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Editorials A Note From The Editors RUMS MSA President Foreword The Director’s Medical School Update
RUMS Review, The UCL Medical School Student Magazine. Vol.II No.II Winter Term 2016
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News The Latest From In & Around UCLMS
Out of Hours Tom Quick
In Focus Ivan Beckley
Editor-in-Chief: Beth Gillies
Surgical Research at UCL: A Whistle Stop Tour 12 Tips on Setting up & Running a Peer-Led Medical Education Society
Deputy Editor-in-Chief: Rebecca Mackenzie
Treasurer: Carol Chan
Vice-Treasurer: Augustina Jeya
Touch Surgery and its Role in Surgical Education Reforming Anatomy: The Interplay Between Art & Surgery Millennials and the Changing Face of Plastic Surgery Virtual Reality, Surgery & Medical Education: The Mount Sinai Hospital Experience Hip Joint Replacements: The History & The Future
Chief Sub Editor: Rebecca Kells Sub Editors: Emily Hall, Rachel Parker News Editors: Anamika Kunnumpurath, Emma Lewin, Jerry Su
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Demystifying Medical School RUMS Misconceptions
Comment & Correspondence
Articles Editors: Melika Moghim, Ian Tan, Otso Pelkonen, Josie Elliott
Research Editors: Richard Bartlett, Eng O-Charoenrat, Magda Tchorek-Bentall
Book Reviews The Unofficial Guide to Medicine
Alumnus Interview Editors: Bill Boucher, Charlotte Leigh, Naomi Joshua
Sports & Societies A Word From the Sports & Societies VP Roundup Reviewing the Revue: A Look Back at the MDs’ Christmas Show
Sports & Societies Editor: Ollie Totham
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COMEDY COLUMN COMEDY COLUMN COMEDY COLUMN
Book Review Editor: Katie Hodgkinson
The iBSc Review
Careers Editor: Izabella Smolicz
Email: firstname.lastname@example.org Website: www.rumsreview.co.uk Facebook: https://www.facebook.com/rumsreview Twitter: @UCLRUMSReview
Demystifying Medical School Editor: Tanya Drobnis Artwork : Karim Chraihi (cover) Kate Mackenzie Design and Layout: Rebecca Mackenzie
Disclaimer: The views and opinions expressed in this magazine are those of the authors, and do not reflect those of the editors, UCL Medical School or RUMS Medical Students’ Association.
Beth Gillies, Editor-in-Chief
Rebecca Mackenzie, Deputy Editor-in-Chief
A note from the editors...
new year, a new issue of RUMS Review! We hope that you all had a well-deserved rest over the Christmas break and that our latest magazine, jam-packed with exciting and interesting content, will help you forget about all of your broken resolutions (including making it in for all those 9am lectures).
Surgeons. Clare talks us through her career in medicine and also delves into the political world and its effect on the profession – a fascinating read! Following the successful introduction of Careers to our previous issue, the section has grown bigger and better thanks to a collaboration with UCLU Surgical Society. Their Specialty Chairs give advice on how to get more involved in your area of interest and an interview with Dr Tara Mastracci lets us know what life as a vascular surgeon is like.
This fifth edition of RUMS Review is all about surgery. From ophthalmology to orthopaedics and from plastics to paediatrics, we have got you covered. The engagement and contributions of our audience mean that we are lucky enough to have a spectacular selection of articles that take us on a journey through time.
Your feedback is incredibly important to us and has resulted in the reintroduction of a revamped In Focus section; this time celebrating the astounding extra-curricular achievements of third year student Ivan Beckley. Ivan was recommended to us by our previous focus, Rhea Saksena, and we hope to continue this chain in order to discover just how talented the students of RUMS are!
Professor Blunn teaches us about the history and future of the hip joint replacement, meanwhile Edward Christie enlightens us on the important link between art and surgery. Saima Azam shares her experience with Touch Surgery, whilst Virtual Reality is explored by the Mount Sinai School of Medicine. In our online copy, we also discover the changing face of plastic surgery, courtesy of David Ward, and Dr Alexander Gray and Gordon Cheung educate us about UCL’s latest contribution to immunotherapy.
Also in this issue (We warned you it was jam-packed!), we have misconceptions of the medical school Demystified, a thought-provoking debate about proposed changes to the Abortion Act, book reviews and – back by popular demand – the RUMS Review Comedy Column. This time our mysterious and mischievous writers are reviewing iBSc courses and – as you may guess – no-one is safe.
We start off with an update from RUMS President Raj Pradhan. Raj and his dedicated committee worked tirelessly for RUMS students last term and this issue gives us a chance to acknowledge and congratulate them on their achievements. Once again, Professor Deborah Gill updates us on the latest UCLMS goings on which, alongside our comprehensive News section, will well and truly catch you up on all of the RUMS happenings.
Finally, we conclude with our Sports & Societies Roundup which is as impressive as ever – even if Ozzy does steal the spotlight with his almost-funny, heavily-edited review of the MDs Christmas show. We would like to thank all involved in this issue for their contributions. Furthermore, we would like to thank the medical school as a whole for their continued engagement and support; without this RUMS Review would not be possible. Lastly, those people we can’t thank enough are our uber-talented editorial team who have done us proud once again.
Next, we take a whistle-stop tour of UCL’s surgical research, before Out of Hours gets to know Mr Tom Quick. Our Alumnus Interview gives us an insight into presidency as we speak to Clare Marx, the first woman ever to be elected as the President of the Royal College of
Editorials presidents - myself and James would like to thank them all as our sports continue to be a pillar of strength. Before we knew it, an abundance of Christmas dinners, ranging from lavish spreads to knock-off noodles, had us adequately fed and watered for an MD’s show to remember and a Bill Smith’s that did not disappoint. However, the term did not come without its challenges. The possibility of an imminent further round of Junior Doctor strikes kept Tay, Carol and myself busy working with the medical school to ensure education was not compromised and arrangements were in place for students who wished to make a stand. Whilst this saga came to a somewhat anti-climactic end, the spotlight was moved to medical students ourselves as the government announced changes to medical school places and fees. RUMS was represented on national television and we then worked and continue to work on mitigating any negative effects of not only this, but also the Medical Licencing Assessment and the proposed (and thankfully withdrawn) Health Education England changes to DGH allocations. And of course, this is on top of all the work Tay and Carol have been doing to improve our course structure and feedback mechanisms. There have been testing times, during which guidance from Dr. Dilworth, our Honorary President, has been invaluable. Throughout the term we have continued to work closely with UCLU. Whilst our relationship is generally good, and the staff are often helpful, I have in no uncertain terms highlighted that more needs to be done to make sure UCLU officers are assisting rather than hindering RUMS and our societies. This is vital in order to effectively represent our members, and work on this will continue into the next term.
RUMS Medical Student Association President Foreword...
The introduction of Sophie as Publicity Officer has meant the often neglected part of RUMS – communication with the student body – has started to see improvements. Rumour has it that after all these years, the hallowed empty noticeboards of the Cruciform may blossom once more. Sophie has also had the dreaded task of managing the many RUMS Facebook groups. I did this last year. It’s a nightmare. Thank you, Sophie.
A campaign to understand the issues behind the welfare system has been a big focus for myself and Nadia. With an issue this complex, we must proceed slowly and carefully - but a recent reshuffle of student support administration may be the first sign of improvement. Please do approach either of us with your views.
As I sit writing this on a damp, family-filled Christmas Eve in the Northern countryside, I hope you too are enjoying the festive period with your loved ones. I’m sure you’ll agree that although it’s been a great term, a break was very much needed – especially, I imagine, for the producers of this magazine. I must once again applaud the tremendous amount of work that continues to go into RUMS Review in order to produce a magazine of this quality. I think it is safe to say we readers are very grateful for it.
Throughout all this, I cannot fault the hard work of my committee. Following early discussions over summer, we have been looking at ways to open our structure to allow students to get more involved.We now have 15 subcommittee members for events, finance, and welfare. Together with the 50 academic reps that work under our Education VPs, there are now 70+ representatives working as part of RUMS.
So. RUMS.Well, the last four months got off to a good start with Freshers’ fortnight. The team, headed by Ozzy, worked tirelessly and, with Nabil’s record haul of sponsorship and sound budgeting, were able to put on 10 events over the 14 days - each a spectacular introduction to RUMS in their own right. Particular favourites included another hugely successful Mums and Dads event run by Nadia, possibly the biggest RUMS Freshers Fair ever, courtesy of James, and of course the annual stroll through Hampstead that I am very proud to say finished neither in A&E nor a lawyer’s office. Equally, the fortnight’s success is due to a fantastic cohort of freshers.
Despite setbacks, we have seen significant improvements across the board over the last four months, and I am optimistic that over the course of this year RUMS MSA will become a more effective representative body. As always, I look forward to your thoughts. Kind regards and Best Wishes,
Following this, things soon settled as we all found our feet. Our flagship sports teams garnered fantastic results, including successive victories against their UCLU counterparts. A plethora of tours jetted off across the country and were as excessive and enjoyable as always. The few issues that did arise were resolved promptly and effectively by respective
Raj Pradhan RUMS President, 2016-17 MBBS Year 4
The Director’s Medical School Update I
am delighted, as ever, to provide an update on UCL Medical School news for the RUMS Review. This is now the fifth edition of an excellent publication which, I am sure readers will agree, plays a vital role in sharing information across a large and geographically distributed school. It’s a rather good read too! As a new year starts, it is a good time to look back on 2016, as well as looking forward to the forthcoming year. It feels like 2016 will go down in history as a spectacularly eventful year, and not necessarily in a good way. Medicine and medical education have not been immune from the impacts of these unsettled times: we have seen the most significant industrial action by doctors since the advent of the NHS, an
announcement of forthcoming changes to the Medical Act that will result in the introduction of a national Medical Licensing Assessment, and we are yet to encounter the consequences of the Brexit fall-out and the introduction of the Teaching Excellence Framework (TEF). So, how do we enter 2017 with positivity? I am a born optimist (Which I discovered this year is very good for my health!) and so I can see opportunity in all of this change and uncertainty. The introduction of the TEF is an opportunity to push good education higher up the priority list for the university; the medical school team will ensure we capitalise on this and focus on the areas of provision that need updating and improving. The Higher Education Bill and planned
increase in medical student numbers are both intended to widen participation; this is an opportunity for UCLMS to look at ways of attracting and retaining a more diverse group of students. The Medical Licensing Assessment will lead to a detailed examination of the GMC Outcomes for graduates. This provides a good opportunity to ensure that core elements of the curriculum which arise in the common assessment are clear and focused on good medical practice. I will be taking part in the group working on updating the “Outcomes for graduates” document and will try to ensure that we maintain the best aspects of the current medical education, while embedding the centrality of “hard to reach” capabilities and orientations to the experience of a UCL Doctor in
Editorials these outcomes. This update highlights four interlinked activities: the new Access to Medicine Office, the new Student Support Fund, our overseas activities and an update on the Rockefeller building project, which will all contribute to UCLMS becoming a better place for all students to thrive and learn. It also highlights the contribution of our excellent teachers. I look forward to an excellent 2017 and thank all our staff and students for making UCLMS such a great organisation to be part of.
Widening Participation and Access to Medicine Widening access is a central concern to all medical schools. Attracting and retaining a more representative group of students is important to the medical workforce of the future. At UCLMS we have been very active in outreach and access through the dynamic Target Medicine programme. We have yet to achieve all our goals in this area, so we are thrilled that 2017 will see us introduce a new Access to Medicine Office that will expand our outreach and widening participation activities for potential new students and look at ways to support students from less privileged backgrounds or with disabilities, enabling them to thrive at UCLMS. The appointment of a full time Outreach and Access Officer is central to this project and we are delighted that UCL have chosen to support the medical school in this way. In the coming months the new Access Officer will be exploring a range of ideas with schools and UCLMS staff, students and alumni, in order to make studying at UCLMS possible for all the brightest students, regardless of their circumstances.
Student Hardship As we highlighted in the last edition, studying medicine is tough
and to study whilst struggling financially is even harder. As studying medicine becomes more expensive, particularly in London, UCLMS and the RUMS Alumni have launched our new Student Support Fund to ensure the financial situation of our students is not a barrier to their successful progress and ability to thrive at UCLMS. Alongside this fund, we will be working to better connect with our huge alumni network to bring together past and current students; ensuring potential and current students benefit from contact with members of the UCLMS/ RUMS family and graduates feel “UCLMS and RUMS for life”. The recent RUMS alumni dinner focused on the launch of the fund and network, and there was great enthusiasm for the project. Work has already begun to identify funding streams such as donations, bequests and regular giving by alumni. We have just received our first donation from the family of an alumnus and the first tranche of income from overseas consultancy by members of UCLMS staff have also reached the fund. Great fundraising ideas or offers of
Professor Deborah Gill joins NGU students and faculty at the first NGU White Coat Ceremonysupport Fund.
identify ways of supporting medical educators overseas to improve their programmes and facilities. This is an important way of ensuring UCL’s global impact and, importantly, also generates income that can be ploughed back into the faculty and school to support research and education at UCL. One of our biggest projects is an academic collaboration with a new university in Egypt. New Giza University (NGU) has recently launched both a medicine and dentistry programme with the support of UCL faculty and resources, and will also be launching a pharmacy programme in 2017. “Challenging the Ordinary” is the guiding principle of NGU and so a collaboration with UCL is a partnership of minds. The new
Dr Caroline Fertleman awarded the Association of Medical Educators President’s medal Caroline Fertleman is a wellknown and respected teacher at UCLMS, particularly at the Whittington campus.We are delighted to announce that she has been awarded the prestigious 2016 President’s Medal from the Academy of Medical Educators. This award is given to an individual who has made an exceptional and sustained contribution to medical education. Caroline was given this award in recognition of her ongoing work supporting the education of a range of individuals: patients, school children, students, junior doctors and senior colleagues. Strangely, her use of a therapy dog in relieving stress during the Whittington OSCEs and her legendary dinner events for first years were not mentioned…. We congratulate Caroline on this well-deserved achievement and are very grateful for all her contributions to UCLMS.
RUMS Alumni dinner 2016 sees the launch of the UCLMS Student support Fund.
support from current and past staff and students are very welcome. Please contact deanne. email@example.com for more in-
programmes are based on the best aspects of UCL programmes such as early clinical contact and patient-centred education, a focus on professional development, education for dayone competency and a global outlook. UCLMS faculty were delighted to attend the “White Coat Ceremony” for new medical and dental students and we look forward to a fruitful collaboration that will benefit both institutions.
UCLMS overseas UCL has been at the forefront of excellent medical education for almost 200 years. UCLMS faculty have recently begun to
Dr Fertleman receives the AoME President’s Medal
Wishing you all a fun, productive, and inspiring new academic year. Deborah Gill, Director, UCLMS
Follow us on twitter @doctordeborah @UCL_MBBS
By Emma Lewin (EL), Jerry Su (JS) and Anamika Kunnumpurath (AK)
The latest from in and around UCL Medical School RUMS Choir Perform at RUMS Alumni Fourth Annual Dinner
UCLH Biomedical Research Centre Win Over £111 Million in Funding The National Institute for Health Research has awarded £111.5 million to University College London Hospitals Biomedical Research Centre for their continued excellence in research. In addition to UCLH, Great Ormond Street and Moorfields Eye Hospital have also been awarded a significant proportion of the government’s investment.This award accounts for part of the UK government’s initiative to invest £816 million in health research undertaken within the NHS and the joint funding of these three biomedical research centres makes UCL the recipient of the highest amount of funding of any other university in the UK. AK
UCL Library Service Charter Introduced
n Saturday the 19th of November RUMS Choir was given the honour of performing at the RUMS Alumni Association’s Fourth Annual Dinner. The a capella group sang beautiful renditions of contemporary songs to a packed audience of UCLMS graduates in the UCL Main Quad. The Choir have been going from strength to strength with their performances, and this occasion further showcased the impressive musical talent of our students. Speaking about the performance, Joseph Cheung, who leads the Choir with Kate Ryan, said, “We really enjoyed singing a variety of hits a capella and providing musical entertainment to RUMS graduates at this special occasion. We hope everyone had a splendid reunion!” By Anamika Kunnumpurath
UCL Library Services has launched a Service Charter, setting out their commitment to delivering high-quality customer services. The Charter includes an assurance to maintain a welcoming and friendly environment and to provide help and resources to the best of their ability. Leaflets are available in the libraries and feedback is welcomed. You can read the full Service Charter by visiting http:// www.ucl.ac.uk/library/customer-service/charter EL
Photo From UCL Special Collections
Nineteenth Century Gentlemen in the Cruciform Hub
December 2016 saw the installation of newly conserved marble and plaster busts in the Cruciform Hub. These individuals once looked out over the heads of students studying in the old Medical School Library – now home to the Grant Museum in the Rockefeller Building. The Library, part of the University College Hospital (UCH) Medical School building that opened in 1907, was typical of its period with lots of wood panelling and a gallery, and in those days it doubled up as the location for ceremonies and functions such as the Medical Society Christmas Ball. It was also the place where portraits, busts and other memorials - presented to the Medical School since its foundation could be prominently displayed.
All of these gentlemen, apart from one, had strong associations with UCL and University College Hospital: • Sir Donald Currie (1825-1909) – shipping magnate and major benefactor towards the UCH Medical School and Nurses’ Home. The galley from his coat of arms remains part of the RUMS crest today. • David Daniel Davis (1777-1841) – first UCL Professor of Midwifery and Diseases of Women; he also attended at the birth of Queen Victoria. • Sir John Eric Erichsen (1818-1896) – alumnus, Professor of Surgery, became President of University College in 1887. • Richard Francis George (1798-1879) – surgeon to the Bath General Infirmary (later the Royal Mineral Water Hospital). • John Marshall (1818-1891) – alumnus and successor to Erichsen as Professor of Surgery. • Edward William Murphy (1802-1877) – succeeded Davis as Obstetric Physician at UCH. • Edmund Alexander Parkes (1819-1876) – alumnus, Professor of Clinical Medicine; known as the founder of the science of hygiene.
At one time, some 20 busts were recorded and the remaining seven, suffering damage after decades of pollution, were placed in storage for a number of years. In a collaboration with UCL Culture and the Institute of Archaeology over the past year, they have now been restored and are part of the life of the library and Medical School once more. MSc Conservation students have subjected the busts to full historical research, material analysis, cleaning and treatments appropriate to their provenance, age and condition.
Kate Cheney, Head of Site Library Services
UCLMS Change Day Staff and students of UCL Medical School joined forces to raise awareness about quality improvement initiatives in the UCLMS Change Day event, which took place in June 2016. The event aimed to engender a collaborative approach to change by encouraging the public and students to come together and instigate improvements in care within the NHS. Throughout the day several activities were on offer, from talks by doctors to exhibitions displaying the work of students striving to make change within the NHS. The team succeeded in highlighting the importance of both patient involvement in guiding change within the NHS and the enabling of students to help implement that change. Anamika Kunnumpurath
End of Term Updates from the RUMS Committee
he autumn term at UCL is, arguably, the busiest of the academic year. There’s been a lot to do, with settling in to a new year, attending all the welcome (and then Halloween and Christmas) socials, getting involved in society events and that’s not to mention the full-on timetables and looming deadlines. This applies to the RUMS committee too, who have been very active organising events, keeping us updated and generally running things. The team have given an update on what each committee member, from Publicity Officer to Finance VP, has accomplished in their role so far. Here are some highlights from the term.
Ozzy, Events VP, has been working from the very beginning of term, welcoming new RUMS students with the RUMS Transfer Curry and the famous Freshers’ Fortnight events. Along with the Boat Party, Scrubs Party and Fresher Pub Crawl, Ozzy arranged many new events including a Toga Party and the Survivors’ Ball at the end to celebrate an exciting two weeks. It sounds like everyone had an amazing time! This term, James, Sports and Societies VP, has organised the RUMS Freshers Fayre and helped recruit a record number of Freshers to RUMS Sports and Societies. He’s also been overseeing sports nights and generally helping out society presidents as well as receiving applications for the RUMS Sports and Societies Scholarship. Importantly, he’s been organising Sports Ball, one of the biggest RUMS events of the year, and preparations are nearly complete!
First of all, Nabil, RUMS Vice-president (VP), Finance and Operations, started a Sponsorship Sub-committee and as a result RUMS has managed to raise the highest amount of sponsorship funds ever. They hope that this will better facilitate everything that RUMS does for us and enable RUMS events to be as affordable as possible.
Carol, VP for representation Years one to three, has been recruiting module reps for each year, who are handily trained to deal with minor technical problems in LT1 to minimise disruption to lectures. She has also been attending module meetings and student staff consultative committees (SSCC) to ensure your voices are heard and that feedback is acted upon correctly.
Sophie, RUMS Publicity Officer, has been busy updating the RUMS Website, myrums.com, with News and changes within Sports and Societies. She has also been managing the RUMS social media pages and helping RUMS Sports and Societies with anything they need publicising.
Tay, VP for representation Years four to six, has also been recruiting student module representatives, attending all the relevant meetings and chairing the SSCC. Tay has helped to introduce Outlook calendars to help improve timetabling and her involvement in the SSCC has already resulted in many positive actions, including an increased number of basement lockers at UCLH. EL
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Nadia, RUMS VP Welfare, organised the extremely successful “Mums and Dads” scheme to help the Freshers settle in. She, along with her subcommittee, are always looking for new ways to increase and enhance the support that RUMS gives, considering feedback and research to help with this, and has some exciting things planned for next term.
locations from September to December 2016, with 40 students taking part in the London heat. Students were tasked to complete five stations – laparoscopy, suturing, knot tying, anatomy, and non-technical skills – to the best of their abilities – Crinnion came in second overall.
RUMS Students Take Top Spots at NSSSC and ACP Oncology Essay Competition Final year student William Crinnion and fourth year student Yang Yu Hsuen have recently placed second and first at the National Student Surgical Skills Competition and Association of Cancer Physicians Oncology Essay Competition respectively.
The Oncology Essay Competition was organised by the Association of Cancer Physicians to provoke interest in oncology among medical students and postgraduate FY/CMT trainees, as well as to celebrate and showcase recent excellence in cancer research. Yu Hsuen’s essay, entered in the category Cancer Survivorship – How should we take this forward? was highly commended by the judging panel for use of evidence and sound reasoning, and was awarded first place overall.
Organised by the Royal College of Surgeons of Edinburgh in collaboration with Medtronic, the NUSSC allows final year medical students to put their surgical skills and knowledge to the test against their peers from across the UK. Preliminary heats were held across 19
By Jerry Su
Notice for Students
News The Royal Free Association:
Changes Made to Reflective Practice Guidance Reflective writing is a skill which is required throughout a career in medicine, from the first year of medical school onwards. Recently, there have been two occasions where reflective entries in e-portfolios have been released in order to aid legal proceedings. Consequently, the GMC has released some guidance on reflective writing and practices. While recognising the importance of reflection for the medical profession, it notes some factors that we must consider to help protect against an occasion, although rare, where disclosure of reflective notes is required. This includes ensuring the writing is as anonymised as possible, with no identifiable patient information nor any personal data of relatives and other practitioners or colleagues. It is also recommended that reflections be carefully written and focus on the learning gained from such events. Over-emotional reflections, written in the heat of the moment, should be avoided as well as criticism of others or discussions of personal differences. As a result, the medical school will be ‘altering written guidance and tutor briefings on written reflective pieces in the MBBS curriculum’. Professor Deborah Gill sent out an email regarding this change in November and is happy to hear any queries. More information can also be found in the GMC guidelines.
he Royal Free Association, which comprises the Royal Free Old Students’ Association, members of the school, consultant members of staff and medical personnel connected with the Hampstead site, has a number of opportunities open to RUMS students: Royal Free Association Student Distress Fund Members of the Royal Free Association support a student distress fund, which provides help to students who have difficulty paying for their studies. Each year, up to six bursaries of £500 can be awarded. To apply for the fund please download our student distress fund form (http://s3-eu-west-1.amazonaws.com/files.royalfree. nhs.uk/RF_Association/Application_form_-_Distress_ Fund.pdf), and send completed forms to Alison Crook in medical school administration at firstname.lastname@example.org. Royal Free Association Student Elective Support In addition to the student distress fund, the Royal Free Association also supports five student electives each year, with two bursaries of £1,000 each and three of £500 each. These are allocated by the Elective Bursary Committee and application forms can be requested from Molly Lavender-Rose in medical school administration at email@example.com.
Royal Free Association Hosts Alumni Lecture Day and AGM 2016 This year’s RFA annual clinical meeting and AGM was held on the 17th November 2016. Both meetings took place at the William Wells Atrium in the Royal Free Hospital, and started in the morning with clinical updates from Royal Free consultants representing a wide range of disciplines, such as emergency medicine, orthopaedics and neurology.This was followed by a presentation by RUMS President Raj Pradhan on medical student life at UCL, and a talk by consultant respiratory physician and clinical sub-dean to the Royal Free Campus Dr Paul Dilworth on the current curriculum for clinical teaching. Three more lectures were conducted in the afternoon following lunch, and the day concluded with an informal dinner at Zara’s Turkish Restaurant in South End Green. About 40 RUMS alumni attended the dinner, including RUMS alumni president Dr Miles Bogle. Raj Pradhan was also in attendance, as well as RUMS Review Editor-in-Chief Beth Gillies and Deputy Editor-in-Chief Rebecca Mackenzie. The next RFA annual meeting and AGM will be held on November 17th 2017, and all RUMS medical students are welcome to attend. By Peter Howden,The Royal Free Association Treasurer
By Emma Lewin
UK Medical Education Database is Launched
ollowing a successful pilot in 2016, the UK Medical Education Database (UKMED) is re-opening applications for research projects in its 2017 cycle. The first of its kind, UKMED is a partnership between organisations responsible for medical education in the UK – participants include the GMC, the UK Foundation Program Office and the UKCAT. It aims to create a multidisciplinary database, linking up undergraduate and postgraduate medical education, to collate information such as assessment results and performance in entrance examinations. Prospective researchers will be allowed access to the database, subject to formal evaluation and a successful application. A broad scope of research is expected with UKMED, which may help with identifying key performance indicators for prospective medical school applicants, medical students and junior doctors, as well as the relationship between an individual’s socioeconomic background and their progression through university and training. Such analysis would give new insight into the factors that have more of an influence than others at different points in a person’s medical career. The deadline for applications is the 31st of January 2017. JS
UCL Medical Students Awarded for Outstanding Performance Following the annual Marsden lecture at the Royal Free Hospital, on the 17th of November, the top medical students in each year were commended for their exceptional performance. The certificates were jointly awarded to the students by Professor Jason Leitch, the National Clinical Director for the Scottish Government, and Jeremy Blanford, Master of the Cordwainers. The students were congratulated for coming top in their year and credited as being “the creme de la creme”, by David Sloman, the Chief Executive for the Royal Free London Foundation Trust. We too would like to congratulate the students for their excep- In October 2016, the UK government antional achievement. nounced plans to increase the number of medical school places by 25% by 2018, from 6,000 The winners are as follows: to 7,500. The increases were announced by • 1st Prize for overall performance in Year 1 - Health Secretary Jeremy Hunt as part of proThe Cordwainers Prize: Miss Emma Woolcock posals to develop a more self-sufficient NHS • 1st Prize for overall performance in Year 2 by training more local doctors and lowering - The Cordwainers Prize: Mr Richard Picardo reliance on recruiting doctors from overseas. • 1st Prize for Best MBPhD Thesis of the Year The move is expected to include a £100 mil- The Cordwainers Prize: Mr Fergus O’Farrell lion boost in funding to support these extra • Runner Up Prize for Best MBPhD Thesis of training places, as well as penalties to discourthe Year - The Cordwainers Prize: Mr Christo- age junior doctors from working abroad for pher Bricogne four years after qualifying. UCLMS students • Runner Up Prize for Best MBPhD Thesis of Raj Pradhan and Ozzy Eboreime spoke to inthe Year - The Cordwainers Prize: Mr Alexan- terviewers in a Five News segment to express der Brown their thoughts about these changes. • 1st Prize for overall performance in Year 4 - “I’m quite concerned that I might get stuck in The William Marsden Scholarship: Miss Sonar a bit of a dead-end job where I’m working but Vadera not actually progressing my career or improv• 1st Prize for overall performance in Year 5 - ing my ability to practice,” Raj said, arguing that The Cordwainers Prize: Miss Enya Cooney the new plans would produce disenfranchised • 1st Prize for overall performance in Year 6 - doctors with little motivation to increase their The Cordwainers Prize: Mr Danyal Jajbhay quality of care.
“I think for patient-centred care, we want doc-
UCLMS Students Weigh in tors in places that they want to choose for the on Jeremy Hunt’s Changes to right reasons,” Ozzy added.AK Training UCL to Invest £1m to Develop New Learning Spaces
UCL Library Services and UCL Estates are jointly investing £1m into developing new learning spaces and enhancing existing ones for students and staff members. Improvement proposals have been approved by the Central Estate Strategy Board, which has awarded UCL Library services £830k to carry them out, along with an extra £200k being invested by Library Services themselves. UCL libraries across different campus sites can expect improvements such as the addition of power plugs to desks in the UCL Institute of Education library and the creation of 91 extra seats for study. These improvements are being made ahead of the New Student Centre which will introduce up to 1,000 seats on completion in 2019. Refurbishment of the ground floor of the Science Library is already underway and is set to provide another 21 study seats and a combined ISD and library helpdesk by February 2017. JS
Out of Hours
Tom Quick Tom Quick is a Consultant Orthopaedic Surgeon, specialising in peripheral nerve injuries in both children and adults at the Royal National Orthopaedic Hospital, Stanmore . He is also the Head of Undergraduate Education for the Division of Surgery at UCL, as well as being an Honorary Consultant at Great Ormond Street Hospital. Tom is an Honorary Senior Lecturer at the Institute of Orthopaedics and Musculoskeletal Science, an active tweeter and an avid beekeeper. Many UCL medical students will recognise him from his frequent talks about getting into surgery or from his supervision of the Orthopaedic Science iBSc – we hope you enjoy finding out more about him as he answers questions for RUMS Review. 11
Tell us about your career: what did you study and where, what have been the highlights of your career, how did you get to UCL?
I grew up in Manchester and went to Manchester Grammar before heading to Magdalene College, Cambridge, where I did my first two years of preclinical medicine and then History of Art in my 3rd year. I then came to London to do my clinical studies as a transfer student at the Royal Free Medical school. In my final year, the Royal Free Medical School merged and I graduated from UCL with my MBBS.
The ability to work with such brilliant colleagues, students and patients. It sounds cheesy, but I am very lucky to have access to the resources, support and mentorship that I do. 11
After my house jobs, I travelled to Australia to do General Surgery and Neurosurgery at the Royal Prince Alfred Hospital in Sydney. I came back to England to do Plastics at Mount Vernon, then Orthopaedic Senior House Officer jobs in Bath, before joining the Bristol Orthopaedics Registrar Rotation in 2006. I began a fellowship in nerve injury at the Royal National Orthopaedic Hospital and then returned to Sydney for a Paediatric upper limb fellowship. Eventually, I came back to England for another year at the nerve injury unit at Stanmore. I was then appointed a Consultant Surgeon at the RNOH in 2013. One of my most challenging appointments came in 2014, when I was asked to lead undergraduate education for the Division of Surgery at UCL. It was a huge opportunity, to which I feel I have still to fully rise to, and has given me the chance to meet many impressive people - there is such a wealth of talent in the student populous at UCL. My highlights are individual patients with whom I have made an excpetional connection with; those cases that touch you for a number of reasons and stay with you, spurring you on. Their comments, their recovery, their character - so many of which changed me just as much as I changed them. 11
The best thing is the enthusiasm I see in so many, the worst thing is the lack of enthusiasm I see in too many. 11
Which one person has most changed the way you think about medicine and science?
Pablo Ruiz Picasso. 11
What are your greatest ambitions that you have left to fulfil?
I wish to succeed - I don’t feel that I have yet. 11
What is your favourite way to relax after a long day at work?
1 2 3
What are your guilty pleasures?
What first sparked your interest in science and medicine?
Big, caring, repetitious, funny, driven, repetitious. 11
What are the best and worst things about teaching medical students?
Reading and swimming (one or the other - not simultaneously).
Describe yourself in five words.
What’s the best thing about working at UCL and in London?
I remember reading science and science fiction books from an early age, but my parents tell me that I said I wanted to be a doctor when I was very small. Which is strange as my parents are not medical and I had never been sick. So, I don’t know what or why I became focused on medicine but I never questioned it.
What one piece of advice would you give to your students for their futures?
Don’t worry if you feel like an imposter - we all do. Be true to your ideals and keep going.
IN FOCUS: Ivan Beckley In Focus aims to delve into the lives of UCL medical students. We hope that, in addition to being fascinating, it will solidify RUMS review’s basic premise to celebrate the successes and achievements of UCL medical students, no matter how big or small! In this issue Ivan Beckley, third year medical student and founder of Suvera, elaborates on his incredible medical journey to date . He also suggests his In Focus candidate for the following issue.
first felt like a Medical student at UCL when I picked up my ID card. It was an afternoon in September 2014 when I entered the Roberts building, waited in the queue speaking to undergrads like myself, sat down, smiled at the webcam, ID card printed, and handed over, and then I left. Pretty uneventful you might imagine, but for me, it was official. I worked very hard to get to this point and was overwhelmed to finally feel like I had accomplished my goal. Yet in that moment, I also recognised that this was just the beginning. I needed to make the most of every year that I was to be at this world-leading medical school. My fascination with people urged me to study medicine, and my interests were so broad and wide-reaching that I couldn’t just study science or art. However, medicine allowed me to do both as it encapsulates. the science of the human body and the art of interacting with people. Having spent my gap year thinking about what I wanted to achieve with my life (Deep question, right?), I realised that my first three years at UCL would be the optimal years to begin the things I had always wanted to do. We as medical students often assume that, to do these things, we have to wait until we are more experienced, older and supposedly wiser. Well, I say, if you break down any dream you have into smaller milestones, you could start the first step of your journey today. In my first two years at medical school, I made every intention of doing the things that excited me. During first year, I set up a community interest company to encourage year nine students to be more ambitious. I became a researcher at Polygeia, looking into abortion laws across key nations in the world. I became a representative for my year on the student staff consultative committee for medical education. I also became
a mentor with Target medicine, a radio show host on the UCLU Rare FM and performed in the Panafrik African-Caribbean annual show. I was accepted as a leadership delegate for the Powerlist student leadership programme at Deliotte UK. I became a student ambassador for Doctorpreneurs. I interned at an architect firm in New York, working as a design researcher over a four week period. I won a number of awards, including being named one of the Top 10 black students in the UK. And, whilst doing all of this, I still managed to pass my exams and was commended for the RUMS alumni award. I don’t say this to brag, nor do I want to suggest that it was all easy. I worked long days and had a very limited “social life”. But I enjoyed the challenge of pushing myself to do better. Since my adventures in first year, I have reined it back a little. However, in second year, I had the opportunity to found a health start-up named Suvera, aiming to develop products that make it easy for the everyday individual to manage their health. My dream is that, eventually, I can work on Suvera full-time, using my recent medical knowledge, fascination for technology, awareness of design, business and psychology to have a positive impact in the lives of many people. Now, half way through medical school, I am humbled by what I have achieved alongside my studies. I hope you are able to take something from my story to challenge yourself to do the things that excite you. Don’t wait. Life is short. Embrace your uniqueness and various interests - believe me, you’ll be a happier student for it!
In our next issue, Ivan has recommended we focus on Ragav Manimaran, fourth year medical student.
SURGICAL RESEARCH AT UCL A WHISTLE-STOP TOUR UCL Partners is one of six Academic Health Science Centres in the UK. Collectively, UCL associated hospitals treat over 1.5 million patients per year, and together they form the largest academic health centre in the world1. In the most recent round of National Institute for Health Research (NIHR) funding bids, UCL affiliated hospitals collectively secured £167m out of a total of £816m available nationally – the largest share of any UK institution2. In turn, a significant amount of world-leading surgical research is currently being undertaken as part of this biomedical research powerhouse. In this special surgical edition of RUMS Review, we turn our attention to some of the pioneering surgical research that is currently on-going across UCL Hospitals. Richard Bartlett, Research Editor
Professor Victor Tsang (Great Ormond Street Hospital)
Mr David Choi (National Hospital for Neurology and Neurosurgery)
Professor Tsang is the principal cardiac surgeon at GOSH, and lead UK investigator for a pan-European project which aims to compare the use of decellularised homograft valves against artificial valves in paediatric patients with cardiac valve abnormalities. The study has just completed the valve implantation phase in the UK, and long term follow-up and surveillance is now underway. Professor Tsang is also the clinical coordinator for a major British Heart Foundation grant which aims to perform detailed proteomic and biomechanical analysis of right ventricular changes in patients with Tetralogy of Fallot. Through this project, it is hoped that insights into the complex pathophysiology underlying right ventricular maladaptation will be uncovered. The cardiothoracic team at GOSH also have an interest in outcome monitoring, and Professor Tsang is currently leading the development of a risk adjusted outcome model for paediatric cardiac surgery. In doing so, it is hoped that the project will lead to increasingly standardised definitions used in paediatric cardiac surgery, thus facilitating better communication with patients and families, and the development of more powerful tools for cardiothoracic audit and research.
Repair of the CNS following traumatic injury currently represents a significant challenge. As such, Mr Choi’s group is interested in investigating whether olfactory ensheathing cells (OECs) might be used to promote repair in the human CNS. OECs have already been shown to be effective in pre-clinical models, and they are also easily accessible operatively via endoscopic biopsy. This means they can be easily harvested autologously and mitigates several of the concerns associated with allogeneic stem cell transplantation. Specifically, Mr. Choi’s group is investigating whether these cells might one day be used to promote recovery after spinal cord injury and brachial plexus avulsion. The group is currently in the process of characterising human OECs in order to better understand their behaviour, and they aim to begin running the UK’s first OEC cell therapy study in 2019. In addition, they are also now exploring how OEC behaviour might be refined and improved by combining these promising therapeutic cells with biomaterials to develop optimised tissue-engineered delivery devices.
1. UCL Partners. Academic Health Science Centre (AHSC). 2016; Available from: http://uclpartners.com/ who-we-are/our-roles/academic-health-science-centre-ahsc/. 2. UCL Partners. UCL receives largest share of NHS research funding. 2016; Available from: http://www. ucl.ac.uk/news/news-articles/0916/140916-ucl-largest-share-nhs-resarch-funding
Ear, Nose & Throat
Oral & Maxillofacial Mr Colin Hopper (Royal National Throat, Nose and Ear Hospital)
Professor Martin Birchall (Royal National Throat, Nose and Ear Hospital)
To date, Mr Hopper’s research has primarily focused around the delivery of photodynamic therapy (PDT). PDT is an oxygen dependent therapy that allows photosensitive cytotoxic drugs to be delivered either topically or systemically. These can then be selectively activated through the application of light, releasing reactive oxygen species to cause highly-localised tissue damage. PDT has already been widely adopted in the treatment of head and neck cancers, yet it is now also being trialled as a novel technique in the fight against MRSA. The established safety and efficacy of PDT, along with its ability to spare surrounding healthy tissue (e.g. nerves in close association with a tumour) have all contributed to the technique’s success. The high prevalence of head and neck cancers in developing parts of the world, along with a relatively low cost, have also made PDT an attractive possibility for the treatment of cancers in resource-limited settings.
Professor Birchall has been involved in a variety of ENT research projects. Most notably, he is currently heavily involved in the VOCALIST trial – a study comparing laryngeal reinnervation against thyroplasty (vocal cord reconstruction) after vocal fold paralysis. In the past, Professor Birchall has also been involved in a number of projects exploring the use of tissue-engineered organ transplants to restore patients’ airways. The team at the RNTNEH are now in the process of conducting MACRO, a trial which aims to establish best practice for patients with chronic sinus disease.The RNTNEH have also recently been awarded a large grant from the UCL-UCLH Biomedical Research Centre, priming the hospital to become the national centre for the treatment of deafness and hearing problems. Accordingly, they are now in the process of running a first-inman trial to explore the use of novel gamma secretase inhibitors to regenerate inner ear hair cells after sensorineural hearing loss (REGAIN study).
Trauma & Orthopaedics
Mr Gregg James (GOSH)
Mr Tom Quick (Royal National Orthopaedic Hospital)
Mr James is Honorary Senior Lecturer at the UCL GOSH Institute of Child Health and a Consultant Neurosurgeon at Great Ormond Street Hospital. He has academic interest in hydrocephalus, craniofacial surgery and cerebrovascular disease in children. He has recently been awarded a grant from the Royal College of Surgeons of England to undertake a study examining a new surgical technique for preventing brain damage caused by intraventricular haemorrhage in premature babies. In this randomised controlled trial (RCT), standard treatment (a ventriculosubgaleal CSF shunt) will be compared to standard treatment plus endoscopic washout. This will involve inserting a micro-endoscope into the ventricle of the brain and using lavage with artificial CSF to wash out the blood and its breakdown products. It is hypothesised that washout may reduce the damage caused by breakdown products, and thus reduce damage to the developing neurons and glia. Through doing so, the research team hopes that the need for a permanent shunt and long-term neurological disability will be reduced.
Peripheral nerve tissue is one of the few tissues which can regenerate and provide normal function after injury. However, unlike similar injuries in lower animals, humans rarely see full functional recovery after nerve damage. As such, Mr Quick is currently recruiting for a human tissue study to compare how damaged nerves switch-on regenerative genes post-injury, and also to explore the role of Schwann cells and immune infiltration in the denervated distal nerve stump. It is thought that this may reveal some of the fundamental mechanisms that underpin successful nerve repair and potentially expose novel therapeutic targets for the future. Mr Quick also has long-standing interest in developing better clinical tools to measure functional recovery after nerve injury, and the team have now developed a hand-held dynamo to replace the somewhat blunt 0 - 5 Medical Research Council Power Grading Scale.
Urology Mr Daron Smith (Westmoreland Street Hospital)
Professor Toby Richards (UCH)
Mr Smith is a consultant endoluminal endourologist specialising in the treatment of kidney stones. He has recently been part of the team awarded a major NIHR grant to run two multi-centre urology trials - these will determine best practice for the surgical treatment of renal stones. The first trial will compare shock wave lithotripsy against flexible uterorenoscopy for small renal stones, whilst the second will compare shock wave lithotripsy against percutaneous nephrolithomy for larger stones. Through conducting these large multi-centre clinical trials, it is hoped that stone surgeons will be able to make better operative choices about the individual patients in front of them. More broadly, the urology department at UCH also has an impressive track-record of pioneering cutting-edge prostate cancer therapies. Most notably, these have included multi-parametric MRI scanning for more accurate staging and diagnosis, and high intensity focused ultrasound (HIFU) for minimally invasive tumour ablation.
Professor Richards’ research portfolio is both broad and varied. Notably, he is currently the lead investigator for the PREVENTT trial – a double-blinded phase III RCT which aims to assess the use of ferric carboxymaltose in reducing the need for blood transfusions in anaemic patients undergoing major surgery. In addition, he is also lead investigator for the EPIGRAAFT study. This multi-centre RCT aims to compare the efficacy of epidermal grafts against split-thickness skin grafts for wound healing. In the context of vascular surgery specifically, Professor Richards has also made significant contributions to investigating whether surgical interventions such as carotid endarterectomy and stenting may be useful in the prevention of ischaemic stroke.
tips on setting up and running a peer-led medical education society.
The dynamics of medical education are constantly evolving. The traditional medical school paradigm, consisting of experienced doctors and academics imparting knowledge to novice medical students, remains fundamental to developing future doctors. However, peer-led teaching, where students teach and are taught by other students, has emerged as an adjunct to core medical curricula, and has gained popularity, credibility and faculty support at many medical schools (Burgess et al. 2014). Peer-led teaching has numerous benefits for peer-tutors and peer-learners alike. It is often at least as effective as expert delivered teaching (Hughes et al. 2010), promotes leadership and teaching skills (Ten Cate & Durning 2007), and may be associated with improved exam results for student teachers (Iwata et al. 2014). Moreover, it promotes collaboration between students and faculty (Buckley & Zamora 2007) and can, if used carefully, alleviate staff shortages (Nestel & Kidd 2005). Engagement in peer-led teaching also provides medical students with vital early preparation
for future formal and informal roles as medical educators (Dandavino et al. 2007). At University College London Medical School (UCLMS), the peer-led medical education society provides teaching and revision tutorials, workshops and lectures for students in all years of the medical school, in addition to producing a range of revision materials and educational videos. Each year the society runs several hundred events, with a yearly aggregate attendance of around 1500 students. The society has a formal relationship with staff at the medical school, who review teaching material, and provide guidance and clarification on curriculum aims and objectives. Feedback received from peer-learners and peer-tutors has been consistently (often overwhelmingly) positive, and the society has established itself as a valued source of teaching and learning opportunities amongst medical students. This article presents 12 Tips on running a peer-led medical education society. Given the lack of advice available to students running or creating such a society, there is a clear need to share examples of best practice in this area. Previous authors have outlined approaches to delivering individual peer-led
teaching initiatives that complement specific aspects of formal curricula (Wadoodi & Crosby 2002), but there is a need to go beyond this by examining peer-led teaching as delivered by formal, student-led medical education societies. This article describes how such societies can produce and evaluate wide-ranging programs of educational activities that span the entire academic year, in addition to actively engaging in academic research. The authors hope that these tips, developed through our experiences on the executive committee of a peer-led medical education society, and current evidence on peer-assisted learning, will be of use to medical students who are considering becoming involved in running a peer-led medical education society, and also to those medical school faculty members who recognize the value in supporting them.
By Alex Fleming-Nouri, Dominic Crocombe & Yezen Sammaraiee
To cite this article and for a full list of refernces: Alex Fleming-Nouri, Dominic Crocombe & Yezen Sammaraiee (2016): Twelve tips on setting up and running a peer-led medical education society, Medical Teacher, DOI: 10.1080/0142159X.2016.1209471
Work with your medical school Enlisting the support of medical school faculty early on can be crucial to the success of peer-led educational events.The strong relationship between UCLMS and the peer-led medical education society at UCL lends legitimacy to the society, whilst emphasizing that the society’s aims and objectives are aligned to those of the medical school (Ross & Cameron 2009). Such a relationship allows access to expert advice on event structure, content and relevance, as well as facilitating access to medical school facilities, such as clinical skills labs and electronic teaching aids. Faculty may also be willing to review teaching material and methods, to ensure the production of high quality and relevant resources. This can allay fears about compromised quality of teaching, which are not unfounded, especially in settings where there is a lack of faculty input (Johansen et al. 1992). Medical schools may wish to provide such input on an ad-hoc basis, or task a specific faculty member (a Clinical Teaching Fellow, or similar) to act as a formal point of contact. A summary of how medical faculty can support a peer-led medical society can be found in Table 1.
Seek inspiration from others Whilst peer-led medical education societies are far from ubiquitous, there are a number of existing societies at medical schools in the United Kingdom, and elsewhere. Dialogue with student societies from other medical schools can provide a useful source of advice, ideas and perspective, whilst allowing students an appreciation of how things are done
Create a manageable and sustainable society
Produce events that students need and want
As any new medical education society will likely fall under the auspices of the student union, their guidelines must be followed where necessary. It should be clear who holds overall responsibility for the society, its finances and activities, and care should be taken to appoint a team leader who has the will, ambition and time to oversee it (Gale 1997). Having a clear point of contact and a flexible, manageable structure facilitates smooth interactions with medical faculty, student union officers and external organizations, and is vital to the success of the society (Ford et al. 1998). Overly hierarchical structures fare poorly in this context (Anderson & Brown 2010): team members should be involved in administering multiple aspects of the society, creating a larger pool of ideas for any given topic or event. Moreover, the structure of the society must be sustainable. Reflecting on and documenting successes, failures, and lessons learned helps to improve practice and provides a useful record for future organisers.The handover process requires careful consideration: in addition to basic information about the running of the society, a successful handover should suggest solutions to previously encountered problems.
When planning and delivering events, it is vital that they will actually be valuable to the target audience. For any new educational initiative, understanding the aims and objectives, and philosophy, of the existing curriculum is crucial during the planning stages (Ross & Cameron 2009). Avoid overlapping heavily with timetabled teaching as this represents an inefficient use of peer-learners and peer-tutors’ time, especially given that most teaching occurs after hours. Be aware that, as medical schools constantly modify their curricula in response to student feedback and performance, topics considered difficult or poorly taught in previous years may now be well provided for.Teaching should target core concepts and contextualize existing knowledge (Ross & Cameron 2009) that students find difficult to grasp, rather than focussing on ‘‘niche’’ aspects of medicine. Organisers should canvass their target cohort to identify areas of least confidence prior to organising events. Continuous dialogue with medical school faculty can ensure the society’s objectives and priorities are relevant.
differently at other institutions. Additionally, student societies that are concerned with other aspects of medicine (e.g. surgical societies or specialty-oriented societies) can often assist with preparing teaching material and contacting other professionals who can assist and advise. Medical education conferences provide invaluable opportunities to network with medical education professionals and other like-minded students. International conferences such as AMEE and ASME are unique in providing a global view of developments in medical education. External organisations, including professional bodies such as the Royal Colleges, medical indemnity companies, and medical publishers are often keen to be associated
with peer-led medical initiatives that reflect their own ethos, and may be willing to help with logistics and finances. Gaining sponsorship or patronage from a well-regarded organisation or individual can increase the profile of events, and provide access to expert professionals, a valuable source of advice and knowledge. Furthermore, when embarking on a new project, it is wise to review the sizeable (and constantly growing) body of medical education literature for ideas and guidance on planning, running and evaluating events.
05 Try new things
Peer tutors are relatively unique among medical educators insofar as they will have recently experienced learning and consolidating the information that they are now conveying (Lockspeiser et al. 2008), and can therefore readily identify gaps in the formal curriculum. Such observations can be utilised creatively to develop peer-led educational events novel in structure and/or content (Furmedge et al. 2014). The relative autonomy of peer-led educational societies has previously allowed students to embrace such novel teaching approaches as ‘‘flipping the classroom’’ (Moffett 2015), creating focused multimedia revision resources (Gutmann et al. 2015) and employing experimental teambased learning (McMullen et al. 2014). Such innovation need not be confined to teaching and learning: successful peer-led initiatives have been seen in peer-assessment (Fletcher & Day 2015), education research (Furmedge et al. 2014) and quality improvement (Nicola et al. 2014). At UCLMS, a number of formal teaching sessions are based partially or entirely upon events pioneered by the peer-led medical education society.
Be prepared for logistical challenges
Running an educational event presents myriad logistical challenges, especially when large numbers of students are involved. Those involved in planning should thoroughly appraise potential difficulties and address them early. Securing venues, scheduling events and communicating relevant information to prospective attendees is often more difficult without access to official mailing lists and university facilities. A robust social media presence, alongside concerted efforts to create a society mailing list, can help to surmounting these challenges. Event publicity should be disseminated early and via multiple channels, including social media. Scheduling is another potentially difficult area. Dovetail with the formal curriculum: events addressing core principles should come earlier in the year, with examinationfocused sessions occurring closer to exams.
Carefully select, and carefully support, your peer-tutors Contrary to a popular perception within the medical community, not everybody can deliver teaching events effectively at the first attempt. The peer-tutor recruitment process should emphasise competency and proficiency in delivering teaching sessions. Previous experience may be preferable but not essential. Peer-tutors may be recruited based on interview selection (Weyrich et al. 2008), or on a voluntary basis (with or without prior completion of specified clinical placements or assessments) (Glynn et al. 2006). Selection based on academic criteria is less appropriate, as peer-led teaching aims to aid the development of peer-tutors as well as their tutees, regardless of previous academic achievement (Wadoodi & Crosby 2002). Regardless of how peer-tutors are chosen, medical education societies should be cognisant of the need to support those who are selected (Sammaraiee & Mistry 2015). A recent systematic review of peer-led learning practices demonstrated vast variation in teacher training across different programs (Burgess et al. 2014). Training peer-tutors in good teaching practice is vital. Practical advice on teaching, including directing a group, dealing with questions, and optimising the group learning process, is essential (Bulte et al. 2007). Medical schools may be able to facilitate formal accreditation for peer-tutors via relevant training courses or qualifications. It may also be expedient to provide peer-tutors with a comprehensive package of teaching materials (Nestel & Kidd 2005), alleviating the burden upon individual peer-tutors of creating and quality assuring material.
Utilize social media Social media is an excellent way to connect with peer-learners prospective peer-tutors, and provides a cheap and efficient way for fledgling student societies to increase their profile and gain members. An active website, Facebook page and Twitter account can be employed to advertise events, upload teaching material, and contact and exchange ideas with other medical educators (Cheston et al. 2013). Social media pages should clearly state the university and society name, and that the society is engaged in medical education. This will facilitate the acquisition of a network of invaluable contacts.
Whilst peer-led teaching has enormous potential as an educational resource, it can be hugely time consuming to organise and deliver, especially where no similar initiatives have previously existed. The importance of planning ahead should not be under-estimated (Hills 2010). Those involved must be realistic about how much can be achieved in the limited time period of an academic year. Medical school faculty can assist with devising a reasonable and achievable schedule of activities, and this should be reviewed periodically to assess progress. Similarly, running a peer-led medical education initiative should not become a full-time venture for the student organisers, nor should it aim to cover entire curricula. Instead of attempting to introduce complex concepts to students, peer-led education events should aim to provide comfortable, interactive revision opportunities that complement what is offered formally by the medical school (Ross & Cameron 2009).
Collect and reflect on feedback
Soliciting feedback on teaching events is essential to improve medical education (Hewson & Little 1998), and peer-led medical education is no different. Peer-learners should be asked to feedback on the quality and methods of the peer-tutors and teaching materials, relevance of the teaching, and structure of the event. It is also pertinent to ask whether an event has improved learner knowledge or confidence in the topic. Feedback from peer-learners and peer-tutors can then guide improvements in current teaching sessions, and the creation of new ones. Moreover, by reflecting on individual feedback, peer-tutors can refine their teaching practices, whilst formalised peer-tutor meetings can provide forums for informed discussions aimed at deeper reflection and dissemination of ideas for improvement. Numerous strategies for collecting feedback exist, incorporating qualitative and quantitative data collection. These include verbal feedback (from informal conversation and focus groups), paper based forms, online questionnaires or live feedback collected via interactive voting handsets. Whilst a discussion of the relative merits of various feedback
Research strategies is outside the scope of this article, the authors’ experience was that strategically distributed paper forms yielded a larger absolute volume of feedback, whereas online questionnaires tended to garner more detailed written comments. When creating feedback questionnaires, careful consideration should be given to what information is being sought. Feedback processes must gauge not only students’ opinions of events, but establish whether key learning points were successfully conveyed and how attendees may think or behave differently following attendance at the session (Stahl & Davis 2011), including how students approach examinations. Guard against ‘‘feedback fatigue’’ (Fysh 2011) by making forms as short and succinct as possible. When analysing data, be sure to contextualise it. Resist the urge to focus on what may be relatively small amounts of negative feedback whilst ignoring the positives; not all negative feedback necessarily warrants sweeping changes. Nevertheless, careful consideration of all feedback can provide a valuable opportunity for reflection and may impact how future events are approached.
of formative medical assessments (Chisnall et al. 2015), student-led research has changed medical curricula and practice, including the previously mentioned changes at the authors’ university (UCL 2015). Peer-led medical education societies provide an avenue for students to actively involve themselves in educational research by conceiving, implementing and critically appraising new teaching approaches. Such practices warrant formal analysis as much as any other form of medical education. Guidance can be sought from medical school faculty or published guidelines that outline best-practice approaches to medical education research (Ringsted et al. 2011; Cleland & Durning 2015). Engaging in such research leaves students with a greater understanding of research principles and methodologies, and can lead to future academic opportunities. To capitalise upon their unique position, prior to embarking upon a program of events for the year, students should survey the medical education research arena. Performing thorough literature reviews and engaging in discussion with medical school faculty is key to identifying areas where peer-led medical education societies could answer new or existing research questions. This can help to focus the society and guide creation of events and feedback gathering approaches.
Actively engage in medical education research Most medical students are interested in their own education and should feel capable of making significant contributions to the knowledge base underlying educational practice. As the subject of medical curricula, medical students are in a unique position to reflect upon what works well, and what could be improved. In areas including improving student confidence in exams (Young et al. 2014), improving feedback methods (Nicola et al. 2014), and critiquing the value
Take it seriously, but have fun Participating in the running of a medical education society cannot be taken lightly, as its output may be relied upon by other students. Whereas formal medical school teaching is backed by a high degree of medical knowledge, quality assurance and (generally) evidence for its efficacy, peer-led medical education societies may initially lack such solid
foundations. For this reason, it is crucial that those responsible for the running of the society strive to deliver the highest quality learning opportunities possible, utilising all of the resources at their disposal. It is very difficult for a student society to establish a reputation for competence, and very easy to lose such a reputation if peer-learners perceive that the society is not diligent and focused (Johansen et al. 1992). At the same time, running a peer-led medical education society can lead to experiences that will bolster a student’s skillset in a number of areas. In addition to improving team-work ability, creating and delivering novel educational events improves teaching, management, and research skills. Helping fellow students, whilst taking advantage of the opportunities afforded by peer-led education, can be great fun and is incredibly rewarding.
Conclusions Medical students have the desire and the skills to play a role in their own education, as demonstrated by the large number of peer-led medical education initiatives at medical schools across the world (Burgess et al. 2014). This positive trend should result in the creation of knowledgeable and capable future medical educators (Buckley & Zamora 2007) However, delivering a consistent set of projects through a formalised peer-led medical education society can be challenging. Students wishing to involve themselves in teaching must receive adequate support from the medical education community, their medical schools, and their peers. The tips presented above address areas where students are likely to encounter difficulties, and avenues that may otherwise not be pursued. By following them, students establishing or running peerled medical education societies should find it easier to create fruitful educational opportunities and experiences for themselves and their peers.
About the Authors
Alex Fleming-Nouri, MBBS, BSc (Hons) (MSc), is a Foundation Year One doctor at Oxford University Hospitals NHS Foundation Trust. He graduated with an MSc in Global Health Science at the University of Oxford in 2016. He graduated from UCL Medical School in 2015 with a Distinction in his MBBS. Yezen Sammaraiee, MBBS, BSc (Hons), is a Foundation Year One doctor at East and North Hertfordshire NHS Trust. He graduated from UCL Medical School in 2016.
If you are interested in working on an education project or education-related activities, please contact Yezen at: firstname.lastname@example.org RUMS Review
RR: What was your experience of medical school like?
CM: I remember that one of the questions they asked me for my interview at UCL was: “How do you make beer?” I said that I didn’t know, and I didn’t even drink it, to which the interviewer responded, “Miss Marx, we’ll never make a medical student out of you!” But they did, and I never drank beer, so there you are. In my first year, I sang in a choir, met my first real boyfriend, and the usual fun things you do at medical school. We were always up early for anatomy dissection and always home late because we were out enjoying ourselves. I made some of my most established friends there – I still see some of them, and they are a very big part of my life. It was incredibly important as a place to make friendships and future relationships. It’s the essence of growing up, isn’t it? The business of your first place to battle life, be independent and try new things.
RR: Why did you choose orthopaedics? CM: In those days surgery was a slightly unusual specialty for a woman to do. It wasn’t a natural choice for me at medical school; the Professor of Surgery was not a charismatic or nice man, and that pervaded the whole of the surgical department – hence why I didn’t want to stay in London to do a surgical job. However, before I went to medical school, I did some work experience with a local surgeon in Coventry and I knew that I would have a really good experience if I went back. So I did a house job working for him and that’s when I realised that surgery was for me. After that job, I came back to London working in A&E at the Middlesex, which I really enjoyed. I then did various jobs of general, vascular, urology and thoracic surgery. Just as I was doing my fellowship exams, I happened to rotate into orthopaedics and I really enjoyed it. I loved the patients and the constructive, enabling nature of the specialty. I passed the fellowship exam, had a very short careers interview with the Professor of Surgery, got back down to the orthopaedic clinic and the rest is history.
RR: What was your election as president like? CM: It was quite a brutal process. Until my election, it was like a papal gathering – everybody was eligible and you could vote for anybody on the council. When I stood, the council had decided that if you wanted to stand for president, you should actually declare candidacy, so ten people stood. The votes were counted and if there wasn’t a majority, there was another round eliminating the people with the least votes. That went on until you had a president. Sitting through that was quite an exciting experience! It’s been a very interesting time and it’s a huge privilege to represent the entirety of your specialty at this level. There were obviously many things that I didn’t know and skills that I have had to acquire.When you take on such a role, suddenly you are in the view of the world outside. If I say something, it’s not Clare Marx saying it, it’s the President of the Royal College of Surgeons, and so you do have to watch what you say. That in itself is a challenge; the learning curve is practically vertical!
Clare Marx became the first woman to be elected as the President of the Royal College of Surgeons in 2014. Having received a CBE for services to medicine before taking up the post, here she talks about giving up operating to lead the surgical profession, the joys and difficulties of such a role, and how she aims to encourage others to follow in her footsteps. We ask, in her presidential capacity, about the lack of diversity in surgery, NHS contracts and the implications of Britain’s exit of the European Union.
RR: Do you miss operating? CM: I haven’t operated for three years now, and I have been so busy that I honestly don’t think I would have been able to concentrate to do it well enough. When I come to the end of the Presidency and I suddenly go from being flat out, I may miss operating then. I will miss the camaraderie and the patients. I loved every day of my operative life, it’s just an amazing career but all good things move on or come to an end.
RR: What do you think about the current system for surgical training - does it allow trainees to see a good range of patients and spend enough time in theatre?
critical family judgements.We are better off here than America, where you’re lucky to get eight weeks off to have a child, there is no statutory paternity leave and they make you work almost until the last minute – that’s wrong and I think people need to have protected time.
CM: It’s very difficult at the moment. One of the sad facts is that seven or eight years ago, we had written a curriculum in orthopaedics that was predicated on a much more educational job, that didn’t happen and the need to provide a service was never really dealt with. We would be eight years down the line if we had addressed these issues then.
Diversity is great - it’s what enriches society and the same applies to medicine. If you look at some groups, like surgeons, there is now a preponderance of public school educated people going into surgery and that’s not good for the profession. So, if you want to improve the diversity both in terms of men and women, of race, but also of social strata, I think we have got to work a lot harder to ensure that all of those groups are included in the ability to see the future. We have to reach out and that means saying to people: “Have you ever considered doing surgery?” I think that if people never actually push you and challenge your views, you probably will never even think about it.
When all of the unhappiness was becoming apparent, I look back at some articles that I wrote, with Angus Wallace in 2009 and 2011, pointing out the need to change surgical training, the need to do something about sorting out the service provision and to focus much more on the actual training. You have to do some service – training is about providing a service in the long run and certainly, as you get older, you should be doing more and more. With the system as it is at the moment, some of the most junior people in surgery simply aren’t getting to their training opportunities. That is clearly wrong and was a missed opportunity by those “in power” seven or eight years ago.
RR: What are your personal views on the imposition of the junior doctor contract and what do you think the implications are for other NHS staff contracts in the future? Do you think it sets a precedent?
“I loved ev my operative an amazing all good thin or come to
I recognise that there is a need for change. The truth is however, it doesn’t matter how long you’re in training, it isn’t until you actually do the job, and do operations over and over again, that you get good. What we can do is try and concentrate training so we can get people competent more quickly and they learn by the mistakes that we made. What we can’t do is give them experience, that just takes years.
CM: This dispute was not managed well by either side. I mean that. And if you actually speak to either side, they will tell you that they didn’t manage it well. The reality is that this new contract will give financial reward to a large group of people, but there seems to be another group of people who, over a lifetime potentially, may lose out; women seem to be one of those groups. If you have a couple of years out for childbirth, unless there is a defined and accelerated way back in, you are going to be slower to make that next hurdle. How do you up-skill people in a much better defined and quicker way to enable them to get back on track? That is something we have really got to look at.
RR: What is your, or the college’s, position on providing whistle-blowing protection for junior doctors? CM: It is really important that people should have the ability to speak up. People have to understand whether what you’re speaking up about is really something related to patient safety and has been ignored, or whether it is a decision that has been risk assessed, and dealt with by a trust, and the trust has then taken a corporate decision about that particular way of action. If you think patient safety is the most important thing, then you have to comply with all the Trust policies and procedures - if you’ve done that, then you should follow the Trust rules and complain. The Royal College of Surgeon’s guidance on raising concerns is worth looking at – it talks about taking people with you, enlisting help, making sure that you’re not on your own, using all the normal guidance, all the normal policies and all the normal steps before you actually become a whistle-blower.
RR: How do you think Brexit has, or will, change the surgical profession? CM: I’ll tell you, I voted remain. The college was neutral. The vast majority of people in the surgical profession I spoke to suggested that remain would have been better because we see the benefit of free interchange of clinical, academic, surgical, scientific knowledge, skills, money that follows programmes and so on. 45% of people in surgery did not have a primary medical degree in this country; about half of those come from the European Union. So a substantial number of our surgeons qualified in the EU, and unless there is some solution going forward, we will miss the opportunity to attract some of the brightest and best in Europe to interchange into the NHS. There is going to be a big time of instability. Sadly, we thought some of the more difficult
RR: What are currently the major barriers to diversity in surgical careers in the UK and what can be done to improve it? CM: The issues are societal. It remains the case that women still have to be the child bearers – they haven’t worked that one out yet – and inevitably, that is going to make a difference when you are making critical career judgements at the same time as you are making quite
aspects of the European Working Time Directive (EWTD) might be solvable if we were out of Europe, but they’ve been enshrined in the new contract. So it looks like EWTD and the information system for European public procurement (siMAP) and Jaeger judgements (which concern some of the periods of compensatory rest) are not going to change. I’m very concerned about access to European research grants and money.
I have managed to get more women to come through into leadership experiences. Starting an emerging leaders group for women has really enabled them to see that they can take up leadership roles in surgery. For instance, there were 560 examiners and only 27 of them were women, and we have managed to attract more women to come to join the examining body.
There are a few good things: potentially we can English language test doctors in a clinical setting and possibly regulate medical devices more effectively. There are opportunities, and we can certainly engage in those opportunities, but the most important message is that we keep explaining to those people who come from Europe that they are highly valued at all levels within the health service. I think, in the short term, we need an influx of people because, actually, we don’t have enough doctors of our own.
We changed our strapline as a college from “advancing surgical standards” (and we had a huge amount of discussion about this) to “advancing surgical care”, which we feel really speaks to the patients as well as to the surgeons. Standards underlie the care we give, but our end purpose is to deliver care.We’ve also been championing various issues that patients have, such as restrictions of access to surgery which have been put in place for financial reasons. That’s not what the health service is about; it’s about giving people what they need at the time that they need it.
RR: So what do you think of Jeremy Hunt’s plans to train more medical students?
The RCS also have plans to rebuild the College building which will inevitably change the way people see the College – it will be leaner and more focused and we will be able to deliver our offer more regionally.
CM: Great, I’m always happy to see more medical students. It starts in 2018, so by 2024, we’ll have 1500 more doctors. Having more doctors is great but we still need to ensure an academic and intellectual interchange so that we are up
There is a lot of work to do to try and support the trainees. Rotas and rotating posts, being sent all around the country and difficulty in trying to match with your family for jobs are issues that have existed for time immemorial but, quite rightly, people have said “we don’t want to do this anymore”, and we really need to focus on influencing that.
very day of e life, it’s just g career but ngs move on o an end.”
We really need to continue to make people understand what a brilliant career medicine is and surgery, of course, in particular. Surgeons have this ability to use our skills to make people better, to actually do something for people. Although people tend to focus on terms and conditions and the financial aspect at present, actually we really want to be getting into the joy and vital nature of that one-to-one doctor/ patient relationship in the practice of medicine.
there with the rest of the world.
RR: What has been the most difficult part of being president?
RR: What advice would you have for medical students, at any stage during medical school?
CM: The saying, “you can’t please all of the people all of the time” really pertains to being president of a college. People have very deep-seated views and strongly held beliefs and there are others who see progress as being absolutely essential, which of course it is. If you don’t progress you fall backwards and the only way to progress is to change. So you have to persuade the people who want to hang on to the past to see the benefit of the changes you make for the future.
CM: Enjoy your time at medical school. Read about the health service widely so that you understand the environment in which you are going to be working. You also have to remember that what you read in the press, even in a magazine like this, may not be the whole truth and nothing but the truth – everything you read has been edited in some way. I think we have to recognise that we are public servants as doctors, and that we are going into a service profession.We’re a very privileged service because people come to us, they trust us and therefore we hold professional values and status which we don’t want to erode.
RR: What has been your proudest achievement since becoming president and what do you still hope to achieve?
Realise it’s a fantastic career and enjoy it. Just because it doesn’t all look rosy doesn’t mean that you can’t have a wonderful experience. Go and talk to people who have that sort of positive attitude and don’t talk to the people who are “glass half empty”. Life is too short!
CM: I think the college has made real progress and the reason I say that is that when people come here now, they think less of it as being a London-centric old boys’ club and more of a professional organisation that is out there to face the world. Now some politicians may not think that, but there have been enormous changes.
Image By Karim Chraihi
...and Its Role in Surgical Education
first heard about Touch Surgery from Mr Jean Nehme, the co-founder and CEO of the company. During talks on medical innovation and entrepreneurship at various educational institutes, including UCL, Mr Nehme explained how his journey stemmed from an ultimate feeling of dissatisfaction with the surgical training he received throughout his specialty’s progression pathway – an unfortunately relatable reality.
industry. He claims that his choice centered on the difference that he could make to patients: as a surgeon, he knew that he could only affect the patients he could physically touch, however, by working on Touch Surgery, he would be affecting the practice of potentially hundreds of thousands of frontline surgical healthcare workers, and by proxy also affecting the millions of patients that they were treating. The positive impact that Touch Surgery could have was far greater than any potential impact he could make as a practicing surgeon.
Many fail to recognise that the first operation a surgeon performs independently is not on a cadaver, nor on an animal model, but on a patient. This practice in surgical training, however risky it may seem, does not vastly differ around the world. While in surgery, junior doctors tend to be restricted to “holding the retractor”, which can make hours of surgery dull and uninformative. Additionally, at the time when Mr Nehme was training, surgeons’ working schedules were being cut from 100 hours per week to only 40. This meant there would be less contact time in operating theatres, potentially limiting the exposure and experience provided as part of the training pathway.
He also spoke of some of the current challenges they were facing. Right now, he said, they are having trouble addressing the huge demand for their platform because they get hundreds of requests from surgeons around the world to build more and more simulations, and that doesn’t even take into account the requests they get for partnerships. They believe they have built the best medical 3D team in the world, and are now working to scale up to address the growing need from the surgical community. Finally, he gave the following advice to medical students who have an interest in surgery, both from an academic and an innovatory standpoint, and about how to pursue these avenues early on in a medical career:
Mr Nehme, along with fellow surgeons Andre Chow, Sanjay Purkayastha and Advait Gandhe, came up with a solution to fill an undeniable gap in surgical education. Touch Surgery was founded as an app that provides realistic step-by-step 3D simulations of surgical procedures, in order to promote the culture of “decision before incision”.
“1 - Scratch your own itch.Start with a problem that affects you, and then see how many other people it affects. By starting with a problem that affects yourself, you already have a deep understanding of it, and can come up with a solution in a more robust fashion.
Further development in the app has led to significant interest from medical students and surgeons alike, and this is reflected in the 600,000 Touch Surgery users. Its surgical simulations have been created from collaborative efforts between surgeons from leading international medical institutes, including Harvard, Stanford, and Yale. There are now over 30 Touch Surgery employees with diverse backgrounds in gaming, animation, programming and software development.
2 - Don’t let your beliefs imprison you. As a doctor, I always felt that I never understood anything about the business world - and that I wouldn’t be able to succeed in that arena. It took me a while to realise that this was complete BS - and that so many of the skills that I learned in a clinical arena translate very well into the business world. Making high pressure decisions, effective communication, teamwork etc. are just a few examples of this.
Few other medical apps on the market have had such a profound impact on the international medical and surgical community. For instance, Touch Surgery is now endorsed by several professional bodies within the UK, including the Royal College of Surgeons. While the app allows surgeons to learn a new procedure, or to rehearse a familiar one, it also has applications for medical students. Too often medical students attend theatres with a poor view of the procedure and little understanding of what the surgeon is doing. Touch Surgery has worked to enhance the quality of learning students receive in operating theatres: by downloading specific surgeries and going through the highly detailed steps, there is the possibility to familiarise oneself with the expected content via a visual 3D platform.
3 - Make a dent. Aim to do something big. Aim to really make an impact. This is not just for yourself, but also to inspire those who you work with. At Touch Surgery we have brought together a group of people from a number of different industries - gaming, movies, medicine. All of these guys and girls could easily have gone to work at other places - but they have all decided to join us here based upon the mission that we have, and the ability to really make a difference. 4 - It’s a marathon, not a sprint.Prepare yourself for the long haul.This is going to take a lot of work, a hundred times more than you think. There are going to be a lot of ups and downs, a hundred times more than you think.You are going to feel some days like you can take on the world, but there are going to be far more days where you really question what you are doing with your life and you are convinced it’s all going to fall apart. Prepare yourself, prepare your family and friends, and then just go and do it.
After hearing Mr Nehme speak at a talk in Manchester, I pursued an internship at the Touch Surgery Labs. The workspace, though different to what we are used to as medical students, allowed me to explore the environment of a start-up.There was a strikingly firm belief among the employees, most of whom had no medical backgrounds, in the vision of the app to improve surgical education and thereby the standards of surgical practice. To improve their anatomical knowledge, the graphics team would have anatomy lessons once a week. On Fridays, we would have a “family meeting”, where one team would present their weekly progress.
5 - Keep questioning.Don’t just bury your head in the sand. Keep on asking yourself the hard questions - why am I doing what I’m doing? Is this really useful? What problem is this really solving? Does this add value? Will this really change behaviour? Is there a better way? Is this really worth it? Continuing to question yourself will help to ensure that you stay on the right path.”
What struck me most about the company were the reasons the two surgeons gave for leaving the NHS to begin a business. To find out more about the founders and their motivations, Mr Andre Chow, co-founder and CEO of Touch Surgery, spoke to Reddit on the matter. During the interview, he admitted that when he first started Touch surgery he never imagined it would lead him to take a step back from the profession; leaving a career as a surgeon for one in the tech
By Saima Azam MBBS Year 3 President of Surgical Society
ART & SURGERY
T HE I N T E R P L A Y B E T W E E N
Image By Rebecca Mackenzie
ften referred to as the founder of modern human anatomy, Andreas Vesalius published his De Humani Corporis Fabrica in 1543—a seminal publication that pervaded the western medical world, and earned him the role of appointed physician to Charles V, Holy Roman Emperor. Along with the printing press, which had been invented less than a century before, the success of the anatomical atlas pivoted on its accompanying woodcut prints by Joannes Stephanus van Calcar from the studio of Titian. These prints theatrically illustrated Vesalius’s performative approach that relied on public dissections.
Also investigating the conditions of the mind and body, artist Deborah Padfield has explored bodily pain through a multi-faceted discourse that has manifested itself in conferences and symposia. Most recently, Padfield has collaborated with Professor Joanna Zakrzewska, facial pain clinicians, and patients from UCLH. This has led to the current UCL CHIRP (Centre for Humanities Interdisciplinary Research Projects)-funded project, Pain: Speaking the Threshold. Aiming to aid experiences of psychological and physical pain felt by those with disabilities, The Alternative Limb Project has revolutionised prosthetics by innovating highly creative and realistic prosthetic limbs. Its founder, Sophie de Oliveira Barata, worked with the amputee pop star Viktoria Modesta to create her music video Prototype (2014). This features multiple alternative limbs, culminating in a scene which depicts Modesta wearing Spike Leg (2014) and insidiously incising the icy ground.
The fruitful relationship between van Calcar and Vesalius was echoed in other early modern partnerships between surgeons and artists. Significantly, Govard Bidloo collaborated with the Dutch printmaker, Gerard de Lairesse, to publish Anatomia Humani Corporis (1685), which responded to Vesalius’s atlas as an alternative way to theatrically demonstrate anatomy. Forming this culture of engagement across the fields of art and science, in the early modern period, anatomical study constituted a fundamental pillar of art training, and, with the rise of empiricism, the artisanal skill of attentive observation emerged as having a crucial role in scientific research.
Comparably, Professor Julian Ellis’s company, Ellis Developments Ltd., employs embroidery techniques to manufacture textile surgical implants. This groundbreaking and novel technology has been used in the tailored repair of abdominal aortic aneurysms, as well as in the creation of orthopaedic implants. More broadly, anatomical study has been a rich source of inspiration for couture designers, including Iris van Herpen and Jun Takahashi.
Just short of half a millennium since the publication of De Humani Corporis Fabrica, the disciplines of art and surgery have changed significantly, and now operate largely independently of each other. Despite this apparent disconnection, collaborations between the fields of contemporary art and surgery continue to result in groundbreaking and dynamic results.
Taking an alternative approach, Dr Rajiv Grover’s plastic surgery practice has been influenced by analysis of portraits by the likes of Andy Warhol and Sandro Botticelli. Grover perceives the central facial triangle to be a crucial mechanism in determining our perception of beauty. These ideas were delivered in his Guggenheim lecture at the Louvre museum in 2009, and have been presented since at London’s Royal College of Art and Central Saint Martins.
The performativity found in collaborations between early modern artists and surgeons has been reformulated in a contemporary context by Roger Kneebone, Professor of Surgical Education and Engagement Science at Imperial College London, through his work with musicians, including drummer Ollie Howell and pianist Liam Noble. This partnership resulted in Jazz & Surgery—an evening which explored the role of improvisation in both fields, and incorporated performances from Howell’s album, Sutures and Stitches (2013), which was inspired by the artist’s experiences of brain surgery. Likewise, Andrew Hall has composed self-generating sound installations relating to cell regeneration after surgery following his role as Musician in Residence for CW+, the charity for Chelsea and Westminster Hospital.
Facilitating discussion amongst professionals and students interested in this field, Reforming Anatomy was founded at UCL last year as an interdisciplinary platform supporting collaborations between contemporary artists and surgeons. Our online presence includes our blog, which offers insight into the field, and our Instagram, which provides visual evidence of the richness of contemporary partnerships across these disciplines. Additionally we will be hosting events in central London in 2017. These will feature lectures from leading relevant professionals along with workshops and performances. Tickets and information will be released to the platforms below in the coming weeks.
Kneebone’s interdisciplinary approach to surgery has extended from the realm of jazz through his work with artists Claire Oboussier and Vong Phaophanit.This led to his inclusion in It Is As If (2015), a multimedia exhibition which consisted of two films featuring uncanny scenes depicting sites of memory and a surgeon’s deterritorialised operation on an absent body. Displayed in an immersive skeletal environment at Block 336 in Brixton, the work can be understood as an investigation into the landscape of the mind, instigated through a surgical lexicon. Complementing the exhibition, Kneebone performed a live simulation of a trauma surgery with Dr Laura Coates in an inflatable “igloo”, which acted as an operating theatre, emphasising the analogous importance of surgical incision to the operation of the wider exhibition.
By Mr. Edward S. Christie, UCL Art History Student and Co-Director of Reforming Anatomy www.reforminganatomy.com www.instagram.com/reforminganatomy
Image By Rebecca Mackenzie
Millennials and the Changing Face of
ecent figures from the USA and UK illustrate that, not only is the popularity of cosmetic surgery at an unprecedented high, but there has been a shift in the procedures requested by patients, and in the patients themselves. Many more men are now seeking cosmetic surgery, with face and neck lifts, male liposuction and gynaecomastia reduction being the most common procedures performed. “Mommy Makeover” surgery, which aims to restore a mother’s body to a pre-pregnancy physique through procedures such as breast augmentation, breast lift and abdominoplasty, has become increasingly popular in the USA, and this demand is likely to spread to the UK.
Perhaps the biggest influence is social media. Its extensive use by millennials - individuals aged 18-35 - is thought to contribute to a rapidly changing attitude towards aesthetic plastic surgery. They represent a generation that consider such surgical procedures acceptable, to the degree that they are often viewed as part of the norm in the pursuit of beauty. This is reflected in figures which show that millennials are considerably more likely to seek cosmetic and minimally invasive procedures than older generations, and also to have it at a younger age. Surveys in the USA have shown that a very high proportion of millennial women say that they are unhappy with at least one aspect of their bodies, and according to the American
Society for Aesthetic Plastic Surgery (ASAPS), in 2015, millennials made up nearly 27% of surgical procedures and nearly 16% of non-surgical procedures1. The President of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) has summarised the anxieties about the younger demographic seeking cosmetic procedures: “The teen and young adult years are a highly impressionable time and the more consumers are inundated with celebrity images via social media, the more they want to replicate the enhanced, retouched images that are passed off as reality”.2
Millennials are exposed to what is perceived as physical perfection by the celebrity culture and media. Though the reach of this influence is certainly not limited to a particular generation, it is the associated general desensitisation to cosmetic surgery and negative psychological impacts of social media that are driving people to seek plastic surgery, often with unrealistic expectations. A 2015 survey by AAFRPRS quantified the impact of social media and celebrity culture when it stated that 82% of surgeons cited celebrities as a “major influence” in their patients’ choice to undergo a cosmetic procedure.2 This comes as public figures speak more openly about their relationship with plastic surgery, while the media plays into the insecurities of the public by continually focusing on the desirable features of high profile individuals. Social media also affects how surgeons manage patients pre-operatively. Patients may have exaggerated concerns about perceived abnormalities, and it is the responsibility of surgeons to ensure that patients view their perceived problems in a proper perspective and manage expectations, especially if the desired features match those of a particular celebrity. Some individuals have unrealistic expectations stemming from an underlying condition that requires psychiatric care rather than surgical attention, and distinguishing this is very important. For instance, body dysmorphic disorder is when a patient believes that their appearance is abnormal when it is not so. As this is a psychological condition, it cannot be treated by cosmetic surgery, and an operation may in fact make the condition worse as the mental health of the patient has not been addressed. The impact of social media extends beyond post-operative care as the work of surgeons is also affected. Interestingly, there is now a mobile app which specifically targets the younger demographic interested in plastic surgery by offering digital consultations with plastic surgeons, opinions, quotes and appointments. This is in addition to the various comparison websites whereby patients leave reviews of individual surgeons. Millennials are often better informed in their understanding due to the ease of access to information from validated sources. Patients now, unlike those of earlier generations, use social media to develop an awareness regarding the predictability of procedures, and more comfortably relay these expectations to their surgeons, with surveys finding that most millennials desire a natural appearance. One distinction that the surgical profession is very concerned about is that an aesthetic plastic surgeon and a cosmetic surgeon do not necessarily have the same degree of training, even though individuals can undergo surgical cosmetic procedures under the care of either. There is no restriction on any doctor practicing cosmetic surgery on patients; they do not need to have received any formal surgical training (in cosmetic surgery or otherwise), passed the Fellowship of the Royal College of Surgeons examination or have been on the GMC’s specialist register. Following Professor Sir Bruce Keogh’s Review of the Regulation of Cosmetic Interventions, the Department of Health asked the Royal College of Surgeons of England to set up an Interspecialty Committee on Cosmetic Surgery and develop evidence-based standardised patient information. This work is now almost complete and, in 2017, the College is introducing a certification scheme for surgeons under taking cosmetic surgery. Surgeons will be required to submit evidence of their training and experience in the types of cosmetic surgery that they wish to perform, and if they meet the required standard they will be certified to perform those procedures. For example, ENT surgeons
might be certified in rhinoplasty and bat ear correction (pinnaplasty), whilst breast surgeons may be certified in breast augmentation, breast reduction and/or mastopexy (breast uplift). However, those surgeons would not be qualified to operate on areas outside of their specialty, such as abdominoplasty. However, plastic surgeons with training in procedures done on all parts of the body may apply to be certified for all types of cosmetic surgery. The list of certified surgeons and extensive patient information will be made available to the public through the College’s website, allowing patients to check that their surgeon is not only a fully trained surgeon, but has also been certified in the relevant procedure. Millennials have an increasing desire for minimally-invasive cosmetic procedures, such as lasers, peels, injections of Botox ® and soft tissue fillers, even though signs of ageing which would warrant such procedures are typically not yet apparent. Demand for such procedures has increased by 29% between 2010 and 2014, according to the British Association of Aesthetic Plastic Surgeons3. This rise is likely to be attributed to two things: firstly, the development of dependence due to the illusion of being ageless, which many high profile individuals promote on social media. Secondly, the impact on a person’s view of themselves and subsequent rejection of the natural ageing process. However, the effects are short-lived. For instance, Botox ® wears off after a few months, and individuals can find themselves committing to many years of treatment. This can cause the appearance of premature ageing at the additional cost of impaired function, such as overly full lips or a frozen forehead. The apparent ease of access to these minimally-invasive procedures, and the fact that they are often undertaken in beauty salons by hairdressers and mobile therapists, is worrying. A reputable practitioner would most likely advise against such treatments, but other less qualified practitioners may not be as scrupulous. Despite the significant risks from these procedures, there is a widespread belief amongst the public that these procedures are no more risky than getting a new hairstyle. Yet lawyers are seeing an increase in enquiries about injuries from these procedures performed at beauty salons, such as burns, scarring, and skin discolouration. Of major concern is the lack of effective regulation of individuals who are qualified to carry out minimally-invasive procedures. In 2015, Health Education England published its qualification requirements for practitioners performing such procedures; however, they are not mandatory. The British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), the British Association of Aesthetic Plastic Surgeons (BAAPS) and the British Association of Dermatology (BAD), working in conjunction with the Care Quality Commission, are leading the development of a regulatory body: the Joint Council for Cosmetic Practitioners. This will hopefully weed out the unqualified practitioners and make treatment safer for patients.
By David Ward FRCS FRCSEd Emeritus Consultant Plastic Surgeon President BAPRAS 2017-18 References:  American Society for Aesthetic Plastic Surgery. Cosmetic Surgical National Data Bank Statistics. 2016; 16-18.  American Academy of Facial Plastic and Reconstructive Surgery. New 2015 Stats: Face of Plastic Surgery Goes Younger Due to Growing Social Media and Reality TV Influence on Millennials. 2016.  Adapted from: Penningtons. Popularity of Non-Surgical Cosmetic Procedures as Demand for Cosmetic Surgery Falls. 2015.
VIRTUAL REALITY, SURGERY & MEDICAL EDUCATION
Image By Rebecca Mackenzie
THE MOUNT SINAI HOSPITAL EXPERIENCE
t seems like everybody is talking about virtual reality (VR). It’s the hottest tech “buzzword” of the year. Broadly defined, the term refers to computer-generated experiences designed to mimic reality. In popular culture, VR has become more specifically associated with head-mounted displays, such as the Oculus Rift, which provide immersive visual experiences. This new technology has spawned a rapidly expanding industry, with massive amounts of human and financial capital invested in developing VR content and delivery systems. Major corporations, including Sony, Google and Facebook, have brought attention to the field with new VR ventures and big-ticket business acquisitions. Much early interest has focused on the place of VR in the entertainment industry; social media applications, VR games and 360-degree videos are readily available to consumers and new content is consistently being released. But the potential of VR extends far beyond entertainment applications; several industries are finding creative, novel uses for VR and healthcare is among one of them. At the Mount Sinai Hospital in New York City, VR applications are being developed to improve pre-operative planning and the way that we educate future generations of physicians. In order to plan and execute an operation successfully, the surgeon needs to understand all anatomical structures involved. Medical school and surgical residency provide foundational training in anatomical concepts, but each individual patient’s body is unique and pathological processes disrupt normal anatomic relationships. For years, clinicians have relied on imaging modalities to learn their patient’s anatomy. Now, surgeons in the departments of neurosurgery and otolaryngology at Mount Sinai are using VR. With help from technology developed by Surgical Theater, patient CT and MRI scans are reconstructed in a three-dimensional format that is compatible with VR head-mounted displays. Surgeons at Mount Sinai can then study their patient’s anatomy in an immersive, virtual reality environment - they “fly through” the patient’s bodies using a handheld controller while their head movements are tracked to display 360 degree views. The technology effectively segments the scans so that surgeons can easily appreciate the different types of body tissue as they move through the VR environment. For complex skull base tumours, otolaryngologists and neurosurgeons can better appreciate the intricate relationships between tumor tissue, normal brain matter, vital blood vessels, and nerves. These enhanced images assist the surgeon in assessing the safety of surgery and planning procedural approaches. For example,VR views can help surgeons decide whether a tumor can be resected entirely through the nose, via endoscopy, or if an open craniotomy is necessary to safely resect tissue. At Mount Sinai, adoption of VR technology is not limited to doctors patients are strapping on head-mounted displays too. Neurosurgeons are providing VR displays to patients during pre-operative consultations, allowing them to see VR reconstructions of radiological scans, which are much easier to understand in comparison to the traditional complex imaging modalities used to display surgical cases. This is an effective and efficient way to educate patients about what is happening inside their bodies. So far, patients and their families have responded positively to this program, expressing gratitude for the clarity that VR provides.
Outside of clinical care, VR is also being used for medical student education. Anatomy is vital to any basic medical understanding, but as medical schools change their curricula the time devoted to cadaveric dissection has diminished. At the Icahn School of Medicine at Mount Sinai, VR applications are augmenting anatomical study. Three-dimensional, immersive VR has a major advantage over traditional surgical atlases. Like surgeons, medical students can more easily appreciate spatial relationships when they are presented in a VR format rather than a 2D image. In an initial controlled study, researches and doctors in the otolaryngology department presented a VR model of neuroanatomy to 60 first and second year medical students. The model was built from CT and MRI scans of patients with normal anatomy. With a focus on the ventricular system and the neurovasculature, the model was labeled with commonly studied structures. Half of the students studied using VR and the other half used 2D materials.The students took quizzes before and after studying, and completed validated surveys to measure their motivation to learn and their mental workload whilst studying. The two groups performed equally well on the quizzes, but the individuals using VR were more motivated to learn than the control group. They also reported that studying was more engaging and more enjoyable. Building on this initial study, the department of otolaryngology has teamed with medical illustrators at the school of medicine to further develop VR teaching systems.With input from anatomy professors, this group is identifying particularly difficult topics in anatomy—such as the cranial nerves—and building VR systems to help teach them. In the past, students have had to study 2D pictures and re-create 3D structures in their minds. Using VR, they will be able to immediately encounter anatomy in three dimensions. The ultimate goal is to reimagine the entire surgical atlas as a VR experience. Healthcare students and professionals will be able to easily access and explore every part of the body. This project will also include pathology. Medical training is contingent upon exposure to disease, but there is no guarantee that a future doctor will encounter every malady. Medical students and residents may never experience the less common diseases.VR can provide exposure to rare pathologies in a safe setting for learning. At the Mount Sinai Hospital, VR is already helping to provide better care to patients and enhanced education to students. And this is just the beginning. It is impossible to anticipate all of the ways that we can apply VR to solve healthcare problems. However, it is certain that this tool is powerful and should be welcomed for its potential to transform the practice of medicine.
By Joshua Zeiger and Alfred Marc Iloreta, MD Joshua Zeiger is a current research fellow working with the Department of Otolaryngology at Mount Sinai School of Medicine, currently in medical school at New York University and a graduate of Georgetown University in Washington, DC. Alfred Marc Iloreta is an Assistant Professor at Mount Sinai School of Medicine, completed a fellowship in Skull Base Surgery and Rhinology. Otolaryngology Residency Training at Mount Sinai School of Medicine
In 1943, Philip Wiles, from the Middlesex Hospital, implanted one of the first THRs. This implant, composed of stainless steel, featured a metal-on-metal articulation (Fig. 1), and was essentially the first metal-on-metal surface replacement. A major innovation was made in the early 1960s by Sir John Charnley, from the Wrightington Hospital in Lancashire, who introduced the “Low Friction Arthroplasty”. This design is fundamental to most modern hip joint replacements and, when Charnley first introduced this design, he made the acetabular component from polytetrafluoroethylene (PTFE), which articulated against a stainless steel femoral component (Fig. 2). However, he realised that this bearing combination resulted in the release of small particles from the articulating surface, causing local inflammation. In 1963, Charnley replaced PTFE with high molecular weight polyethylene, which was more successful. Charnley’s total hip replacements were fixed to the bone using acrylic bone cement, which is composed of a liquid monomer, methyl methacrylate and polymethylmethacrylate (PMMA) powder. It was mixed at the time of surgery, forming a dough-like, grouting material, and was then packed into the intramedullary cavity or around the prepared acetabulum before the stem or the cup was inserted.The PMMA sets within about 12-15 minutes, locking the implant components into place. There have been a number of innovations in the way that cement is delivered: nowadays cleaning of the cavity is used, together with pressurisation and mixing of the cement to avoid the generation of air bubbles, to optimise the cement’s strength and integration with the bone.
HIP JOINT REPLACEMENTS:
steoarthritis results from the breakdown of joint cartilage and underlying bone, and is believed to be caused by mechanical stress on the joint along with low-grade inflammatory processes. In the UK, a third of people aged 45 and over have sought treatment for osteoarthritis (OA) and over 70,000 Total Hip Replacements (THR) each year are carried out, mostly to treat OA.THR is a very successful operation, with a success rate greater than 90% at 10 years.
THE HISTORY AND THE FUTURE
The success of THR has resulted in younger patients with OA being treated. However, it was believed that the strength of the cement-implant interface was too weak to sustain the loads associated with the high activity level of these young patients and therefore, cementless fixation by direct bone integration (osteointegration) of the implant surface was advocated (Fig. 3). A number of surfaces have been developed to encourage osteointegration. These surfaces rely on some form of porosity into which the bone grows. Alternatively, the surfaces may be coated with a thin layer of hydroxyapatite, which is the calcium phosphate mineral found in natural bone - this encourages bone formation on the surface of the implant. Uncemented implants can be associated with non-physiological loading of bone due to the relatively high stiffness of the metal alloys, resulting in bone resorption. This is known as stress shielding, where stresses are lower than normally found in natural bone. In the 1980s, it was noted that implants by bone resorption at the cement-bone interface failed. Whilst this was first attributed to the break-up of the cement at the interface, it was realised that small wear particles which are usually under 1 µm in size - are generated from the articulation, causing a macrophage response, in turn leading to inflammation and osteoclastic bone resorption. This is termed aseptic osteolysis. In order to reduce the release of these polyethylene wear particles, new cross-linked polyethylenes with lower wear characteristics were developed with considerable success. Alternative bearing surfaces, such as ceramic-on-ceramic and metal-on-metal, show even less wear. McKee and Farrar from the UK started to work with cobalt chromeon-cobalt chrome metal bearings in the 1950s, but it was not until the use of PMMA in the 1960s that satisfactory results were obtained. However, in the 70s and 80s, these metal-on-metal devices were not extensively used due to the success of metal-on-polyethylene implants and the continued poor results associated with some metal-on-metal
implants. In the 1990s, these metal-on-metal bearing surfaces were developed further and, at around this time, large head metal-on-metal articulations were being developed, again largely by British surgeon innovators.These hip replacements were able to resurface rather than replace the femoral head and, therefore, the operation was considered more conservative than a THR. Due to the large head, the stability of the implant was better than that seen with THRs and simulation studies in the laboratory demonstrated low friction between the articulating surfaces, meaning large metal-on-metal heads were then adopted for THRs. However, data from National Joint Registries - particularly those in Australia, England and Wales - which monitor different designs of implants over a period of time, indicated that metal-on-metal articulations were associated with poorer outcomes than metal-on-polyethylene or ceramic-on-ceramic articulations. Although the wear from metal-on-metal bearings was low, wear particles and corrosion led to adverse biological reactions that were associated with T-cell
Image By Karim Chraihi
The Wiles Hip Replacement. Developed in 1938 by Philip Wiles from the Middlesex Hospital
A) Charnley hip replacement showing the stem and head made from stainless steel and the cup made from polyethylene. B) Radiograph of Charnley hip replacement. The hip stem has been inserted by a trochanteric approach which these days is rarely used. The wires are used to reattach the greater trochanter to the femur. C) Section through a Charnely cup showing that the wall thickness of the plastic is reduced in one aspect and this is associated with wear of the polyethylene.
infiltration, formation of cystic masses (pseudotumours) and necrosis of soft tissues. Modular, large head metal-on-metal hip replacements, where a head fits onto a stem taper, have been shown to produce additional corrosion products and debris from the modular junction referred to as trunnionosis, leading to even greater adverse reactions and failure. Nowadays, we rarely perform large head metal-on-metal hip replacements; surgeons in the UK generally use metal-on-cross-linked polyethylene or ceramic-on-ceramic articulations with either a cemented or uncemented fixation. Surgeons prefer these new bearing surfaces because they reduce the release of
Cemented fixation shown in Ai with a transverse cross section in Aii showing the stem, cement and bone remodelling around the cement. Cementless fixation in Bi showing a cross section A-A and a cementless interface in Bii with bone red growing into the porous structure.
debris, and so loosening is less of a problem. As these problems are addressed, often in an empirical way, new challenges to increasing the success of THR are encountered. A chief limiting factor today is the infection rate of implants, which currently for THR is between 0.5 and 2%. Treatment of an infected implant often involves removal and revision of the prosthesis, which is disastrous for patients - not to mention costly. Infection is associated with the formation of bacterial biofilms, which stick to the implant surfaces and are difficult to eradicate using conventional antibiotics. As bacteria become more resistant to conventional antibiotics, the infection rate may well increase
and, as such, future challenges include the development of new agents, prostheses and techniques to combat biofilm formation and infection. By Gordon Blunn Professor of BioengineeringÂ President of the British Orthopaedic Research SocietyÂ John Scales Centre for Biomedical Engineering, Institute of Orthopaedics and Musculo-Skeletal Science, Division of Surgery & Interventional Science, University College London, Royal National Orthopaedic Hospital
Weâ€™ve been busy gathering misconceptions about various aspects of RUMS, and then asking the relevant representatives to explain their views. Read on to have your questions answered! Tanya Drobnis,Demystifying Medical School Editor RUMS Review
Demystifying Medical School affects your education such as lecture slides not being uploaded, audio-visual issues and even personal tutors. Most importantly, we go through the Student Evaluation Questionnaires that are filled out by you after every module and implement changes based on the feedback.
1. RUMS societies appear to be extremely heavily centred on sport. Whilst it’s not true to suggest that all RUMS societies are sport-based, I do think they have a much higher profile because the people involved tend to be very active in the medical school social sphere. We also rely on a smaller group of people within the medical school to be extremely committed to sustain the sports club itself. Furthermore, sports night is a staple part of the week and is inevitably associated with sports teams. In reality, the prominence of RUMS sports is simply a reflection of the large number of people involved. The standard some of our teams operate at is higher than UCL equivalents, and as such so is the publicity that players or results attract. Having said that, our comedy revue society, the MDs, have won more UH competitions than any other society.
Demystified by Carol Chan (yr one-three) and Tay Mohamed (yr four-six), Educational Representation VPs
4. It can be hard to get in touch with any of the RUMS representatives unless you know them personally. It’s hopefully not unreasonably difficult to contact RUMS representatives, as we always strive to make ourselves more open to students. We have over 70 reps spread across the six years of the medical school. You can also find our names and contact details on the RUMS Facebook group, and we’ve set up year specific groups which allow us to spot year specific issues. If you don’t use Facebook, you can tweet or DM us on twitter, we have RUMS noticeboards dotted across the three central sites, and all our details can be found on myrums.com (our website). Our primary role is to represent students, and we are aware that we can’t do that if you don’t find us approachable, so we have worked very hard to make ourselves as easy to contact as possible. This year in particular, we have made great efforts to increase communication between RUMS and the student body. Notably, we have introduced a Publicity Officer, whose main remit is to make sure the work of RUMS is as accessible as possible, and who ensures that channels of communication and feedback are open. In fact, with the recently updated noticeboards, and rumours of a feedback video on the horizon, it won’t be long before you can’t move for seeing our faces, for better or for worse. And if you have any further questions about this topic, please do get in touch with me at email@example.com.
I often ask other societies if there is anything I can do to increase the publicity of their organisation, but most opt to persevere themselves without my involvement. This is not to say they are excluded, they are given an equal footing by the RUMS committee. Indeed, we had a record 38 stalls at Freshers’ Fayre this year - of which only 11 were sport related. The RUMS committee offers its support to any of our proud and successful groups, and as they know, are more than happy to assist with any issues they may face. Demystified by James Shuttleworth, Sports and Societies VP
2. RUMS societies are exclusively for medics. RUMS is a medical school society and it caters for the medical students of UCL. We are here for six years, have different needs to many other students and tend to stick together. We also make up nearly 10% of the entire student body and have a voice quite unlike any other faculty or group at UCL. It is not a clear cut line that only medical students can join RUMS clubs, but it is one that in my opinion should depend on circumstance. RUMS is one of the finest medical student representational bodies in the country, and maintaining its autonomy as a body for medical students is a key aspect of its identity. I am aware of a few individuals who have joined RUMS sports teams citing close friends they made during their first year, and exceptional cases are fine if there is a legitimate reason. We are not out there to turn people away or separate people from the first friends they have made at university just because they are not medics. I am well aware that RUMS groups are dissociated from UCL and that there is a reasonably intense rivalry, but this is fundamentally an organisation for the medical students, and should continue to be viewed this way.
Demystified by Raj Pradhan, President
5. It becomes increasingly difficult to juggle RUMS commitments with academic life as you move through medical school. Getting through a degree in medicine is not easy. For those that don’t believe me, wait until late April when you’re sleeping with two volumes of Dean and Pegington under your pillow, using a trail of your own tears to guide you to and from your spot in the library, and praying to a small clay idol of Finn Werner. In fact, being a medical student is about far more than just getting your degree. The people you meet and the things you participate in will shape you far more than the four letters you get after your name. Whether it’s staying at Bloomsbury for a few extra hours to spend time with children in PlayTeam, dragging yourself out of bed on a Sunday for a sports match, or working out how to parade 300 freshers through an obstacle course of older years in Hampstead without ending the night in A&E, there is something deeply rewarding in the achievements you make beyond your timetable. Regardless of how you do it, it’s vital to maintain a life outside of the library. As you get older and start your clinical placements, it can seem harder to manage your commitments.Yet it is often those very same commitments - the people you meet, and friends you make - that keep you grounded and help you get through the obstacles you face.
Demystified by James Shuttleworth, Sports and Societies VP
3. RUMS seems to just be about the social side of things - what about academic support? We do take the academic aspect of RUMS very seriously too. The RUMS Education Vice Presidents, Carol (Years one-three) and Tay (Years four-six) have just as much weighting as the two other social VPs. We have recruited a team of student academic representatives from every year group to ensure that you are represented and your voices are heard, and we cover initiatives ranging from the faculty lunches to the academic modules. Every term, we chair Student Staff Consultative Committee (SSCC) meetings with all the student representatives as well the faculty responsible for our education. We talk to year leads, module leads, and the dean of the medical school as well the library staff and the admin team. We discuss everything education related – portfolios, lecture content tutorials and formative quizzes. We also go into the nitty gritty that
The truth of being a medical student is that no matter how hard this course gets, you’ll find that you can always make time for the things that really matter. And it’s those things that will shape how you live your life. Demystified by Raj Pradhan, President
Comment & Correspondence
The Debate With Many Sides In the spirit of sparking discussion amongst our readership, in this issue of RUMS Review our comment and correspondence section takes the form of a debate. In only 500 words, each guest debater must argue either for, or against, our topic:
Should abortion based on the grounds of disability be made illegal? On the 21st of October 2016, the Abortion (Disability Equality) Bill, which seeks to amend Section 1(1) of the Abortion Act 1967, received a second reading in the House of Lords. Section 1(1) of the Abortion Act 1967 currently gives foetal disability as one of the criteria for which abortion can be requested. The Bill proposes to make it illegal for women to seek an abortion based solely on foetal disability. In practice, it would still allow women to abort a disabled foetus right up until birth, but only on the grounds that the disabled
foetus poses a serious risk: • to the Mother’s life • of permanent damage to her • the physical or mental health of the mother or her existing children Abolishing Section 1(1)(d) of the Act would mean that, practically, any abortions by reason of disability would need to be carried out within the first 24 weeks. Supporters of the Bill believe the amendment will remove the eugenic and discriminatory tendencies currently enshrined by the law.
roponents of the Abortion (Disability Equality) Bill would argue that a contradiction exists in our legal system. The Equality Act 2010 prohibits discrimination arising from disability, (while at the same time) discrimination is deemed to be enshrined in UK law as life begins, prior to birth. Although an able bodied foetus may be aborted in a time frame of up to 24 weeks, those who are disabled may be aborted up to birth. What (is implied) about the value, or lack thereof, for disabled life? The source for this contradiction lies within the Abortion Act 1967, wherein Section 1(1)(d) states explicitly that grounds for abortion exist should “two medical professionals [agree] that … there exists substantial risk that [a child should be born with] physical or mental abnormalities as to be seriously handicapped”. It may be said that what constitutes a “serious handicap” has changed significantly with medical advances in the last 50 years. So too have our attitudes and expectations for people living with disabilities. Advocates for this Private Member’s Bill would therefore argue that it is intended to correct an incompatibility, which has arisen from outdated, anomalous legislation.
**Disclaimer: in this debate, the views expressed by the writers are not necessarily their own, but rather are a summary of the most compelling arguments for each side of the debate.**
abnormality present risk to the pregnant woman’s life or risk of serious permanent damage to her, amended legislation would conserve the right to abortion up to birth.This covers situations arising in which a parent would be unfit or unable to fulfil their caring obligations. Indeed, if a woman chose to terminate on grounds of disability, the law would still allow her to do so up to 24 weeks. It has been suggested that a number of terminations arising from foetal disability were, in fact, conducted on grounds of injury to the mental health of the mother. As a result, the impact of this Bill on the expected number of terminations is deemed to be minimal. The difference of focus lies in the fundamental principle of equality.
Why abortion based on the grounds of disability should be made illegal.
Discussions around the access to abortion services for women are always distressing. Yet the Bill’s proponents maintain that, in practice, limiting abortion is not within the Bill’s scope. Consider a case in which a severe foetal abnormality is diagnosed late – too late for a 24 week cut-off. Such a dilemma may, unfortunately, arise for women who in dire circumstances, are unable to support a child.Yet, should a foetal
However, the Bill is contentious and there are many who oppose it, including the BMA who believe the new Bill would be “inhumane” and “risk psychological harm”. In this debate, we have asked two medical students to argue either for, or against, the passing of this new bill.
Grounds for abortion remain unequal. By supporting the status quo, Parliament is argued to have legitimised discrimination on the basis of disability, or even to have normalised it. The relevance of this normalisation extends to the consulting room, and to the reader as a future doctor.Were disability not reason for abortion, it would go unmentioned. While it remains an explicit justification, doctors will, inevitably, mention to those carrying a foetus with risk of disability that she could (or should) have an abortion. That comment carries the authority of the medical profession. Significant numbers of parents state that they felt real pressure to pursue an abortion. It is the pressure exerted – by clinicians, by legislation, by societal norms – which proponents of the Bill seek to challenge.
By Joel Sugarman, MBBS Year 4
Comment & Correspondence
Why abortion based on the grounds of disability should not be made illegal.
epealing the right of women to termination where “a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped” exists has been offered has an answer to the “pro eugenic” stance of the status quo. Realistically, not only does this claim seem to be untenable – the new proposal is damaging to both mother and child. Parenthood is centred around an obligation to nurture and care for the child. Where the child is “seriously” disabled, the intensity of care needed increases with the severity of the disability. Currently, prospective parents can opt out of an increased responsibility. The new bill would remove this option, and compel a woman to carry the baby to term. Under the new bill, the state would be enforcing its interpretation of what is morally correct onto the mother. Whilst there are situations in which the state’s moral code takes precedence over that of the individual (e.g. legal status of recreational drugs), state precedence in this case forces parents to take on a responsibility they may not be willing or able to, providing little in the way of practical and financial support in fulfilling this responsibility. The removal of choice is just only when its benefits outweigh its harms – as shown below, the removal of choice here leads to tangible harm, and few benefits. The base unit of society is said to be the family. Families are built on relationships between relatives – in this case, parent and child. Where the state forces the carriage of such a child, maternal and parental resentment of that child is a serious risk. Such resentment leads to the deterioration of the parent-child relationship. Where a child is seriously disabled and greater intensity of care and nurture is required, this deterioration could lead to a shirking of an increased parental responsibility.This presents a serious risk to the development and wellbeing of such a child. Where this relationship deteriorates to neglect, the child may become a ward of a state which is woefully inadequate in its provision for such children, presenting further tangible risks to wellbeing. If a pregnant woman considers the above and wishes for a termination, currently, she can undergo one. The proposal would deny her this option.This removes from such a woman the rights she has over her own body, and cedes them to a state claiming higher moral authority.Valuing the potential for life of the unborn child over the established existence of the woman reduces her to a mechanism by which to give birth. Devaluing an autonomous individual to a mechanism is contrary to current narratives of gender equality, and is regression in the face of progress on this front. Preserving the status quo does not mandate termination with risk of foetal abnormality, but serves to protect both mother and child from the harms shown above.
By Yousef Mahmood , MBBS Year 1 37
Image By Kate Mackenzie
Careers Work Shop: Surgery Welcome back to the Careers section of RUMS Review! In this issue, it’s all about Surgery. We have some great tips from the UCLU Surgical Society specialty reps, along with information on how to find out more about a career in surgery. In addition, we have an interview with Dr Tara Mastracci, consultant vascular surgeon and aortic repair lead at the Royal Free Hospital. We hope you enjoy reading the section and find it helpful! Izabella Smolicz, Careers Editor
Image of ENT Course
urgery is a specialty that appeals to many people for a variety of reasons including: its immediate nature, practical aspects and daily team-based environment.
There are many ways to find out more about surgery and show your commitment to this competitive specialty, such as attending surgical skills courses, carrying out relevant SSCs or research projects, presenting at conferences, going on surgical electives and, of course, networking! Who better to speak to than surgeons themselves? Surgeons must keep logbooks during their training; it is a good idea to start early and record the surgeries you have observed to show your interests.
What resources are there for medical students? UCLU Surgical Society (or “SurgSoc”) is a great place to start for information on what a career in surgery is like. Here is a selection of the many different activities that medical students can get involved in, outlined by Saima Azam, the president of UCLU Surgical Society 2016/17:
• Basic Suturing Workshops for freshers. • Advanced Suturing Course consisting of eight sessions working through basic to advanced techniques e.g. vascular anastomoses. • ENT Skills Course. The most recent was on 12 December 2016 which included the stations: epistaxis, nasoendoscopy and microscopy to look inside the ear – look out for two more sessions in 2017! • Orthopaedics Skills Course - five to six sessions, occurring on the first Tuesday of every month. • National Undergraduate Surgical Conference (www.nugsc.co.uk) - 200 tickets have already been sold and the event will include an incredible array of workshops and high profile speakers including Nadey Hakim, a transplant surgeon. • Anatomy revision courses for first and second years and surgical revision courses for fourth and fifth years, beginning next term. • Successful Battle of Specialties event held with Medsoc. • Specialty specific talks, including Introduction to ENT, Debunking Plastic Surgery, and an Ophthalmology Careers evening. • A Duke Elder revision course for Ophthalmology will be started on 19th January 2017, covering topics such as ocular physiology, anatomy, neurophthalmology and paediatric opthalmology.
Surgical Shadowing Scheme Many specialties are involved in this scheme, including Paediatric Cardiothoracic Surgery at Great Ormond Street Hospital. “The Surgical Society’s shadowing scheme offers a great opportunity to experience the clinical side of medicine, which we wouldn’t otherwise experience until year four. I found it interesting, enjoyable and interactive. Not only do you observe surgery conducted by the consultant and registrar, the opportunity to build a rapport with the fourth year medical students undergoing their clinical rotations is an invaluable opportunity. They are all friendly, explain the procedure being completed and even offer advice about the year ahead. Plus, with our rigorous lecture-based schedule, how often do you get to play with polycarbonate cement, wear a lead apron or watch power tools in action?” - Alexander Ng, first year medical student. There really is something for everyone! More information can be found at www.uclusurgicalsoc.com and on our Facebook page https://www.facebook.com/ uclusurgsoc/
Trauma and Orthopaedics
The Royal College of Surgeons is another source of information regarding a career in surgery and includes useful resources such as the National Undergraduate Curriculum in Surgery. This outlines what is expected of medical students in terms of their knowledge and exposure to surgery throughout medical school. A key page in this document is page 12, which outlines the key surgical conditions students should be familiar with before graduating - so clins, take a look! Pages 26 and 27 outline key skills and interventional procedures.
How long does it take to become a consultant surgeon? It generally takes 10 years following graduation from medical school to become a consultant, including a two-year foundation, two years of core surgical and approximately six years of specialty training. However, as mentioned in our Global Health Issue, people do take time out, for example to undertake a PhD, which can extend the training pathway.
Advice from SurgSoc Specialty Chairs
Celine Goh, Paediatrics
Paediatric surgery is a rewarding specialty that attracts some of the most diligent and caring doctors. Examples of common operations that paediatric surgeons perform include appendicectomy, inguinal hernia repair and orchidopexy for an undescended testicle. Patients range from neonates to older children.
For pre-clinical students, anatomy is extremely important in surgery so ensure you learn it well. It is certain that, at some point, you will be asked by a surgeon in theatre where a muscle originates and inserts or which organs are retroperitoneal, and you will definitely want to know the answer - believe me! In addition to the Royal College of Surgeons website, each specialty has their own website which provides further information. They are worth looking at, as many have studentships and competitions open that medical students are eligible to apply for.
Ophthalmology is a good specialty for those who like both medicine and surgery, offering a mix of both pathways. There are also exciting sub-specialty overlaps, such as neuro-ophthalmology, ocular oncology and oculoplastics. Sight is a vital sense for quality of life. It is therefore highly satisfying to see a patientâ€™s sight improve following often very routine and low risk operations. Eye surgery is very delicate and can involve all sorts of exciting instruments such as lasers and micro-robots. For those looking to gain an insight into ophthalmology, do come along to our Duke Elder revision course at the start of next year. You are also welcome to contact me at gabriel. firstname.lastname@example.org with any questions, comments or ideas.
Oral and Maxillofacial
are unlikely to turn you down and even if they themselves are unable to help, they are usually happy to recommend somebody who is. UCL Medical School is very fortunate to have top-rate departments spanning all specialities. For ophthalmology in particular, Moorfields Eye Hospital and the Institute of Ophthalmology are both internationally renowned departments full of opportunities and projects.
Gabriel Lee, Ophthalmology
A general piece of advice, applicable to all specialities, is to not be afraid to approach people. If you are genuinely interested, people
This year, UCLU Surgical Society invited two renowned paediatric surgeons from Great Ormond Street Hospital to share their experiences with UCL medical students.
Careers Mr Joseph Curry is a paediatric general surgeon who talked about complex cases he encountered in gastrointestinal surgery, and Professor Victor Tsang is a paediatric cardiothoracic surgeon who shed light on some of the more philosophical and social aspects of his work. Both agreed that although the training path is long (paediatric surgeons become consultants in their thirties or forties!), paediatric surgery is a specialty that makes a great difference to children’s lives. How do you find out if paediatric surgery is the specialty for you? As a medical student, you can try to obtain clinical and/or research experience in paediatric surgery. UCLU Surgical Society offers a paediatric cardiothoracic shadowing scheme at Great Ormond Street Hospital (sign up at http://www.uclusurgicalsoc.com/shadowing-1/). You could also try performing research in paediatric surgery – a good time would be during your intercalated BSc year! You can email paediatric surgeons at Great Ormond Street Hospital to ask if they would be willing to supervise your iBSc research project. Outside of your iBSc, you can also do audits and research projects (such as with Acamedics) in paediatric surgery.Your clinical/research taster of paediatric surgery may then help you decide if the specialty is for you!
no plastic surgery rotations in our undergraduate curriculum but if you can organise a day in your holidays to join a team in theatre or clinic then you’ll get a great insight into the life of a plastic surgeon. Plastic surgery is competitive relative to other surgical specialties and because of this, it’s important you give your CV a boost and show commitment to the specialty by getting involved in research. By taking part in projects not only will you have evidence that you’re interested in plastic surgery but you will also get a chance to help advance the specialty. You should also keep an eye out for plastic surgery events for undergraduates run by BAPRAS (the British Association of Plastic, Reconstructive and Aesthetic Surgeons) and UCLU Surgical Society of course! These are a great opportunity to hear from a range of plastic surgeons and also to learn and practice surgical skills from an early stage.
At UCL, we are lucky enough to have strong links to the National Hospital for Neurology and Neurosurgery, the UK’s largest hospital dedicated solely to neurological conditions and a major international centre for both training and research. In fact, half of all fourth year students complete their neurology placement there, although for the eager pre-clinical student there is still a lot you can get involved with to give yourself a leg-up in getting into this extremely competitive specialty.
Plastic surgery is a truly diverse specialty; with most specialties you tend to specialise in operating on a specific part of the body whereas with plastic surgery you are learning a set of skills and procedures that are relevant from head to toe. While it’s true that as a senior consultant you may choose to specialise in one particular area, there is nothing to stop you from performing major breast reconstruction in the morning and hand trauma in the afternoon. The best way to decide if plastic surgery might be for you is to get involved. There are
Academically, the Neuroscience iBSc is always a popular option and, although not technically surgical, it is great for budding neurosurgeons to cement knowledge of head/neck anatomy and neural physiology. In the incredibly fast paced world of neuroscience, advances happen daily and, therefore, it is vital to stay abreast of new techniques and knowledge, and to gain an awareness of important neurological research – so get reading!
Leyre Vanaclocha Saiz, Urology David Peprah and Katie Barnes, Neurosurgery
Max Greenfield, Plastic Surgery
to find real surgery clips to give you a taster!
Schemes like Acamedics frequently offer multiple research projects involving neurology and neurosurgery, which are great opportunities to learn how to undertake research, polish your presentation skills and make contacts. The latter is extremely important, as many surgeons are more than happy to let you observe in theatre if asked nicely! Neurosurgery really is like no other specialty and is in itself hugely varied: from awake craniotomies and microsurgery (surgeries requiring a microscope) to gamma knife radio surgery. Because of this diversity, it is incredibly important to get in there and see as many surgeries as possible to find which one is right for you. Alternatively,YouTube is a great place
Urology is a medical branch focused upon genitourinary conditions and disorders, for which, nowadays, the majority of procedures can be done laparoscopically or minimally invasive. The most common urologic disorders include benign prostatic hyperplasia, incontinence, urinary tract infections, and sex reassignment procedures. The best way of getting some insight into the world of urology is to experience it yourself. You are welcome to apply for our shadowing scheme at the Westmoreland Street Hospital, where they see the most unique cases. Please be sure to review the pelvic and perineal anatomy before beginning shadowing. The main piece of advice I would like to impart is to experience as many aspects of medicine as you can before deciding on what you want to dedicate your life to. Urology is a specialty which many students do not consider as a potential career path until later on, as it is studied in the fifth year. However, it is a vast and interesting field well worth considering.
Soheeb Mehr, Oral and Maxillofacial Surgery
Oral and maxillofacial surgery (OMFS) encompasses the treatment of disorders regarding the neck, head, face, mouth and jaws. Dealing with areas that are so important to
Careers Gastrointestinal (GI), breast, vascular and transplant surgery. Whilst a large proportion of elective surgeries within the NHS are carried out by general surgeons, they also have a crucial role to play in emergency situations due to the wide range of skills they develop.
patients’ quality of life makes this specialty extremely fulfilling and rewarding. From congenital cleft lip corrections to thyroid surgery, OMFS provides ample opportunity to treat a variety of interesting and complex cases. Uniquely, this specialty requires dentistry and medicine degrees to allow admission into its training. As a result, many believe that the pathway for OMFS is long and arduous, but this could not be further from the truth. OMFS surgeons register with the GMC and enter onto the specialist register in the shortest time and, therefore, the time span of becoming an OMFS surgeon is similar to other surgical specialties, even with its prerequisites. However, you do need to be dedicated to pursue this path, as attaining two degrees whilst working through the surgical training pathway is no easy task. Since the difficulty of securing a core training post is greater than achieving a place at a dental school, it is advisable to finish core training first and subsequently complete the dental degree. If you are interested in this specialty, it is quite easy to learn more about it. The society’s shadowing scheme can expose you to a plethora of different cases encountered on a daily basis. You will be able to see the workings of a multidisciplinary team, and the skill and precision they employ. OMFS surgeons can be contacted themselves and many will be happy to answer any questions that you wish to ask. Upcoming Surgical Society events will also be useful in gaining a better understanding of this specialty.
Arnav Srivastava, General Surgery
General Surgery is, by nature, an extremely varied field within surgical specialities. Most general surgeons will train further into a sub-speciality, which include upper and lower
The career path for General Surgery is as follows: subsequent to your (hopefully!) successful MBBS graduation, foundation and core surgical training, you will apply for a highly contested ST3 higher surgical training post. The general surgery specialist training post lasts six years (ST3-8) and entails multiple examinations leading to a fellowship with the Royal College of Surgeons (FRCS). If that’s not enough, don’t worry, we’re not done just yet! Before applying for your consultancy post, you’ll need to complete another exam – the intercollegiate FRCS Examination in Neurosurgery (FRCS (SN)). This is required to gain a Certificate of Completion of Training (CCT) making you eligible to be on the GMC Specialist Register. To get past the barrage of interviews and exams, and attain these highly coveted acronyms, you must be highly focused and look for opportunities to gain insight into the field - for example, through joining UCLU Surgical Society. Even as a medical student, there are steps you can take to separate you from the competition. Building a strong portfolio from the start of your degree is one of the best ways to do this. Undertaking projects involving surgery, such as literature reviews, can be highly beneficial and are widely offered throughout the course. Networking is another important aspect of career progression (*cough* NUGSC 2017 *cough*). In all seriousness, at this level it is essential that you expose yourself to as much surgery as possible and confirm whether it is the right choice for you.
occlusion has provided the opportunity to develop, through collaborative efforts with interventional radiologists, the field of endovascular surgery. Adaptations to the training pathway have been made to ensure that vascular surgeons have an incredibly comprehensive and adaptable core skill set and future prospects for vascular surgery are exciting. With an expanding and ageing population, demand on the specialty will only continue to rise, but with the application and educational integration of robotic techniques into vascular surgery, higher standards of care with reduced surgical mortality/morbidity can be promoted. Though a highly competitive specialty, with approximately just 20 national ST3 entrance positions offered annually in the last couple of years, projections indicate there will be increases in available posts due to demographic and disease prevalence variations. Reported changes to the training scheme and more information about a career in vascular surgery can be found at the Vascular Society of Great Britain and Ireland. We thank Saima Azam, the specialty chairs and all other students from SurgSoc who contributed for their input. Orthopaedics Skills Course – plastering!
Melika Moghim, Vascular Surgery
Vascular surgery is a rapidly evolving surgical specialty. It was only independently recognised in the UK in 2014, as the dedicated work of specialists cemented the move away from the “generalist model”. The nature of vascular surgery exemplifies the importance of multi-disciplinary: patient-centred care delivery. An increased focus on providing minimally invasive endovascular solutions to
“Aneurysms have no borders”: an interview with
Dr Tara Mastracci MD, MSc, FRCS(C), FACS
r Tara Mastracci is a consultant vascular surgeon at the Royal Free Hospital, where she is also the clinical lead for complex aortic surgery. She grew up in a small town near Niagara Falls in Canada, and went on to study Biochemistry followed by Medicine at McMaster University, Hamilton, Ontario. After qualifying as a doctor, Dr Mastracci continued her training in general and vascular surgery residency programs, as well as completing a Master’s degree in Health Research Methodology. She then worked at the Cleveland Clinic, Ohio, for eight years, before moving to London in October 2014 following the “challenging” Professional and Linguistic Assessments Board (PLAB) test. Although cultural acclimation has been a challenge, she describes the NHS workforce as “absolutely inspiring” and is enjoying her life here in the UK. Her move to London was “everything to do with the NHS…to figure out a way to build an excellent aortic centre without all the funding that private healthcare has”.
The journey began when she watched her very first surgery. The only female cardiac surgeon at McMaster University at the time was performing a valve replacement, which Dr Mastracci found “totally inspiring”. This was emphasised by the fact that in 1997, and even now to a certain degree, surgery was viewed as more of a male specialty. Dr Mastracci found the way this surgeon conducted herself brilliant and
Dr Mastracci is evidently proud to have attended McMaster Medical School, “the birthplace of evidence based medicine and problem-based learning”. She described her experience:
“I know you want to be a colorectal surgeon, totally fine, your choice, but why don’t you approach this rotation, pretend you want to be a vascular surgeon, see if you like it, and just go in with two feet, learn everything you can”. Dr Mastracci did, and she loved it!
found herself being drawn towards surgery - it was the “natural thing.”
RR: Why vascular surgery? Towards the end of her residency, Dr Mastracci was ready to start a colorectal fellowship. However, when Dr Mastracci did her mandatory three-month rotation in vascular surgery, the chair of the department gave her invaluable advice:
“It’s a very unique curriculum and from the beginning of its conception back in the 1960s and 70s, it was kind of a hippy school. Instead of having a didactic curriculum like the traditional medical schools, it was pretty much problem based - you would go into clinical roles very early and it is the model by which many other medical schools have developed their curriculum. So, going to McMaster was almost as inspiring for me as going to medical school itself”.
RR: So why did Dr Mastracci decide to become a surgeon?
Dr Mastracci passes on this advice, saying to “approach everything as if it’s what you want to do, because you never know.” Dr Mastracci feels vascular surgery is absolutely perfect for her as it holds the “full complement of medicine…your arterial tree is everywhere right? [smiles]”. There are surgical specialties which are more separate to medicine, however she did not want to give that aspect of her training up. With vascular surgery, she felt she would be able to keep doing the medicine she loved along with surgery. But surgery and medicine are not all that Dr Mastracci balances. Alongside leading the aortic programme, Dr Mastracci also finds time
to undertake research. She views herself as a clinician and researcher, “wearing both hats all the time”. “You can’t dabble” as vascular surgery is a “very volume based practice”, and so Dr Mastracci makes research her clinical work. Although Dr Mastracci does not describe herself as a basic science researcher, her impact on patients and the healthcare team due to her clinical and evidence-based academic commitments is evident.
healthier. “The most joy I have is holding a patient’s hand after surgery, so I never want to give that up, so that’s the balance I’ve struck… It’s been great to try and change things with all these eager people who want to do better for the patient”. Vascular surgery is a very fast moving specialty, described by Dr Mastracci as having undergone a “phenomenal metamorphosis in the last 20 years” because “it’s gone from being primarily scalpels to primarily x-rays”. She acknowledges that the area is patient driven and that patients hope for more minimally invasive surgery. She considers that biological interventions will become more of a focus in the future, with
Dr Mastracci has two research focuses at present, the first being in radiation safety, where she and her dedicated team are looking at ways in which endovascular surgery can be performed using a decreased radiation dose for both the patient and clinician. Implementing a teambased approach and using fusion imaging (augmented reality and computer-aided assistance) have both shown to decrease radiation dose. Dr Mastracci’s second focus is studying the clinical outcomes of aneurysm disease, for example, kidney function following insertion of stent grafts that are used on a daily basis in vascular surgery.
interventions at a molecular level, which will be a challenge.
RR: Lastly, what would Dr Mastracci’s advice be for medical students? “You have to be humble to be a good learner.You have to acknowledge that there is stuff that you don’t know in order to learn and I think if you can take a spirit of humility with you through your education and beyond, it will always serve you well. If you can say confidently ‘I don’t know the answer to that’ and not feel bad about it (Because who knows the answer to everything?), you’re going to get far more out of life than walking around saying ‘I know everything’. So, the best advice I can give to anybody is to not be afraid of the things you don’t know, because that’s where you learn”.
Within her work, Dr Mastracci acknowledges the importance of personal reflection, a concept that is emphasised throughout medical school for students in the UK. “I learnt through my life that self-reflection is probably the most critical thing you can have to make yourself a better person. If you don’t sit back and think about what you are doing and really kind of have that meta-cognition, you’ll never improve. Because otherwise it’s just the same pathways, right?” Dr Mastracci tries to have transparency in her work in order to inform people of the progress and developments being made. Patients are central to her goals, and healthcare equality and appropriate use of resources are clearly fundamental to her work. Dr Mastracci still loves operating and does so twice a week but, at the same time, takes an interest in the public health system and how to make patients
Dr Mastracci acknowledges that support from many people is required to succeed and that her “path is pebbled with people” who have helped her. It was a pleasure to speak to Dr Mastracci and we thank her for her time.
The Unofficial Guide to Medicine The Unofficial Guide to Prescribing by Martin Hamilton-Flack, MBBS Year 4 Like all of the Unofficial Guides, this book follows a clear and structured approach to teaching you about pharmacology and prescribing, both in theory and in practice. It presents systematic ways to assess, investigate and manage patients with a clear emphasis on safe prescribing, and does so in a manner suitable for both medical students wishing to practice prescribing and junior doctors who actually have to do it. A concise, easy to read book, this covers all of the practical elements you’ve tried to glean from the wards alongside the theory often forgotten from second year. It’s like reading Rang and Dale but without having to bash your head on the keyboard from boredom every five seconds, and with practical applications as well to avoid the sheer thrill of theory. The cases are presented in detail and would be a good source of OSCE practice as well as for the Prescribing Safety Assessment. This book will be used a lot in our house!
The Unofficial Guide to Medical Research, Audit and Teaching by Katie Hodgkinson, MBBS Year 4
This book makes what could seem a very boring set of subjects into an interesting read, forming an excellent introduction for each in a way that isn’t just long boring paragraphs – the only issue I have with it is the dry-sounding title. With check boxes, top tip lists, clear graphics and focused tables, this is really reader-friendly and makes complex topics seem much simpler. Research, audits and teaching are becoming a part of everyday practice more and more but it isn’t something we really cover, so this book works as a brilliant introduction to something we all should be considering. This book means you bypass the need to ask your lecturers seemingly stupid questions when you’re planning your iBSc research project; there’s also plenty of information for how you can get involved in audits and research even as an undergraduate. This is well aimed at medical students, helping you to get a legup on topics that are crucial but seldom mentioned.
The Unofficial Guide to Practical Skills by Katie Hodgkinson, MBBS Year 4 If your overachieving final year friend wrote down the most comprehensive examination handbook ever, this would be it. With clear instructions for each skill and photographs and diagrams to make it easier, this book could probably teach a dog all the clinical skills needed. The breadth of this book is astounding, covering the majority of procedures you will probably see and be expected to know about as a medical student, with introductions and step-by-step guides for each. There are also mark schemes so you can be sure you have the basic pass/fail knowledge down pat. This book is a brilliant skeleton to be used for both OSCE revision and just making sure your day-to-day ward teaching has covered everything. This works well as a reference guide too, with more advanced skills being covered later on. This book is set out in a similar style to the OSCE guide books and would be the ideal companion to them.
The Unofficial Guide to Passing OSCEs: Candidate Briefings, Patient Briefings and Mark Schemes by Niki Wolff, MBBS Year 4
This book is best used as a companion to The Unofficial Guide to Passing OSCES. With briefings for everyone involved in an OSCE, this would be perfect for putting on your own OSCE or seeing what it’s like from the patient or assessor point of view. It covers all the basic pass/fail points for each station, which helps to ensure that you are solid on your foundations. The cases are quite straightforward things you’d see regularly, but as a result they require a broad range of knowledge and there is lots of scope for extending the situations to test further clinical competency. This book is also really good at testing you on specialities you may have spent less time or had less teaching on – in particular, it makes sure your spiel of, “To complete my examination I would…”, is comprehensive. The mark schemes are particularly useful as a basis for revision to make sure you cover all the key points and can research further into the more unfamiliar topics.
The Unofficial Guide to Passing OSCES by Niki Wolff, MBBS Year 4
The Unofficial Guide to Radiology by Katie Chapple, MBBS Year 4
This unofficial guide may as well be the official guide because it covers pretty much every popular OSCE station in detail. With clear, easy to read chapters, you can break down your revision into each individual station. There are lists, fun graphics, tables and longer paragraphs so however you learn best, it’s covered. The only problem this book has is that in trying to cover all the potential stations, it does lack some depth - but it gives you the basis for a solid structure. This book would be best for supplementing or drawing together more in-depth notes; if you were truly trying to learn everything for the first time it wouldn’t quite be enough. It’s very colourful and clear so is a good quick reference textbook, especially with the breadth it covers. Some areas can be slightly vague and if you hadn’t been to a teaching session you might miss that there is more knowledge needed in some parts. This book would be best for fourth years - amazing for learning a quick overview of what to expect from the usual stations, a good skeleton to build from, but not enough to be tested on for finals.
This guide to radiology is the perfect starting point for anyone wishing to learn the basics of radiology. There are well-organised chapters that give clear descriptions and methods for describing X-rays of the majority of areas, including large sections on the chest and abdomen.This book also includes CTs, MRIs and ultrasounds, giving you a really good basis of how to interpret any imaging you may be confronted with. With simple explanatory diagrams as you start, and then more complicated images further in, you’re truly walked through every level of imaging in the same clear and concise manner. There are images with the labels for both normal and pathological findings, and even some blank ones where you can test yourself (the answers are given further on).
The only fault with this book is that there isn’t much of an emphasis on taking a history, especially not for some subjects that could quite easily be OSCE fodder. The history taking sections are useful, but you’d have to be aware of the need to cover more histories for specific conditions that aren’t covered.
This book is methodical and systematic with key point summaries, colourful diagrams and a clear escalation in difficulty - almost like the CGP guides you may remember from secondary school! It makes what could be quite a daunting subject much more reasonable by breaking it down, making it simple and then slowly guiding you through the more difficult elements.There are even sections that would work wonderfully for using as a mock OSCE station with your friends. Perfect for anyone on Year Four module B, this book is a combination of all the imaging teaching you need, but never quite get on the wards.
If you have a book you would like reviewed, please contact our book review editor at katie. email@example.com
Sports & Societies
A word from the Sports and Societies Vice President...
he first term went quickly, but has been very busy from a RUMS committee member’s point of view. Initially, my focus was on the Oxbridge transfers, giving them a flavour for what RUMS is all about and getting members of all years along to a curry so they at least had some initial connections at a new university. Further to this, I hosted several additional talks with Raj and Ozzy to emphasise the importance of getting involved with RUMS and how it can enhance anyone’s university experience. Then it was freshers’ week! As the Sports and Societies VP, my role was to organise the freshers’ fayre. This entailed advertising stalls to over 40 separate organisations in the Royal Free Recreational Hall. Then came the stress of marshalling the subsequent pub crawl! Fortunately, both events ran smoothly, resulting in a record intake of freshers across RUMS sports and societies this year! I should stress that the role is deeper than this. As a member of the RUMS committee, I was one of the first people at UCL that the freshers could relate to and ask questions. These opening two weeks were vital to settle people down and encourage them to fill their six years here with an extracurricular activity that would shape their time at university. Everyone leaves with an MBBS, but the experiences during that time are hugely valuable and are what people remember about their time in medical school. In some cases, people were very much on the fence about joining a RUMS sport or society, but I am happy so say most of these people are now well integrated into the medical school sphere!
The RUMS Sports and Societies Scholarship has been run for the third year, with numerous high achieving performers and athletes successful again. Award winners were chosen by Dr Paul Dilworth, Raj Pradhan and myself towards the end of last term, and they will be notified in due course. Sports Ball preparation is well underway, with a date (24th March), venue and catering all finalised. The relevant forms have been submitted to the union for the event budget, a photographer booked and a DJ found - not much more remains left to do on this front apart from confirming Sports Ball awards and advertising to the student body! Both myself and the RUMS President, Raj Pradhan, recognise that RUMS as a sub-union is one of the strongest aspects of life as a medical student at UCL. Having spoken to other students we acknowledge that something should be done for prospective applicants to recognise our body before they join university. As a result, we are currently pursuing promotion for RUMS Sports, Societies, Welfare and Events to be added to the UCL prospectus (initially the online version). This will allow us to showcase all that is great about our organisation, the family atmosphere within it, and some of the aspects of life as a medical student in central London! It has been a real privilege to work with the superb RUMS committee this term. Raj in particular has taken a very active role in the organisation, backed each of his VPs and has really set the bar high for his eventual successor. Furthermore, the freshers have been brilliant, really taking to life at university and integrating seamlessly into various societies - keep it up! I really look forward to next term - Naked Sportsnight, Sports Ball and RUMS Dine With Me all to come - I hope all of you are too!
It is also my role to oversee sports nights and keep the presidents in the know about upcoming events. This included HIVE and Bill Smith’s sports night. Additionally, I represented RUMS at UCLU sports meetings and have personally discussed problems with Katie Sykes and the mythical Bikram Bains. During these meetings, I have brought to their attention the importance of travel reclaim and how non-BUCS sports now have access to it (which led to a huge union funding gap, explaining why membership fees went up), as well as team specific problems,
solving some with more success than others.
James Shuttleworth MBBS Year 4 Sports and Societies VP
Sports & Societies RUMS Badminton We at RUMS Badminton have had a fantastic term. Our men’s team have been on top form, progressing to the last 16 in the cup and maintaining an unbeaten record in the league. Despite having just been promoted, they’re looking to be promoted again very soon! The women’s team narrowly missed out on a victory in their last cup match (losing on points with a 4-4 draw), but have won their last two games, and are making their way up the table as well. Our mixed team have also been strong this year, currently placed second in the league – they’ve had some great games close to home playing universities such as SOAS, and far and wide, playing Chichester and others. With the intake of very enthusiastic freshers, all three teams are sure to continue to do us proud. The high points of the term would have to be the great number of social events we’ve enjoyed, including the Freshers’ Curry, Harry PotTour, and Christmas Sports Night, to name a few. Additionally, we managed to raise over £380 through our Christmas carol singing for a local charity we have partnered up with for the year: North London Cares. A low point would have to be becoming the butt of an MDs’ joke (we ARE cool!), orchestrated by one of our very own team captains. Something to look forward to in the coming three months would be the first couple of matches for our brand new second men’s team! Ken Kawamoto, RUMS Badminton President
RUMS Boat Club It’s been a very successful first term for RUMSBC. Our membership is at record levels, our freshers are finding their feet and our results are promising. Intake was healthy this year - we are fielding two Women’s Novice Eights for the first time ever and the squad has already laid down the gauntlet to the rest of UH as the crew to beat. With some late joiners, the Men’s Novice squad are starting to come together as a crew and are showing that they’ll be a force to be reckoned with next term. Racing for the year began in Cambridge, with an excellent performance from our victorious Women’s Senior Four (beating many full university crews). After that, it was onto UH Novice Sprints where our Women’s Seconds and Women’s Novices stepped up to ensure RUMS won two out of four categories on show. A valiant effort saw the Men’s Seconds fall just short of victory but left them hungry for success next term. In our final race of the year, Allom Cup, our Women’s Four retained last year’s title and reaffirmed themselves as the best in London.There were strong performances from our Men’s Firsts, Women’s Firsts and Women’s Novices - all narrowly losing to strong UCL crews. Looking forward to next term, we have our biggest races of the year where every crew will be gunning for gold, as well as our most beloved and feared socials. We will also be competing at our first ever Varsity
rowing event on the 15th March, so training is more intensive than ever. Highlight: in a “for pride only” re-race of the Women’s Novice final from the last race of the year, RUMS beat UCL. Lowlight: being one place lower in Stu’s good books. Sam Jackson, RUMSBC President.
RUMS Cricket “The Year of the Cricket” has started with a bang and another stellar term is in the books for RUMSCC. Stay tuned for more of the same in Term Two from RUMS’ very own Barmy Army. With a big fresher intake secured, the club paired tradition with innovation in term one. Weekly nets at Lord’s were accompanied by a brand new indoor cricket tournament – the RUMS Premier League (RPL). Pitting RUMSCC members against each other for bragging rights, the RPL consisted of intra-club sides who battled weekly for the title of RPL Champions. The tournament proved a tremendous success, and culminated with Mustafa Butt’s “Mafia” overcoming Sameer Khan’s “Knight Riders” in a tense final. With all of this Indoor Cricket practice under the belt, RUMSCC’s talented squad of nine took the BUCS Indoor League by storm in December. Dominant performances saw the boys win seven out of eight games, including victories over UCL, Imperial, King’s and Queen Mary’s.This resulted in us qualifying for the national knockout stages of the competition as one of the top eight university teams in the South of England. Congrats to all involved and good luck to the squad for the next stage of competition in Cardiff on 11th February! There is plenty on the horizon to keep members excited. Nets at the “Home of Cricket” will continue, whilst the social calendar will be as vibrant as ever. Finally, the touring party of 16 has been confirmed for RUMSCC’s Barbados Tour and excitement is building at the prospect of a tour of a lifetime. HIGH POINT: Making RUMSCC history in the BUCS Indoor League. LOW POINT: Hasan Iqbal ruling himself out for weeks when his vigorous shaping to a “Bieber banger” in Harry Pottour fancy dress resulted in a sprained ankle. LOOK OUT FOR: RUMS T20 Day – which will be returning to Regent’s Park this year on the 29th May! Bring your beers and BBQ to watch the RUMS Sport clubs battle it out for the title of 2017 RUMS T20 Champions! James Groves, RUMSCC President
Sports & Societies Islamic Society
We kicked things off with our icebreaker where we welcomed in the new batch of freshers and introduced them to what we do as a society! Throughout the term we have consistently held regular academic tutorials which enable our members to learn in an engaging environment and feel comfortable in asking questions. In the coming term, we will also have smaller group tutorials to complement the current teaching so that we can make the learning process as personalised as possible. In addition to our academics, we were also heavily involved with Charity Week where we delivered our AspireMed BMAT and Interview courses for hopeful medics. We then rounded off the week with the annual RUMS Charity Auction Dinner; a night where we raised more than £40,000 and auctioned off a cake for £30,000! We have also grown our outreach department which has successfully delivered basic life support (BLS) courses in many mosques, whilst also attending secondary schools to teach suturing and BLS to students with the hope of inspiring them to pursue higher education. There will be plenty more school visits in the second term so if you’re interested, please contact us and we will teach you to suture and enable you to help a great cause. Further to the clinical OSCE practice days we’ve held, we aim to deliver mock OCAPEs for our pre-clinical medics this term, better preparing them for their summative exams! We will also host an iBSc fayre, allowing our members to talk to current and past students of the iBScs which interest them. There will be a lot going on in the coming term, so do get involved. The more the merrier! Lukon Miah, RUMS Islamic Society President
We started the term fresh from our second sell-out run at the Edinburgh Fringe Festival - shameless self-promotion done. This year saw the return of our surprise fresher lecture, where we give a fake lecture to inject some fun into the introductory week. The freshers are still petrified of Robyn Brown, so it was a resounding success. For some reason they wanted more and turned up in their hundreds (give or take a few hundred) to our freshers show in Mully’s. After another successful fresher performance, we got to welcome the newest additions to the MDs family. Following a weekend getaway to the Forest of Dean, we were ready for our Christmas show! The funny bones in our society worked hard to provide RUMS with some scrubs party nostalgia in the form of this year’s production: The Italian Swab. A special mention goes to our fabulous freshers who continued through the ever-merciless heckles (but thank you to all the sports teams for coming to provide them and support of course!).The only downside is the trough of waiting another year before it happens again. However, keep a lookout on our Facebook page for details of other gigs and, in particular, our big February showcase with other UCL comedy groups at the Shaw Theatre. Just in case you fancy scaring yourself silly again with our Tutors video, you can enjoy some favourite moments on our YouTube channel! Ozzy Eboreime, MDs President
Medic to Medic
RUMS LGBT+ RUMS LGBT+ had a quiet start to the academic year, but it hasn’t been without its highlights. Dean Street Sexual Health Clinic hosted our first social, chatting to our society in depth about modern LGBT+ sexual health in its entirety, which was very interesting. In term two, we have organised a large social with some funding behind it on the 16th January; we are working alongside UCLU LGBT+ to run a huge workshop on addiction, with plenty of guest speakers. We are also planning a “Gender in Medicine” event in the coming months. All exciting stuff and we encourage anyone who is remotely interested to at least come have a drink at the social and meet some similar people! Andrew C.Tindall, RUMS LGBT+ President
What a start to the fundraising year it has been! The team is proud to announce that so far we have raised over £700 to help sponsor our link medical students. The latest review involved catching up with the progress of the students and it was a delight to hear that M2M are continuing to make such a difference to their training and career prospects by funding resources and tuition. In the long run, this is ultimately working towards improving healthcare in Malawi. One student, Elias Charles, said, “Once again special thanks to you M2M for considering my life.” This term has included a Christmas bake sale and carol singing collection days at Piccadilly Circus and Pimlico tube stations, where singers have very generously accompanied us from RUMS Hockey and RUMS choir. The occasions were a lot of fun and it was a pleasure to work with both groups; we look forward to working with others in the future.The new and fabulous team have been working hard to plan many exciting events for the year ahead. Watch this space for film nights, a Tropical Medicine and Electives Study Day, as well as the opportunity to take part in Tough Mudder and go sky-diving (!) all in aid of Medic to Medic. As ever, for more info and how to get involved, please visit: https:// www.medictomedic.org.uk. Elle Wilson, M2M President
Sports & Societies not only providing authority and direction on the court, but also organising exciting socials that often, though not exclusively, involve pie. A real high point for the club came from the social team once again taking to the streets around Bloomsbury with eight bags filled to the brim with items to distribute to the homeless this winter, proving that we are so much more than just a netball club! Our only low point came in the form of a particularly rainy Monday in which four of five LUSL matches got rained off...a missed chance to play our favourite game is always upsetting, but we look forward to the rescheduling of those matches so we can rack up some more wins! Next term, we will be welcoming our alumni back for the Alumni cup, followed (naturally) by a classic RUMS Netball social.We will also be competing in another varsity challenge against GKT, and need RUMS Rangers from far and wide to come and support us in this epic battle! We are super excited to see you all again on court in a matter of weeks for the historic Lumsden cup at the end of March! Frankie Cackett, RUMS Netball Treasurer
RUMS Mixed Basketball It has been an awesome start to the first ever season of RUMS Basketball. As the club continues to grow, we welcome players from all reaches of the medical school, regardless of experience. The term kicked off with outdoor training held at King’s Cross, where we had some epic fast-paced sessions. As the light began to fade, we changed to our mainstay training venue to ULU’s EnergyBase. We have had weekly training sessions, usually taking place on Thursday nights, where slamdunks, lay-ups and all sorts of B-ball mastery are regularly witnessed. A healthy collaboration with UCL Basketball has ensured that our sessions are packed out and have a suitable element of competition! We continue to half-court press for new members to join in with our high intensity games and Alley-oops! Half Season Awards for commitment and skills go to J-C. Calixte, M. Valls Garcia, J. Ma, A. Yip, C. Hong and S. Botros. The 2016 Best Shot goes to C. Hong - congrats Chris! In the New Year, plans are afoot for pro-Basketball match trips and an inter-RUMS Sport tournament. Come join in! Elle Wilson, RUMS Mixed Basketball President
RUMS Rugby It’s been a mixed year so far for RUMS Rugby. After winning the UH Sevens tournament for the third year running, our First XV lost two of their opening three league matches. However, they’ve bounced back strongly to win four on the bounce and have catapulted themselves into second place in BUCS 1A. The Second XV have also been struggling for form, winning three and losing three of their six games this season. The low point of the year would have to be the First XV’s narrow defeat to Reading, who currently top BUCS 1A, although the return leg at Fortress Shenley will give us some opportunity to make amends. The highlight of the season so far is surely the First XV doing the double over UCL, inflicting two heavy defeats on the “auld enemy”. The club is now looking ahead to the UH Cup campaign, which kicks off in the New Year, and each team will be aiming to win their respective competitions after claiming two of the three on offer last season. Jack Smith, RUMS Rugby President
RUMS Netball RUMS Netball started this year with another fantastic intake of enthusiastic freshers. Trials were exciting for the incumbent committee owing to the brilliant standard of play - we all knew this was going to be a big year for us. With so much interest, a new sixth team comprising largely of freshers was created – currently with an unbroken streak of wins this season against some difficult opposition from King’s and Imperial. With seven highly competitive teams, the club has expanded not only with regards to court space, but also by welcoming a new coach into the mix. Our two coaches have kept the whole club moving forward (quite literally) on the court, leading to impressive score lines and the majority of our teams placing in the top five of their respective leagues at the halfway point of the season. A special mention goes to the first and third teams for their dominance on court (And on the club Instagram!). All teams are gelling brilliantly thanks to the fantastic work of our seven captains,
Sports & Societies RUMS Men’s FC RUMSFC has gone from strength to strength this first term, picking up a massive 43 freshers and transfers to help bolster our five squads. Subsequently, all of our teams have done really well and definitely haven’t only won 11 games between the five of them. The highlight of this term undoubtedly has to be our fresher tour to Brighton in early November. With freshers and doctors making up over half of the tour group of 50 brave souls, this was an unforgettable weekend for all involved. The only low point was, of course, the loss of Harambe (RIP). A few awards of note from the season so far: • Unceremonious Dropping of the Season goes to Matt Mort • Fresher who most dedicated himself to the sesh goes to Chris “Sesh” Pantelides • Most glasses broken at sports night goes to Ross “the Educator” Holloway • Best Will Grigg impersonation goes to Dairui Dai Next term only promises more from RUMS Football, with our first ever appearance in the London Varsity Series and a chance to extend our winning streak at NAMS to 189 triumphs in a row - we simply can’t wait. Girish Murali, RUMSFC President
RUMS Squash The year started on new territory for the squash club as we smashed our membership record; unfortunately, our squash was not so good. Cheeky summertime pigging out had left most of our team members taking not-so-cheeky mid-game breaks. However, in our new coach Wendy Levine, we found the right taskmaster to set us back on track to winning ways. The men’s First team poached some quality players from UCLU squash in the summer transfer window, allowing us to field what is most certainly our strongest line up in history (well, in my five years at the club anyway). Unfortunately, as has come to be expected, the biggest low point of the season was dealt in the first week: a union cock-up listed all UCLU squash teams (RUMS and UCL) three divisions lower than we were actually supposed to be. Nightmare. As a result, our LUSL matches (usually hyper competitive) were a bit of a non-event. Imagine racing a Ferrari against a Ford Focus… over before it began. In any case, all our teams massively improved the quality of their play. Towards the end of the first term we went on tour to Birmingham for the annual NAMS tournament. Here, we bested of strong competition to win in the Men’s First division, being crowned champions of medical school squash! Our women’s and men’s Second teams also performed impressively but were trumped by a strong Birmingham squash team in the finals. Sri Sivarajan, RUMS Squash President
RUMS Music The first term of the 2016/2017 year has been an exciting one for RUMS Music, with plenty of success! We have welcomed the addition of not one, but two new a cappella choirs: the male Barbershop quartet and the female close harmony choir.These two couldn’t be running more smoothly alongside our inclusive classical and contemporary choir and string ensemble. All our groups have been working hard at rehearsals and have had plenty of chance to perform for charitable purposes this season: on the wards or in the foyers of UCLH, Royal Free and the Whittington, at the Cancer Centre, in tube stations, at St Pancras Church and more! We’ve also organised some evening socials at Olive’s Indian Restaurant and Ronnie Scott’s Jazz Bar. The committee this year has been fabulous, and have worked tirelessly to allow RUMS Music to grow and flourish. Voice music, in particular, has never been better in the society! The high point has been all the enjoyment in rehearsal and performances, from all our music groups. Unfortunately, we haven’t managed to expand our outreach to more instrumentalists. However, we’ll be going on a renewed drive in the New Year in an attempt to remedy this! In the New Year, people of RUMS should look out for information about our performances – not least our annual Spring Concert. Any musicians or singers itching to get involved should contact us either by our Facebook page or email (RUMSMusic@live.ucl.ac.uk). Lloyd Warren, RUMS Music President
RUMS Tennis RUMS Tennis has had a fantastic year so far, with lots of activities and events taking place! Our year started off with a massive intake of freshers, who have been absolutely great in committing to the society both on a squad and social level.Training sessions have been more jampacked than ever, and coaching of both our development and social contingents is going really well too. Hopefully this will continue into next term! In terms of other events, our freshers’ meal kicked off the year and was huge! The Halloween pub crawl was equally awesome, with a number of interesting costumes coming into play. Our yearly visits to UH AGM at Wimbledon and the UH dinner at the Queen’s Club were also highlights – two great occasions which we are lucky to be a part of. Sports nights are rocking as per usual; our Christmas edition was phenomenal! The league this year has, unfortunately, been very tough for our teams, but I’m certain they will step up to the challenge next term and things
Sports & Societies will definitely come through for us. Events to look forward to next term include more meals, more sports nights and one more thing which I can’t quite remember… oh yeah,TOUR! Our yearly tour to an undisclosed location will be taking place in January, and it’s safe to say that everyone is pretty excited! Next term is going to be incredible! Ammar Hilali, RUMS Tennis President
UCLU Wilderness Medicine Society Hello again from UCLUWMS, and a happy new year! Our first term was eventful, and we hope that everyone who took part in our activities enjoyed themselves (and learned a bit!). It was great to meet so many people at the Freshers’ events, and our first event of the term, the Walking Wounded hike on Hampstead Heath, proved to be an exciting first foray into wilderness medicine for this academic year. We followed this up by continuing our wellknown lecture series, welcoming Dr. Nick Tarmey, a military anaesthetist, and Dr. Matt Wilkes, an altitude physiology expert and anaesthetic registrar in Scotland. Our speakers discussed a wide range of topics, spanning global public health, altitude and expedition medicine, military medicine and more. We also started our workshop series with a Basic (Trauma) Life Support session to introduce concepts to people who may have not done any first aid before. This term brings a lot to look forward to. By the time this goes to print, our conference on all things fractures – joint with the Prehospital Care Programme – will have been and gone. But fear not! In the pipeline: the continuation of our workshop series, jungle medicine, more exciting lectures, a sneaky weekend away in the Yorkshire Dales, and, of course, that paintballing we promised. Stay tuned… Mark Gavartin, UCLUWMS President
RUMS Men’s Hockey The back end of 2016 has been a veritable bonanza for the stick-wielding boys in blue and yellow. The club is verging on a whopping seventy members for the first time ever, thanks in no small part to an onslaught of disturbingly loose freshers – now poised to become the next Golden Generation™ of RUMSHC. Huge turnouts at Monday training sessions, combined with coach Asif’s exhausting drills, have led to all three of our teams performing admirably in their BUCS leagues. Our enthusiastic-yet-inexperienced Third team bagged their earliest ever win, while the Ones and Twos are playing the best hockey seen in RUMS colours for a generation. Sunday stickball continues with aplomb; places for the two invitational LUSL XIs remain as highly coveted as Paisley Deary’s affections in the Roxy. In November, the club left its highly reproachable mark on the fine cities of Southampton and Cardiff as we enjoyed two tours; the latter having the marvellous theme of Roald Dahl. Fun was had. High point: Tour and Christmas dinner were (of course) amazing, but for sheer surreal hilarity this has to go to our “Fifty Shades of Beige”themed Halloween sports night. Low point: It’s a close call between the stench at the rear of the coach on the return leg from Cardiff, and the trough-y Wednesday when the Ones and Twos both lost matches that should have seen them go to the top of their respective BUCS leagues over Christmas. The stench takes it; I don’t want to experience anything like that again for as long as I live. It gives me untold pleasure to record the following award recipients: Jon Archer (Man of Tour); Karan Dahele/Adam Everett (Freshers of Tour); Harry Bamber/Rob Tuckwell/Rhys Johnson (Men of the Half-Season); Jonny Leong/Matt Spoor/James Cai (Freshers of the Half-Season). In the spring, plans are afoot for a curry with the RVC girls, a visit to the Super Sixes indoor tournament, and club members will be able to bounce along to a freejumping social. We look forward to hosting hundreds of RUMS Rangers at Lee Valley to watch us take on GKT in the London Varsity Series on Saturday 11th March. See you there! Ollie Totham, RUMSHC President
Sports & Societies RUMS Women’s FC Christmas holidays have come at last and RUMSWFC definitely deserves a rest! We’ve had a fantastic first half of the season, starting off with our freshers’ events - a BBQ (where RUMSWFC did what we do best - eat a lot of food) and introductory training sessions.We recruited the largest number of freshers we’ve had in recent years which has been incredible! Liz has been an outstanding BUCS Captain so far, involving ladies of all abilities across the club in the games and encouraging high morale and team spirit even in times which would normally be defined as “low” (i.e. when we lost by quite-a-lot-to-nil). Kerry and Anne have worked together to foster a great environment for people to try football for the first time and the Seconds team have carried on with their reputation of having too much fun. The Firsts ended on a winning streak, yet to concede a game - thank you Judith for leading by example and scoring a bazillion goals, we really appreciate it! The high point was probably BRIGHTOUR, where we headed off down south dressed as characters from the Lion King for a weekend of not playing any football, eating too much pick ’n’ mix, and being beaten at laser tag by seven year-old boys. We rounded off 2016 with our annual Christmas dinner where we definitely undid all the fitness gains we’d achieved over the past couple of months. Here’s to 2017, where you’ll see us at the first medic football Varsity in years! Lucy Tiffen, RUMSWFC President
RUMS Women’s Hockey It’s been a great first term for RUMSWHC, kicked off by 16 fabulous new members joining our ranks. All three teams have started the season well, with the Twos undefeated and topping both of their leagues, and the Ones on target for their desired promotion. Both the Ones and Twos remain in their respective cup competitions – something that has never happened before! The Threes have gone from strength to strength, with many beginners now playing weekly matches, cumulating in a win against UCL. In mid-November, we headed to Cardiff for Amy’s Marvellous Roald Dahl tour, with the only low being a four hour coach journey with no toilets. We ended the term with a delicious Christmas dinner at Guanabana and then danced the night away at Club de Fromage. Congratulations to the following for receiving halfway awards: Livi Baker, Man of the Half Year; Becca Thorne, Fresher of the Half Year; Chloe Mullins, Man of Tour; Millie Duckett, Fresher of Tour. Next term, the Ones will be training hard to take on GKT at Varsity on the 11th March; everyone is massively looking forward to it and we hope a good RUMS contingency will make their way to Lee Valley to support us. Emily Croft, RUMSWHC President
UCL Medical Art Society What happens when art and medicine collide? UCL Medical Art Society is a new platform for exploring the interdisciplinary bridge between the creative and the scientific. Our events are open to students of all disciplines and artistic abilities. They will include gallery and studio visits, talks led by external speakers, and creative workshops.Those looking to appreciate and solidify their understanding of the human figure and anatomy will be able to take part in our anatomical life-drawing sessions starting in January 2017. Our inaugural event last term featured a visit to The Hunterian Museum at The Royal College of Surgeons for a drawing event. This was followed by a social at an eerie candlelight cellar, Gordon’s Wine Bar. It was fabulous to see such a wide range of students – from those studying Architecture to those involved in Global Health. Everyone channeled their own interpretations and expressions in their work. The term culminated in a Vanitas Still Life Drawing workshop at The Royal Free Pathology Collection, which involved working closely from pathological pots - all presented as part of a magnificent baroque display.We plan to hold further events at this venue so that members can explore the magnificent private collections of the museum. Upcoming events also include life-drawing classes and an Embroidery and Suture Workshop, featuring Julian Ellis OBE, in collaboration with Reforming Anatomy. For more information please visit: FB page: UCLU Medical Art Society Instagram: @uclmas For the Julian Ellis event: www.reforminganatomy.com Nazanin Rassa, UCLUMAS President
Sports & Societies SKIP UCL
Towards the end of the term, our Sports & Exercise Medicine section hosted an exciting forum on the makings of a successful Olympic medal team. Held at the Institute of Sport, Exercise & Health, the event was well-received and had a great turnout. Special mention must be made to our Global Medicine section, who worked hard to organise the Clinical Electives Fayre. Attendees gave plenty of positive feedback and the event showcased the many extracurricular benefits of a MedSoc membership. The Medical Society hopes that RUMS will continue to benefit from our extensive calendar of events in the new year and would highly recommend that students attend the Paediatrics Conference on Saturday 18th March Kemi Oladinni, RUMS MedSoc Publicity Officer
Students for Kids International Projects (SKIP) is a UK student-led charity which supports child welfare in communities throughout the developing world.At our branch, SKIP UCL, we run a five-week project over the summer in rural Ghana, West Africa. Our project involves working in sheltered housing for children with cognitive and physical disabilities. We aim to implement sustainable interventions which support the wellbeing of the children and educate the local community about the stigma surrounding disability. We also help out on a daily basis, from feeding the children to leading sports sessions. It is a hugely rewarding project for both volunteers and the community, and there are also many opportunities for travelling and experiencing Ghanaian culture. I was lucky enough to travel to Ghana with SKIP UCL last summer; being able to work so closely with children and directly observe improvements in their wellbeing was very rewarding. We reviewed the children’s programmes for physiotherapy and the summer school, both of which were funded and implemented by SKIP. Teaching and playing with the children was extremely fun, both in one-on-one and group sessions. My personal highlight was pool time; the kids often needed our assistance to take part, which inevitably ended up with us getting soaked in water balloon fights! The whole experience was very enjoyable and worthwhile, and I would recommend it to anyone interested in working with children in developing countries. If you are interested in getting involved in the work of SKIP, please follow our Facebook page @SKIPUCL to stay in the loop, or drop us an email at firstname.lastname@example.org Alison Mansfield
Call for Fifth Years We need YOU, yes YOU, to get involved with this year’s Fifth Year Show. If you have any experience in any form (be it to do with shows or not) then you are PERFECT for the job. We are looking for actors, writers, musicians, dancers, choreographers, techies, backstage crew, costume designers, props people and more! Join our Facebook page NOW to find out more: https://www.facebook. com/groups/2195359444022798/ Go on… you can fill your logbook in later.
UCL Medical Society The Medical Society has had an excellent first term. We kick-started our event calendar with the ever-popular “Battle of the Specialties” which was a great success and definitely one of the best-attended events so far. MedSoc are always keen to encourage fundraising activities within the society and were proud of the efforts made by the Oncology section to host their own Macmillan Coffee Morning. Our next charity event will be the Paediatrics Disney Quiz in aid of Great Ormond Street Hospital in February. Early in November, we saw the launch of the Psych Buddy Scheme run by the Psychiatry section. Now in its third year, the scheme allowed students with an interest in the specialty to network with psychiatrists for expert careers guidance. Keep an eye out for their hugely anticipated collaboration with MedSoc Obs & Gynae on maternal mental health next term.
Sports & Societies
Reviewing Revue: Look at the
ABackMDs’ Christmas Show
he days were growing shorter and the temperatures were dropping. The December doom and gloom slipped in like the Facebook acquaintance you’d hoped wouldn’t turn up to the house party. If only there was some remedy, some cure to help us lift the melancholia. If only one had access to what the experts call the best medicine… No, not kale - laughter of course! And what better dispensary exists than the MDs’ Christmas Show? Judging by the extensively edited promotional posters appearing ubiquitously across any free flat surface in a 10-mile radius of UCH, we could all tell a lot of time and effort had gone into the show. So, with bated breath and professionally hidden booze, RUMS packed themselves into the Peter Samuel Hall, took their seats and waited. The show kicked off with a bang. Countless MDs assembled onstage and danced to their parody of Closer by the Chainsmokers, setting the bar high for the rest of the evening. The laughs began in earnest with a sports night sketch which saw the average Wednesday’s circle transposed into a church setting. I know, church and sports night - what could they possibly have in common? Apparently quite a lot (some people said it was at this moment that MDs’ President Ozzy Eboreime stole the show with his stellar performance as a Baptist preacher from the American Deep South...well, just one person said it... that person was me). Moving on with the night, the MDs delivered sketch after sketch portraying medicine in previously unheard of - but comically appreciated - scenarios. Then came the first of the triad of MD video-tapes (or VTs for short, because as medics we know that if it is not in an acronym, it is too accessible to lay people and we do not feel special enough). The creatively named Ramsay Hall VT brought the audience back to their first year, which for the majority was spent in halls. The video went through all of the modern amenities that we all took for granted and desperately never ever want to “enjoy” again. Special mentions to Jacob Laing or Ed Peeler who was able to accurately portray all estate agents ever in the history of “estate agenting” and Shaun Waldie; the brilliant videographer, for his remarkable skill in constantly sneaking up to and scaring Ed Peeler/Jacob during filming. The pair brought the house down. Following this, there were sketches about Ubers, precocious A-level students, the Tube in rush hour and even one about a father wanting to recreate the birth of his child which he had missed. Choice lines from that sketch include the fan favourite, “I’m not even a real stool”. Who knew jokes about stools could be so funny? Then came something the MDs have never done before; a song written, performed and
Sports & Societies
sung by the Ectopic Beats, the MDs’ own beautiful band. Not only are they aesthetically pleasing, they are also musically talented. I Love Your Beanie was sung by one of the society’s newest recruits Vivekka-“Sings like an angel”-Nagendran. It was this performance that saw Vivekka awarded the coveted “Player of the Year” award. Each year, the MDs alumni celebrate one performer who especially stood out in the shows. With a voice and performance like that, the winner was no surprise. Rumour has it that the song was first performed on the MDs’ Weekend Away in November as a gift to the directors, Charlie Richardson and Ankit Bhatt. The society loved it so much they demanded that it was put into the Christmas show! The song in question was an ode to none other than Stu, RUMS’ friendly neighbourhood Head of Security. With fresh reports of Stu leaving UCL popping up hourly, the MDs were hoping to entice him to stay with this love song. Stay tuned to see if they succeeded. The night continued and hilarity ensued as the audience watched the other two VTs specially created for this year’s show. The horror trailer, originally conceived by Jerry Su and filmed by Ed Bragg, addressed the mysterious phenomenon that of emails from the ever elusive ‘“personal tutors”. The final VT was a behind-the-scenes look at the making of D&P: The Movie. With a star-studded cast including Professor Christopher Dean, Dr Sandra Martelli and Professor Fred Spoor, it was no wonder this was a fan-favourite. With a special shout out to the late co-author Professor John Pegington, not an eye in the house was dry. After the group song about how we would never forget RUMS brought the first half of the show to an end, heartstrings had been plucked throughout the Peter Samuel Hall. A current finalist and former RUMS President was even overheard during the interval saying: “I feel really emotional now”. Some people were in floods of tears (by people, I mean me, again - I was in floods of tears). After a surprisingly long “10 minute” interval,
the second half began. This saw the MDs’ freshers take to the stage to perform The Italian Swab. A new take on the classic heist trope saw the protagonists of the show trying to save the much-loved Freshers’ Scrubs Party. In a break from tradition, the MDs created a show with a plotline that is actually coherent, which went down well with audiences. I have heard plans to do the same next year, but I wouldn’t hold my breath. Intrigue was evident from the start, thanks in no small part to two of the main characters in cross dress. In a fashion that surely no-one could have seen coming, the good guys won and the scrubs party was reinstated. Hooray for the freshers! Along the way, the audience were treated to moments of comedy gold and showbiz sorcery. Yes, that’s right, I’m talking about the oddly mobile and human shaped trees alongside the very cardboard looking car. The resemblance was uncanny! Another piece of showbiz wizardry was the CCTV scene. We saw a cast member seamlessly slip off stage, into the recording on the big screen and back again! “How that is possible?” I hear you ask. Personally I do not know because our MDs techies operate at a level beyond my understanding. Thank you guys; I’ll be sending my three wishes later. I’m looking at you Jonathan Au and George Barker! There were questionable accents, songs, and an obligatory ward-round scene before the show was closed with a final dance number from bizarrely-dressed MDs. The audience could want for nothing more from a Christmas show!
Once again, the MDs have come out of the grotto of comedy* to administer their remedy for what can be a dark and dreary time. Of course, an MDs Christmas show would not be complete without the progressively drunk heckles coming from the audience and, naturally, the audience members who produce those heckles. As always, the RUMS support is massively appreciated; we hope you enjoyed yourself as much as we enjoyed putting on the show for you. So, until next year, [insert witty statement thanking everyone for turning up and also humbly congratulating the MDs for another successful show]. See you next December!
By Ozzy Eboreime, MDs’ President *This doesn’t actually exist.
Comedy Column Neuroscience
The Oxbridge, Slytherin and Sith of the iBSc world. If you didn’t think second year was enough of a challenge or you just really love looking down at your peers, then this iBSc is perfect for you. I mean, did you really do an iBSc if you didn’t do neuroscience? More coveted than Stu’s friendship, you may think getting into this iBSc means your life is sorted. Think again: it’s more Prison Break than Big Bang Theory. Rumour has it Attenborough will be featuring the Neuro iBSc in Planet Earth III, likening it to the Venus Fly Trap with its beautiful and alluring facade. However, once trapped you’ll be caught in a sticky dirty mess of your own tears, sweat and Wasabi leftovers. But no worries, at least you’re still the most sought after and competitive iBSc option... Oh wait.
Pharmacology, Physiology and Physiology & Pharmacology
You’ve heard of doing GCSEs a year early, but have you ever wanted to do your Religious Studies GCSE five years late? Did Daddy not let you do the beloved arts degree that you so badly wanted? Do you feel like a bohemian trapped in a middle class medical student’s body? No need to write a new personal statement, no one applies anyway.
Is your personality reminiscent of the Dulux beige colour chart? Are you so vanilla that people constantly come at you with a knife to split you down the middle for seeds? Did J.K. allocate a sheep as your patronus on Pottermore? If you don’t think you’re good enough for neuro, you’ll be pleased to see the average phys/ pharm student has:
• Three As, six Bs at GCSE and a BTEC in P.E. • “Satisfactory” in 2011 end of year report card • No real aspirations in life
Don’t worry if you don’t get into straight phys or pharm, the alternative combinations are endless: phys phys pharm, pharm phys phys, phys phys psych, phys pharm FNM phys, pharm phys phail phail pharm…. Quotes from friends of phys students include: “Wait, I’m confused, are you doing phys or just resitting second year?”; “At least you’re pretty”; “I’ve lost all respect for you as a person”. P.S. Just because you chose the space medicine module, it doesn’t make you interesting.
A.K.A. Clinical Sciences’ hotter younger sister - until you get to know her. “Make you work hard, make you spend hard, make you want all of her love” - Nelly Furtado on her experience of women’s health.
Bones, break, strong, power, love, myself, muscle - do any of these words appear in your tinder profile? We may have the perfect iBSc for you. An added bonus for all you Northerners: it’s actually closer for you to commute from home rather than living in London! One student even found it easier to commute straight from Hong Kong! On the bright side, a five hour journey every day will give you time to think about your favourite person - yourself.
Medical Physics and Biochemical Engineering
If Imperial was truly your first preference for medical schools, have no fear. This iBSc tries to recreate the Imperial lifestyle and curriculum on the Bloomsbury campus. Does the idea of a RUMS Mathletes society appeal to you? Were you getting too many matches on tinder and looking for a way to tone your profile down? Did you know before Cady “that the limit does not exist”? The Med Phys iBSc may be the perfect nerd paradise you’ve been dreaming of.
Paediatrics and Child Health
If you have an excess of feelings or your friends constantly refer to you as a wetter, paeds may be the iBSc for you. Here at the Comedy Column, we want to help you as much as we can so we picked out a few of our favourite personal statement extracts: “I wish we could all get along like we used to in middle school... I wish I could bake a cake filled with rainbows and smiles and everyone would eat and be happy…” “I’ll never let go, Jack. I’ll never let go.” “Why didn’t you write me? Why? It wasn’t over for me, I waited for you for seven years. But now it’s too late.”
Do you enjoy talking about your “gap yah”, but find that no one else cares? Looking for a safe space to discuss your morally and intellectually superior views? Searching for a one year course to teach you how to solve all-world problems? For some medical students, third year represents a second “gap yah” - that’s where global health comes in. If you love doing no work, not getting a first and complaining about problems that won’t get solved, then this is the iBSc for you. Plus, everyone knows a solid 2:2 guarantees you a job with the WHO - get ready for that summer internship! Here’s a snippet from the minutes of a recent tutorial: “Cause we were like ‘woaaaah’, and I was like ‘woaaaah’, and you were like, ‘woaaahh’...”
Been looking for a new diet where you lose two stone in two months and get an iBSc at the end? Struggling to find an excuse to quit RUMSBC? Trying to find a reason to explain why you don’t have a social life? If you’re a bit of a masochist and love crying yourself to sleep most nights, then this is the iBSc for you. Forget tennis elbow and housemaid’s knee, it’s all about the classic Clin Sci zygomaticus major cramps from fake smiling to your family.
This page is currently under maintenance, please speak to the class of 2008 for more details on how this course is run.
By Ros & Roger Java 56
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