you are unlikely to be able to again. It also exposes the communities who are less linked in to the benefits of the NHS – something that every current and future medic should be aware of. It is worth grasping whilst you have the chance.

“I think I’ll give the diazepam tablets to my husband, the last time I had access to all my medications it didn’t end well”. She was the last patient of the day, and when the consultation had finished and I began walking home, the outside weather was perfect pathetic fallacy - a bleak, dull overcast sky, darkness stealing over, a fast cold wind. This patient is not unique on the island - the GPs all said mental health was a big issue here, and drinking problems are also very prevalent. Scilly’s remoteness sometimes means doctors aren’t able to provide the care RU MS MA GAZ I N E

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by Peter Woodward-Court

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by Rebecca Kells

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- RUMS ALUMNUS INTERVIEW -

JEREMY FARRAR Exclusive Interview

Having battled on the frontline of infectious diseases in South East Asia for the best part of two decades, Professor Jeremy Farrar now holds the esteemed position of director at the Wellcome Trust. Professor Farrar has enjoyed not only a successful but also a highly diverse career, having trained as a Neurologist and worked on several WHO advisory committees. In this interview, he discusses time spent fighting SARS in Vietnam, reminisces about memorable cases with the WHO and provides a wealth of advice for medical students and doctors alike.

RR: Tell us a bit about your background. JF: I was born in Asia and I travelled around as a child. We lived in Singapore, Malaysia, emigrated to New Zealand, lived in Libya for 7 years and then came here when I was a teenager. I think that sort of background naturally gives you a slightly different perspective on the world. I studied medicine here [UCLMS], went through my postgraduate training in general medicine, trained as a neurologist in Edinburgh and did a PhD in Oxford.

RR: What made you switch to tropical medicine and infectious diseases? JF: Whilst Neurology is a wonderful specialty, it wasn’t the future for me. I remember being at an Association of British Neurologists meeting in Norwich in 1995, and I looked up at the audience and realised that I didn’t want to do neurology for the rest of my life. Coincidentally in the same week, an opportunity came up to work in Vietnam and I went, thinking I would go for 2 to 3 years to do some neurological infectious disease and come back to being a neurologist, but I ended up staying for 18 years and only returned a couple of years ago! RUMS MAGAZINE - 26 - SPRING TERM


RR: What was it like being in Vietnam, at the front line of fighting infectious diseases such as SARS, dengue and typhoid? JF: Sitting here in London on a cold, January day it sounds exotic, but the reality is you get used to whatever you’re doing - it just becomes your natural environment. Yes, [a country containing] SARS, bird flu, dengue, typhoid, malaria, and huge outbreaks of enteroviruses seems like a different world to us, but in reality that just becomes your world, and you become comfortable with it. In the end you get into a routine, you work with the same people, you work in the same environment - it just becomes home. I think the things that are challenging are those you haven’t experienced yet.

RR: From acting on WHO advisory committees to research in Vietnam, why did you choose a career path so different to that of a traditional clinician?

RR: Do you think enough is being done to get students with medical and science degrees into sectors such as policy and management?

JF:In Vietnam, I did 2 ward rounds a day for 18 years – so I didn’t do less clinical work than I would have done in London or Edinburgh. Somebody who was a very strong mentor for me was a Professor of Neurology in Edinburgh, Charles Warlow. He told me that the most exciting place to be is when you have your own sphere of skills, expertise, interests, and you find someone else with an allying set of interests. The interface between those two is a very productive, stimulating place to be. For me just doing one thing all the time for 40 years, however good, would get a bit boring. Being able to combine different facets, I think, is great – and medicine allows you to do that, I hope!

JF: I do. I worked for a year in Australia and I was very impressed that there was a very well-explored and respected pathway for doctors, medical students and postgraduates to go into other walks of life –like policy and management, not just medicine. I think that’s a very positive thing. Professions, whether medical or nursing or any others – remain involved in the organisation and management. I think it’s very important that these people contribute to those bigger, broader discussions –, whether in politics or policy, or global governance of health, or indeed within the NHS. If you walk away from that, then it’s left to people without the necessary skills and experiences.

“The most exciting place to be is when you have your own sphere of skills, expertise and interests and you find someone with an allying set of interests, so the interface between those two is a very productive, stimulating place to be” RR: A lot of medical students feel under pressure to have a plan very early on. Given your immense success from several unplanned career changes (such as training in neurology then changing sectors), what advice would you give them? JF:I think that you are under enormous pressure as a student to have a vision of where you want to go, and I think whilst you do have to have ambitions and goals, you need a sense of where you want to get to. Don’t ever exclude or close off your mind to any opportunities that come up - I think that the crucial element is to retain that willingness to be flexible. And that’s still possible in a career in medicine - I hope! If you look at the great and good around the various universities, hospitals, and places around the world, very, very few of them have just followed a straightforward, narrow path. They’ve all explored different things, and I think that’s enriching, and that it broadens your mind.

Do you think you acquired the skills that equipped you to be a leader or manage a team during medical school, or is it something you developed afterwards? JF: No, it’s an area that universities, academia and also the medical profession don’t pay enough attention to. If you look at comparators in other walks of life – industry, for instance, lays much greater emphasis on the importance of leadership and teamwork, and I think that the medical profession could learn the lessons from that. The idea that you’re a born leader, I think, is nonsense. Of course everyone has different talents, and some people will have a natural talent for working in teams, or working as an individual, or being something called a leader. But any of those can be improved, by learning, by teaching, or exploring different leadership styles. Now, the medical curriculum is even busier today than it was 35 years ago, but it’s about prioritising and I think you want your students to be equipped to play those leadership roles in the future - we all need help with that. I know I need help with that today as much as somebody thirty or forty years younger than me!

“You have enormous pressure as a student to have a vision of where you want to go” RR: What do you do to keep your feet on the ground outside of work at the Wellcome Trust? JF: I’ve been doing some clinician work in Kathmandu, Nepal, since about 2003, and I went back over Christmas – I’d forgotten what it was like to be up at night but it was very energising. I can’t do it again for many weeks a year now because of commitments here [at Wellcome Trust], but I still play a role within the broader policy agenda of the WHO and [...]>>

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RR: Given that you’ve acted on many WHO advisory committees, are there any memorable cases you’ve been involved with?

global health governance as well. Roles like this and understanding the enormous challenges that come with it is really important, otherwise you can get carried away with your own propaganda. I think that’s a way, professionally, of keeping your feet on the ground. Retaining humility is very important.

RR: Do you think the role of the doctor will change under the influence of new technologies, such as those funded by the Wellcome Trust? JF: If you go back in history, the heart of the profession has not changed much. Technology changes around you, but the wonderful relationship between a doctor and their patient has stayed largely true. I think patients will demand changes, hold more of their own information and data; the relationship will change and become more of an advisory role, less of a patriarchal role. There’s going to be unimaginable opportunities to treat and prevent things you currently can’t. But I worry that as technology takes over, there will be an increase in opportunities to put technology in the middle of that relationship – and then the medical profession becomes a technician’s role. The medical profession must never lose the doctor-patient relationship; that emotional connection is something of an art and is what makes the profession enjoyable. Science is offering wonderful opportunities in many of the ideologies, and the healthcare needs of people and populations will be different 30 years from now. Doctors need to have the bridging capacity to bring science into ways that can make a difference in people’s lives. I think that that is a very important role for clinicians in the future.

“There is no one who goes to medical school who doesn’t have the ability to do what they want” RR: Do you think there needs to be a stronger drive for engagement in policy and other areas of medicine that are traditionally quite closed off?

JF: Yes a number. SARS was a real eye opener for the world – that something could emerge in southern China, bubble away and spread round world within 12-24 hrs really changed the dynamics of how the world sees itself. China was not in a good position in 2003/04 but there was no doubt that information wasn’t shared and as a result the epidemic spread. After that, China made some of the most radical changes in its public health system that I think any country has ever made. It moved a whole pile of younger people into positions of authority, and set up a structure. I think that’s a demonstration where influence of WHO and China looking at itself and saying we need to change lead to profound change which has made a massive improvement and the structure of public health now is in a great position because of that. I also think the way WHO handled the recent development over the last 20 years for a dengue vaccine has been fantastic. We don’t have a perfect dengue vaccine yet, but we have a vaccine and I don’t think that would have happened without the WHO playing a contributing role to that.

RR: Do you have any advice for current medical students? JF: My only advice would be to not listen to the sceptics and the cynics who say that it is too difficult. The truth is that the sun shines! If you really want to do something, there is no one who goes to medical school who doesn’t have the ability to do what they want. The selection process is brutal, and if you are in it, you have a set of intellect and skills, which allow you to do anything. Trust yourself, listen to people (but not too hard), and try to retain the exuberance and idealism that took you into medicine in the first place. Don’t let the system, the pressure of exams, the need to learn 150 causes of jaundice put you off! You’ll be pushed and buffeted along the way, like in any career, but somehow you have to keep hold of that idealism – and you can, because it’s a wonderful profession.

RR: What are some of the challenges of pursuing a career in research? JF: Going into research is not easy. You come out of medical school now, after six years, you then have your foundation years and some of you – all of you - will have debt, which I never had. I had a grant to go to university and the government gave me a train ticket to go home every term! They bought me a skeleton, I had a book allowance, and of course there were no university fees. The world is different now, and you’re ending medical school with whatever it is in debt. My salary when I went back to do my PHD was lower than peers who were staying in the clinical realm.

JF: The role of medical professionals and doctors is very broad. Ultimately, we are going through a scientific golden age. Medicine and science cannot exist in a vacuum in the absence and appreciation of the culture of which it exists in. You are not some separate font of knowledge that the whole world will follow because you are called a doctor or a scientist. The last 40 years of investments in scientific endeavours have had huge ethical, legal and policy related activities, incredibly complex to understand even for a clinician or a scientist.

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JUNIOR DOCTOR CONTRACT DISPUTE. WILL BLOOD BE DRAWN?


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Sport as ever plays a huge role in the life of RUMS. Whilst, this year saw slightly lower numbers of freshers join our sports clubs, those that have joined are taking full advantage of the opportunities on offer. With over 400 active members of our sports clubs, many of our sports teams are flourishing. Highlights of the past term include RUMS RFC winning the United Hospital 7s, as well as recent wins for RUMS WHC over UCL (3-1) and RUMS FC defeating the current LUSL champions, ICSM (4-1). Our sports clubs have been following tradition by touring the country and demonstrating the finer side of RUMS. Whilst Leeds was a popular destination for many clubs this year, RUMS Squash decided to outdo everyone by taking their members to Bruges - it was like a fairytale. Not to be outdone, The MD’s Comedy Revue put on another brilliant Christmas show. The level of talent on offer made me feel rather inadequate! Despite the inevitable shouts of ‘kiss’ (which, having recently attended the GKT show, appear not to be something unique to RUMS) they made it through three nights of laughs, sketches and seriously heavy consumption of “OB”. Congratulations to all involved!

Whilst our sports clubs and societies inevitably play a huge role in the life of RUMS, in the last term your education reps have been working hard to put your feedback to the medical school and bring about the changes you want to see. Notable achievements from last term include an agreement from the medical school to release examination results at a specific time. Hopefully this will put an end to the hours of stress whilst you try to guess what time someone will press send on that email…Another exciting development is the introduction of electronic timetables for clinical placements. Hopefully, this will make coordinating your clinical attachments seamless (we can but hope).

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This year has also seen the introduction of RUMS / UCLMS staff-student “mixers” for first year students. Our aim is to ease the transition from school to university and to improve engagement with staff. As is inevitable, there have been some problems created by the medical school, which RUMS has worked hard to deal with. For example, a large number of fifth years were recently given Concern over Professional Behaviour (CoPB) forms for missing more than two lectures in the first week of term. I would imagine the medical student who has missed fewer than two lectures is a rarity…Thankfully, working together with our honorary staff president, Dr Paul Dilworth, we were able to overturn these and clarify the medical school’s attendance policy. I would like to thank all of the reps and the RUMS VPs for Education (Ravi Mistry and Ozzy Eboreime) for their tireless work, which often goes unseen.

I hope you will agree that RUMS MSA is growing in stature and I am looking forward to the next six months. Upcoming events include RUMS HC’s Varsity matches versus GKT, United Hospitals Rugby and the Fifth Year Show! If you do have any suggestions, feedback or questions please do not hesitate to contact me (www.myrums.com).

On a wider level, RUMS MSA have taken a leading role at UCLMS in coordinating medical student action supporting our junior doctor colleagues. Working with United Hospital MedGroup, we put out a press release and ensured that students across UCL understand the issues through a UCLU motion. RUMS also held the first RUMS Forum event in 2 years to discuss the issue and it was great to see so many students responding seriously and enthusiastically. The event was backed by the BMA and the North London Junior Doctor Committee and the high quality of the discussion is definitely encouraging for the future of the NHS - even as Jeremy Hunt does his level best to destroy it. It was also great to see the large numbers of UCLMS students attending the two London demonstrations. Whilst the industrial action in December was postponed, RUMS remains in contact with the BMA reps at our three main sites and will work to help disseminate information to students and coordinate action if negotiations breakdown again. RU MS MA GAZ I N E - 3 1 - SP R I N G T E R M 2 0 1 6 RUMS MAGAZINE - 33 - SPRING TERM


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IN FOCUS

Bill Smith’s: Secon

As the term draws to a close and the cold creeps in, we start to reflect on which portfolio tasks we still have to submit before we head to that final Sports night of the year. However there is still one event on everyone’s mind; the Bill Smith’s Cup, a long-standing tradition within the medical school. It annually sees the 1st years take on the 2nd years in a match full of big tackles, plenty of flair, and absolutely no kicking! The match is played in honour of the late Professor William “Bill” Smith - a professor at the medical school who showed a great fondness for the rugby club, willing to help out whenever they were in need.

“Dance moves that belong only in the darkest depths of Loop.” Every year both teams are tasked with producing a video that will entice big crowds for the game. The second year’s video documented a gallant journey from dover to London, complete with 80’s music, onesies and a very colourful shirt. The freshers’ video was delayed in production (I wonder why) while they decided to come up with the original idea of travelling as far away as possible. To Paris they went. Ollie Pfeiffer described the freshers’ video as ‘the Hangover 2, to the second years original Hangover’. With the pre game hype well and truly built, it was time to take it to the rugby pitch. 14:00 16/12/15 Onlookers waited in suspense. Would Ben Pattenden’s band of arrogant second years be crowned double winners or would Barnaby Glover have led Team Fresh to the biggest upset in Bill Smith’s history? All would be determined in 80 minutes. Team Fresh kicked off. 8 minutes of the most intense rugby passed by, with crash ball after crash ball. Every big hit was met with an even bigger tackle, it seemed Team Fresh were determined for this game to go down in the history books – with them in favour. They showed real resilience against fast runners. They could only resist bombardment for so long though, and ten minutes into the match captain Ben Pattenden crossed the try line, leading from the front for Team Second

Year, with Joe Hearle adding the extra points with the conversion. Not to be disheartened, Team First Year came back at the second years with a few knock ons from a nervous back line; it was time to prove the mantra ‘RUMS loves SCRUMS’. Two scrums in however Cambridge transfer Ken Boumbe had a serious neck injury, forcing the match to go to uncontested scrums, with outrage from Team Second Year and the supporters. This decision merely riled the second years with Joe Hearle scoring a beautiful try, only to be told by the ref that it was indeed the dead ball area and not the try area. A quick short 22 drop out was taken, a knock on and with the uncontested scrums the back line of the second years made mince pies of the freshers’ defence. 14-0. Yet still the fierce freshers’ heads didn’t drop, fueled on by a drinks break they kicked off again. Not even the shouts of Rob Galloway’s ‘rip’ could put Max Moss off of that high ball. Joe, angered by his earlier line confusion decided to discuss the technicality of pitch markings with Jim Fodder, resulting in Joe being sent to think over the pitch layout in the bin for ten minutes. With Team Second Year down to 14 men, surely this was the time for ‘Jake Baker’ to return to his sky sports prowess and smash it up through the middle?

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nd Years Become Double Winners

The whistle blew for half time. The second years knew they still had another 5 or so minutes down at 14 men but they had the hill with them this half, but Team Fresh still had the supporters behind them – ‘no one likes a double winner’. Team Second Year kicked off, chasing after the high ball with the same intensity as Liyang handing out his notes to the freshers. They pinned Team Fresh into their own 22. Five minutes later and with some nifty footwork from the Pirate team second year go 20+1 points up to nil. Team Fresh kicked to the second years again, the ball was fumbled and a knock on was given away. An uncontested scrum, and Jack Baker went for the 8 pick up only to be shut down by Charlie Travers with a shin shattering tackle. Team Second Year won the turnover and kick, using the hill to their advantage with the ball going out towards the halfway line. The freshers’ lineout had been relatively unsuccessful due to Luke Thompson’s speed and agility at the line. To distract the simple minded forwards the freshers pulled out some dance moves that belong only in the darkest depths of Loop. Even so, the second years turned over the ball and Max Moss took a run down the wing mistaking an innocent female bystander for Barnaby Glover and boshed her aside.

Joe Hearle returned to the pitch making a near end-to-end run down the wing, beginning the end for Team Fresh. A further four tries came and Ben Pattenden went to his bench to bring on some impact subs; ‘Dr Abdul’ and John Partridge made a large impact as scrum specialists. The game finished 45-0. The second years crowned double winners, cementing themselves in Bill Smith’s history with the biggest win in recent years accompanied with the first 0 scoring by the losing team. Noteable performances must go to both captains; Ben Pattenden and Barnaby Glover, for leading valiantly. Man of the Match on the freshers’ team went to Ayo Olotunji for strong performances in all areas particularly defensively against the powerful centres of the second year. Nick Cox was awarded Man of the Match for Team Second Year, putting his body on the line, with strong carries and his signature bosh. Thanks should go to Tom James for refereeing a fair and interesting game and to the organisation of those senior RUMS rugby members behind the scenes who make the day possible. Finally to thank all the supporters who came down to make the day what it was; with the atmosphere, support and plenty of port.

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by George Wall


- RUMS COMMENT & CORRESPONDENCE -

LETTERS Have your say.

RUMS Review Received some wonderful comments from many students and alumni in response to our pilot issue. We are working on this feedback to improve the magazine. Please find below some of our alumni comments: Absolutely loved the RUMS review!! - as the waves of nostalgia broke over me it made me realise how much I miss London and UCL. Please keep sending me this excellent publication, if it is available to alumni. Great work!

David Slovick Consultant Physician, Ealing and Clayponds Hospitals, London

The practice of medicine has changed considerably in all these years; but I still follow the advances and new discoveries with interest. I am saddened by the conflict of cost and the provision of good health care here and in the U.K too. Best wishes in the success of your publication.

Dr. Frederick W. Vonberg (UCL 2013) MA MBBS Research Fellow in Neurocritical Care Boston Children’s Hospital and Harvard Medical School

Dear Editors, Many thanks for sending me your excellent new journal which I have enjoyed reading. As a Middlesex Hospital graduate, I have occasionally regretted the merger unto death of our schools, but this was inevitable. I was interested to read Tony Rudd’s reminiscences on stroke. Surprisingly recently, considerable ageism was still on display by radiologists, although nobody needs plastic surgery now after requesting a CT scan!

Robin Andrews. Brandon, Manitoba, Canada. Graduated in 1954. Emigrated to Canada in 1965. Retired 1998.

We would like to encourage more students to get in touch with their views and opinions! If you have something to say that is related to any of our content or events in the medical school, your opinion could get published in the next issue. Please email rums-review@ucl.ac.uk RUMS MAGAZINE - 40 - SPRING TERM 2016


Student Comment: Why Stop Now?

Student activism has traditionally been seen as the prerogative of the mildly eccentric and the fervent left. The majority of the student body - at UCL more than 15,000 undergraduates and 13,000 postgraduates - remains silent and indifferent, whilst supporters hand out pamphlets, attend protests, and thrust copies of the Socialist Worker in your direction. Nevertheless, some issues do seem to have widespread support, such as the lowering of rent and student fees. The associated demonstrations are not always in vain either: one group at UCL sought to achieve compensation for disruptive and subpar conditions in student halls, and recently secured around £500,000 for the affected students. Despite this, actual engagement and involvement remains scarce. Nationally, using the Ipsos MORI estimation of voter turnout as an approximation of those who are at least interested in politics, only 43% of those aged 18-25 voted in the 2015 general election, compared to 78% in the 65+ age bracket.

“Yet, in the lull in this period of unrest, as negotiations have recommenced and the Hunt-bashing has slightly abated, why should we not extended our enthusiasm in opposing the contract to other matters?” However, the proposed junior doctor contract has politically invigorated a whole cohort of medical students. Despite initially feeling powerless and disillusioned with politics, most have disregarded these reservations. We felt so strongly about the imposition of these heinous proposals and their effect on our future careers that we attended what was, for most of us, our first protest march.

To our family and friends, we declared our undying love for the BMA and the NHS, and expressed our frustration at the usage of the NHS as a political football. Although certain mainstream media outlets embarked on smear campaigns and accused junior doctors of ‘attempting to plunge the NHS into crisis with mass walkout,’ social media was also awash with details of the mistreatment of junior doctors by the government, and the contract and its creator was discussed and dismissed. We raised awareness and public support, and attempted to dispel any misinformation. The unity of the junior doctors and the support of the public has given us hope that the dispute surrounding this contract can be resolved in our favour. Yet, in the lull in this period of unrest, as negotiations have recommenced and the Hunt-bashing has slightly abated, why should we not extended our enthusiasm in opposing the contract to other matters? Our involvement in politics should extend further than the communication of concern or encouragement through the medium of a like or a share or a signing of an online petition, which has seemingly become the norm in this era of feelgood slacktivism. Just as we in the medical profession should feel obliged to take a stand against the proposed junior doctor contract, we should also feel obliged to be interested in wider politics, as it is entrenched in the very society and its economy in which we live. Many important policies have emerged in the past few months which have significant personal, national, and international repercussions; it is our duty to engage in and encourage discussion and voice our objections, to prevent injustice at home or abroad.

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by Liyang Pan


We’ve got the books to get you through medical school!

Visit http://bit.ly/CRC-20 to automatically receive 20% DISCOUNT on all revision guides WWW.CRCTEXTBOOKS.COM


- RUMS BOOK REVIEWS -

BOOKS & RESOURCES Read, learn, relax.

If you have a book, website or app that you’d like to be reviewed, please contact the Review editor at Katie.hodgkinson.13@ucl.ac.uk. THE HEALTH GAP: THE CHALLENGE OF AN UNEQUAL WORLD by Michael Marmot Professor Marmot follows expectations with a work that is wonderfully written, clear and engaging. It is a must read for all UCL medics. He differentiates the state of health between and within countries, making readers realise just how fortunate they are to be living where they are. He also shows us all the different factors that feed into health, both in terms of healthcare and pathology, as well as something that is not taught often at UCL: how to view the patient in the context of their environment. The Health Gap will make you think; perhaps recovery is not down to how good a medic one may be, but is instead down to where the patient stands in society. Social injustice is covered neatly and precisely, describing why we cannot allow it to go on and igniting a sense of outrage in you, seen before only when they cancelled a 9am lecture after you’d already turned up! Child development, education, maternity leave, pay, access to health care and working conditions are also covered- all of which you think only affect healthcare in the most marginal of ways, but which may actually be the most important factors.

WWW.

GEEKY MEDICS found at geekymedics.com

Geeky Medics is an online revision website created by doctors and medical students for medics of all stages of training. It includes quizzes, flashcards, posters, revision notes, video guides to examinations and clinical cases, all put together by contributors to the site. If you enjoy the content but find something missing, you can even contribute to it yourself. Not only does the site cover the difficult anatomy, physiology and pharmacology, but there is also a whole section to help you prepare for the OSCE and thousands of sets of notes for CPP work. The site is laid out beautifully and topics are easy to find, with clear and simple diagrams, as well as references in case you want more information. Some of the articles are good overviews for quick revision on the go, whereas some will have you working on it for days. Since they’re produced by medics from all over the UK, you get a good view of what medical students at other universities are learning and what’s particularly useful to know when it comes to clinical practice.

EUREKA: CARDIOVASCULAR MEDICINE by Paul Morris, David Warriner and Allison Morton RUMS Review was sent the Eureka series; I can honestly say that they are wonderful. They are absolutely great for both the C&B module and clinical revision, walking you through the anatomy, physiology and several related clinical cases. The pictures and cartoons are both clear and entertaining, backing up the text beautifully and making sure all styles of learners will pick up lots of information from this book. There are also several SBAs at the back, making this perfect exam revision. This book is quite condensed, like a Dean and Pegginton for cardio instead of anatomy. Everything is well spaced out and easy to read, and as you get introduced to new and old topics very gently, this resource is great for any stage of work.

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- RUMS EVENT REVIEWS -

TALKS AND CONFERENCES Watch, listen, do.

If you have an event, talk or conference that you’d like to be reviewed, please contact the Review editor at rums-review@ucl.ac.uk.

Around the World with MSF: Earthquakes, Ebola and More… a Talk by Dr. Javid Abdelmoneim 23rd November 2015, UCL Anatomy Building

On a Monday evening, the JZ Young lecture theatre welcomed back alumnus Dr Javid Abdelmoneim for the first time since graduating from UCL in 2003. Having spent some time as an Emergency medicine registrar he realised that he wanted a change-up in his career path, and after one unsuccessful application to MSF in 2005, he was finally accepted in 2009. That following year, in March, he embarked on his first of what would be 5 missions to date with MSF. It took him to Iraq where his official role was ‘ER doctor’, however, he quickly found that his role would require much more than clinical skills. After targeted kidnappings of MSF representatives at the previous mission in Iraq, Javid and his team could not wear any MSF logos, had to leave their accommodation at different times, and use algorithms to randomly allocate a route to the hospital. His next few missions took him to Haiti, Syria, Southern Sudan and

Sierra Leone: where he was involved in the Ebola effort. One of the most memorable moments of the talk was when Javid talked about the lack of resources in Southern Sudan. They experienced severe malnutrition in patients on a daily basis but MSF were physically unable to bring more of the food supplements. Therefore, Javid’s team found themselves facing an ethical dilemma; deciding whether to give all sachets to those patients that were worse off, or do a little bit for all. Another striking moment was when Javid talked about the several breakdowns he experienced during his missions, which had long-lasting emotional effects. It was interesting to hear that these opportunities are available to those who want to practice medicine in different parts of the world and carry with them some unforgettable experiences. It is certainly not for everyone though! I would like to thank Javid and ‘UCLU Friends of MSF’ for organising such an enthralling talk.

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by Yul Kahn Pascual


UPRAS 2016 (undergraduate plastic and recon- Ellison-Cliffe Lecture- Interactive and Thought structive, aesthetic surgery) Provoking 28th November, Royal Society of Medicine Entering its eighth year, UPRAS weekend has had great success in reinforcing interest in the specialty. With a selection of talks from prominent leaders in the field and practical sessions, it is at the forefront of available undergraduate seminars for the plastic and reconstructive specialty. After arriving on Saturday and Sunday morning, we were welcomed with tea, coffee and biscuits. The talks began at 9am and the seminar weekend was opened by Dr Jorge Leon-Villapalos, a consultant plastic surgeon specialising in paediatric burns, who talked about the different types of burns and treatments that he deals with on a daily basis. It was followed by a thought-provoking talk by Mark Soldin entitled ‘Reconstruction after massive weight loss’. He discussed the political influence resulting in funding being focused on operations like mastectomy and less on post weight loss contouring surgery, because the latter is seen as an ‘aesthetic surgery’; though one could argue that both cause similar psychological scarring for patients. The most memorable talk was one by Mr Jonathan Britto, a consultant plastic and craniofacial surgeon at Great Ormond Street. He spoke about a craniofacial operation as a multi step process, with most cases taking more than one operation to complete. Initially the surgeons’ concern is fixing the functional issues and then in later surgeries the aesthetics, which will ensure the smooth transition for the children back into school and society without any stigma. He showed us some before and after images of cases he had seen in his clinic. Lunchtime was a great opportunity to speak to some of the fellow students, distinguished speakers and companies that had set up stands in the lobby. It was after lunch that we got the opportunity to put all the techniques described in the talks into practice. Though a long way down the road for many students, it was nice to attempt a local flap or Z plasty. I highly recommend UPRAS for any student with interest in reconstructive or aesthetic surgery because it gives you a deeper view of the specialty and the many subspecialties within. There was also the opportunity to present or submit a poster on something topical, which is another incentive to get involved next year! by Yul Kahn Pascual

On the 20 October, the Royal Society of Medicine hosted the Ellison-Cliffe lecture, an annual event dating back to 1987. It was established by Dr Carice Ellison and her husband, the late Dr Percy Cliffe. The lecture provides a stage for medical scientists to share their contribution of fundamental science to the advancement of medicine. Previous lecturers include UCL’s Dr Kevin Fong and Professor Hugh Montgomery. This year Professor Paul Freemont of Imperial College London delivered an interactive and thought provoking lecture on synthetic biology, placing a particular focus on its role in therapeutics and health. The lecture commenced with a controversial question about the limits of synthetic biology and, when he asked the same question at the end, opinion was still divided. Through the use of audience place cards, each with a letter corresponding to a DNA base, Professor Freemont began by explaining the fundamentals of biology and DNA; appealing to all members of the audience. From here, he delved into what synthetic biology is and its most successful medical applications. This included bio-sensors for bacterial infections, demonstrated by an experiment performed live on stage, and phage therapy. The lecture was stimulating and interesting, despite being familiar material to medical students. However, this made it all the more refreshing, providing an opportunity to see real world applications of what you learn in lectures. The evening attracted high calibre academics and was ended by a heart-warming word of thanks to Dr Carice Ellison.

by Rebecca Mackenzie


Up & Coming Events Trauma Symposium 2016 Date: Tuesday 23rd February- Thursday 25th February 2016 Time: 8:30 - 17:00 Venue: Royal Society of Medicine Price: £110(3 days) £85(2 days) £50 (1 day) The Orthopaedics Section are pleased to announce that the very best of the worldwide trauma faculty will present topical, common and controversial case studies and lectures at the RSM, which will be perfect for senior trainees and consultants in practice.

Personalised Medicine: The Debate Date: Monday 1st February Time: 18:00-19:00 Venue: Cruciform LT2 Neuroscience of Gender and Sexuality Date: Monday 8th February Time: 18:00-19:00 Venue: Cruciform LT2 THB Conscientious Objection Undermines the Practice of Medicine Date: Monday 15th February Time: 18:00-19:00 Venue: Cruciform LT1 My Most Memorable Case - Harrie Massey Date: Monday 22nd February Time: 18:00-19:00 Venue: Cruciform LT

Changing Minds and Mental Health Date: Wednesday 10th February Time: 18:00 - 19:00 Venue:Museum of London Price: Free What happens when people change their minds? In this lecture, I will offer a historical perspective on changing minds, starting with a discussion of the role of medicine in changing minds. I will discuss the move from changing behaviour to changing thinking, and changing stories; and how modern mental health services use such ideas.

Emergency Medicine in Humanitarian Crises Date: Monday 29th February Time: 18:00-19:00 Venue: Cruciform LT2

Germs, Genes and Genesis: The History of Infectious Disease Date: Tuesday 16th February Time: 18:00 - 19:00 Venue:Museum of London Price: Free

MedFest Date: Monday 14th March Time: 18:00-19:00 Venue: Cruciform LT2

Where do infectious diseases come from? Some come from animals, but we gave some back (as cattle picked up TB from farmers). Leviticus discusses the problem of leprosy at some length and even develops an early form of quarantine. Epidemics of various kinds began only when human populations and the first cities (Babylon included) were large enough to sustain the infectious agents responsible. Now genetics, of humans and their enemies, is beginning to tell us more. And the news is not good. UMAX 2016 (Undergraduate Oral and Maxillofacial Surgery Conference) Date: Saturday 13th February 2016 Time: 08:30 - 18:00 Venue: Royal Society of Medicine Price: £35(lectures and practicals) £25 (only lectures) UMAX acts as a medium to promote the specialty and to facilitate the sharing of knowledge and experience of consultant surgeons to aspiring surgeons. This national conference has been designed specifically for junior doctors, junior dentists, medical and dental students interested in the field of oral and maxillofacial surgery.

The Artificial Heart: A New Ending? Date: Wednesday 16th March Time: 18:00 - 19:00 Venue:Museum of London Price: Free Since the development of the heart lung machine in the middle of the last century, cardiac surgeons have dreamed of developing an artificial heart to deal with the failing human heart. Those dreams have now reached reality, and the first fully implantable artificial hearts are in use. This lecture will describe these developments and consider some of the risks of the devices both for the individual and, if successful, for society.

RUMS MAGAZINE - 46 - SPRING TERM 2016


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RUMS Review Issue 2  

2016 spring issue of the magazine for UCL medical students and alumni.