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Your Essential Reading List for UCL Medical School Exclusive 20% discount on all these books! Atlas of Human Anatomy 7th Edition

Frank H. Netter

ISBN 9780323393225 PUB DATE March 2018 PRICE £65.09

NEW N EDITIO

The only anatomy atlas illustrated by physicians, Atlas of Human Anatomy, 7th edition, brings you world-renowned, exquisitely clear views of the human body with a clinical perspective. In addition to the famous work of Dr. Frank Netter, you'll also find nearly 100 paintings by Dr. Carlos A. G. Machado, one of today's foremost medical illustrators. Together, these two uniquely talented physicianartists highlight the most clinically relevant views of the human body.

Visit the website, select your books and use the discount code RUMS20 to get an exclusive 20% off for all readers of RUMS Review. Expires 1st July 2018 Kumar and Clark’s Clinical Medicine

Guyton and Hall’s Textbook of Medical Physiology

Netter’s Anatomy Flash Cards

9th Edition Parveen Kumar & Michael Clark

13th Edition John Hall

5th Edition John T. Hansen

The ninth edition of this best-selling textbook of clinical medicine builds even further on its formidable, prizewinning formula of excellence, c omprehensiveness and accessibility. 'This book is stunning in its breadth and ease-of-use. It still remains the "gold standard", thorough guide to clinical medicine its forefathers were.'

The 13th edition of Guyton and Hall Textbook of Medical Physiology continues this bestselling title's long tradition as the world's foremost medical physiology textbook. Unlike other textbooks on this topic, this clear and comprehensive guide has a consistent, single-author voice and focuses on the content most relevant to clinical and pre-clinical students.

Learn the essential anatomy you need to know - quickly and easily! Each flash card in this full-color deck features high-quality Netter art (and several new paintings by Dr. Carlos Machado), numbered labels (with hidden answers), and concise comments and clinical notes for the most commonly tested anatomy terms and concepts. Focusing on clinically relevant anatomy, this easy-to-use, portable study tool helps you learn anatomical structures with confidence.

ISBN 9780702066016 PUB DATE July 2016 PRICE £56.99

ISBN 9781455770052 PUB DATE June 2015 PRICE £79.99

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BMA Medical Book Awards judges.

www.uk.elsevierhealth.com

NEW N D E ITIO


Editor-in-Chief: Melika Moghim Director of Medical Journalism: Izabella Smolicz Treasurers: Carol Chan Augustina Jeyanathan Sub Editors: Rachel Parker Sophie Douglas Davies Sabrina Matica Hickey

UCL Medical School Student Magazine Vol. III No. III

The Anaesthesia & Critical Care Issue Email: rums-review@ucl.ac.uk Website: www.rumsreview.co.uk Facebook: https://www.facebook.com/rumsreview Twitter: @UCLRUMSReview 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.

News: Emma Lewin Anamika Kunnumpurath Summer Chan Out of Hours: Melika Moghim Research: Eng O-Charoenrat Andrien Rajakumar Features: Ian Tan Alumnus Interview: Naomi Joshua Sports and Societies: Asha Dave Perspectives: Cheh Juan Tai Demystifying Medical School Tanya Drobnis Book Reviews: Katie Hodgkinson Eleonora Vulpe Careers: Izabella Smolicz Online team: Jonny Knight Ian Tan Liam Taylor Design Editors: Rebecca Mackenzie Rosie Clarke Artwork: Karim Chraihi Grace Navin


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Skull / Editorials Editor’s Welcome RUMS President Foreword The Director’s Update RUMS Exit reports

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Clavicle / News The latest from in and around UCLMS

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Sternum / Out of DrHours Robert Stephens

Scapula / Alumnus Interview Dr Kevin Fong

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Radius / Research Dr Suellen Walker

spine / Features Xtreme Everest: The Lab at the Top of the World

Professor Mervyn Singer: Sepsis and the Known Uknowns Research Roundup: Anaesthesia

UCL MedSoc Anaesthetics and Critical Care Women in Medicine: Celebrating the Women of RUMS

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Pelvis / Perspectives Perioperative Medicine: Is this the future of Anaesthesia? “But I won’t wake up in the middle of the operation, will I?”

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metacarpal / demystifying medical school Demystifying Exams

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Careers Anaesthetics and Critical Care Medicine

Femur / Book reviews

Contents Fig. 1 Plan of RUMS Review Vol.III Issue III

Tibia / Sports and Societies VP Editorial Round-up FOTY: Where are they now?


Editorials Editorials

Editor’s Welcome Melika Moghim RUMS President Ozzy Eboreime Director’s Update Professor Deborah Gill RUMS Exit Reports 5

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ith the sweltering midApril heat now well and truly behind us, replaced once again by grey skies, there seems to be a no more fitting way to enter the dreaded exam season of third term - pathetic fallacy at its finest! In our final issue of the academic year we hope to bring you some light relief from revision and those Sports Night blues by exploring the single largest hospital-based specialty, Anaesthesia. With its increasingly intrinsic academic and clinical ties to critical care, perioperative medicine and pain management, Anaesthesia is well and truly stepping out into the spotlight. A particularly fascinating and rapidly advancing area of this specialty is research; from international collaborations to develop pre- and intra-operative translational tools, to conducting experiments on the varying effects of hypoxia at the summit of Mount Everest. Excitingly, much of this research is occurring right on our doorstep at the UCL Centre for Anaesthesia, Critical Care and Pain Management, and further information can be found in the Research Round-up. Alongside this, we talk with Dr Suellen Walker, whose current position as Research Lead for Pain at the Institute of Child Health sees her focus on projects aiming to establish a strong and more substantial evidence base in paediatric anaesthesia and pain. To conclude our snapshot into Anaesthesia and research we also have a piece exploring the history of sepsis classification. The article, aided by the expertise of Professor Mervyn Singer, a Council member of the International Sepsis Forum and an Intensive Care physician, explores how the many unknowns of sepsis pathophysiology are driving further research. In Out of Hours we catch Dr Rob Stephens (a familiar face for many clinical students) midsurgery to chat about his career, the development of the new Anaesthesia iBSc modules (see News for more details), and his love for pain aux raisins! Skip the Wikipedia page and head over to Alumnus Interview for our sit down with (former)

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NASA employee, academic, anaesthetist and all-round polymath Professor Kevin Fong, as he talks about staying true to your interests while forging a career, and the importance of effective public engagement with health. This issue, our Features section takes a look at the incredible 222- man trek to Everest Base Camp led by UCL’s Xtreme Everest team and how a decade on the data collected has been translated into further research and patient care. In honour of 2018 marking the 100-year anniversary that Britain gave (some) women the right to vote, we also take a look at UCLMS’ rich history of female trailbrasers who had to take advantage of loopholes and continually fight institutional gender discrimination just to attend Medical School alongside men. Then, in Perspectives, we speak with Professor Ramani Moonesinghe about the future of Anaesthesia and her work as the Associate National Clinical Director for Elective Care of NHS England. In line with our central theme, Book Reviews takes a closer look at three drastically different but informative and necessary insights into the field of Anaesthesia. Our spotlight on Anaesthesia then concludes with the Careers section, providing a brief guide for those of you interested in pursuing this interesting and varied specialty. If all of this is not enough to satisfy your procrastination sweet-tooth, our Demystifying guru has come up with a set of top tips for studying and exam stress management. Then head over to Sports and Societies to reminisce about the amazing achievements of Term two, and what is waiting for you on the other side of exams!

MELIKA MOGHIM/Editor-in-Chief

Editorials

As always, we kick things off with our directional update from Professor Gill and, sadly for the last time, a presidential update from Ozzy Eboreime. The support that RUMS Review receives from both Professor Gill and Ozzy, and the bodies they represent, is always greatly appreciated. Reading through all of the RUMS VP exit reports in Editorials truly shows what another magnificent year we have had. Our News section continues to grow to showcase these achievements - something which we could not be more glad about! Finally, we would like to extend our greatest thanks to Dr Rob Stephens for his tremendous help and guidance with this issue. Wishing you all the best for upcoming exams and have a lovely summer, see you in September!


Editorials

ear all,

I am addressing you as President for the last time, which is probably more strange for me than it is for you. I hope the Easter holidays were a much needed break and have given you the chance to recuperate ahead of the final term of the year. And what a year it has been. As we approach the homestretch to the summer holidays, I cannot help but look back at the year we have had. I wish the incumbent Executive all the best in trying to top this year. Annoyingly, they all look very highly capable and competent, so I have no doubt they will. In addition, I have no doubt that they will be more than happy with the state of RUMS they will inherit. Our Sports and Societies seem to go from strength to strength. Our students never cease to amaze me with how gifted and talented they are. Watching the UH victories and Varsity fixtures this year has made me proud to bleed blue and yellow. Helping to select the RUMS Alumni and Royal Free Association Award has made me aware of just how impressive so many of our student body are. However, I am equally impressed with those who may not achieve or compete at the highest level. Their dedication to playing or performing for RUMS week in and week out, regardless of result, embodies what I believe makes us so great. I cannot ever fully thank Charlie for choosing to honour and encourage our student body with their dedication and achievements at all levels. Overseeing the first RUMS Society colours and championing our students who are excelling in a range of different activities shows his determination in helping RUMS become more and more inclusive. His Sports Ball was one of the most enjoyable that I can remember and was rightly more in demand than ever. We still remain at the top with our academic representation. Ensuring this happened has been the aim of both Anush and Aayushi and their academic reps. If they would accept my feedback, I would happily tell them that I believe they have been great. However, I will let the objective facts of how many changes and improvements they have made to the course on our behalf and using our feedback, speak for itself. Though it is an often thankless job that involves making changes

On the theme of staff and student collaborations, our RUMS Welfare Week this January was perhaps the crowning glory of RUMS Welfare. From the Planet Organic smoothie bike, massage chairs, free Krispy Kremes, labradors and bunnies to the various stalls and talks, this week was a resounding success. Tackling the issue of mental health and wellbeing is an ongoing struggle. However, I am so proud with how Iram and her welfare subcommittee have gone about doing so this year. If their success and level of commitment to the welfare of our students carries on, I am confident that this will be an issue we will finally be able to say we have tackled. Our events have grown from strength to strength this year thanks to Dan and subcommittee. With the addition of the Refreshers’ Rave and Take Me Out, our calendar has never looked so full of many very enjoyable events. I am so happy to hear that a number of the dates resulting from Take Me Out were so successful. Another personal highlight was RUMS Dine With Me, which was bigger than ever this year. Whoever volunteers to hold a group of RUMS medical students in one venue must be brave, and we are thankful that the curry houses of brick lane are willing. I look forward to what the last few socials of the year have to bring for us.

of people working behind the scenes. Firstly, massive thanks to Dr Dilworth for always being there to fight our corner and advise us on how best to approach. Secondly, to Professor Gill for always respecting and protecting our autonomy and trying to work with us in everything. Thirdly, to Deanne Attreed for always being there to lend a helping hand with all the random requests that I throw her way or to lend an ear when I need to rant. Thank you for being there and being our unsung hero. Fourthly, to Carl in the Union, for never ceasing to save the day in emergencies. Lastly, a massive thank you to all of you. All we do would not be possible without your continued support. Thank you for being the best student body I could ask for and for giving me something so worthy to protect. I would also like to thank my Executive for being my inspiration and source of support this year. I am afraid the time is coming when we must hand over the mantle to Dan and his Executive. I have no doubt that his capable hands will be able to not only handle, but also grow the Presidency. For the last time, with RUMS Love, Ozzy Eboreime RUMS President, 2017-18

OZZY EBOREIME/RUMS President

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that unfortunately often do not come into place until the next cycle and after their time, I would very much like to thank them both. Thank you for ensuring that our thoughts and opinions on our course are materialised into change for the better. I would also like to thank all the teaching staff and administrators who are involved in the process of implementing these changes.

Last, but by no means least is our finance and operations subcommittee headed by Ankit. Though they have not been with us long, they have already made much needed improvements to our finances and publicity. They have funded new initiatives like the RUMS Welfare Week and helped to run the first election hustings to improve our visibility as a committee. I cannot thank them enough for their commitment to enabling RUMS to actualise our vision of how we can better serve you and grow. The work of the committee would not be possible without a number

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Editorials

and about and see more of our students and alumni and what they are up to. I was particularly delighted to see so many students and alumni at the UH Rugby final. The crowd was huge and vocal and provided an excellent example of the school spirit that makes UCLMS and RUMS so special. Winning the cup (again) was the icing on the cake and we are busy making plans to put it back on the purpose-built plinth in the Cruciform Hub - sorry, MDs but I am sure after one year of use of the plinth to display the Moira Stewart Cup you are happy to give it up for this mighty trophy!

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s ever I am delighted to be providing an update about the Medical School news for this edition of the RUMS Review. I am sure readers will agree that this publication has become an important part of how we share news about the school and its people: how did we do without it? The medical school has had a busy term as ever. We have just passed over 350 of our students in finals, conducted over 800 entrance interviews, launched the first events in our concerted and coordinated alumni engagement programme, launched the revamped student support system, established a new overseas consultancy project, signed off the plans for the Rockefeller Building refurbishment, and been engaged in some important research and policy work on careers and post graduate training. All this besides running the MBBS for almost 2,000 students. We are relatively small in number at UCLMS but we are mightily productive!

Meeting people The Medical School is a big and complex organisation and as Director it is easy to become removed from the very thing that makes us special: our students, past and present. This term I have been making a concerted effort to get out

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The MD’s Christmas show was another opportunity to meet students and was, as ever, informative about the programme and the school. I think we should do away with the student evaluation questionnaires and all just read the script of the comedy revues throughout the year and listen to the heckling to get feedback on what works and what does not! The MD’s exhibition event in the Hub on 13th April will be a great event for bringing together current and past MDs. Over a glass or two of orange blossom there will be a chance to look at the fantastic MD’s archive, hear some irreverent anecdotes, and network with alumni. As an MD myself I hope to see many old friends and meet some of the latest members of this motley crew. Our biggest student event this term was the Finals party where we celebrated 353 successes at finals. A lot of beer was drunk, a lot of pizza eaten and a lot of students shared fantastic reminiscences of the people and incidents that shaped their experiences at medical school and helped them to be ready to become new UCL Doctors. Like all medical school faculty I am a personal tutor to a small group of students. This bunch keep me busy/amused/informed/challenged in equal measure and each one of them is a delight. This role allows me to get to know some students really well and reminds me that every single entrant to UCLMS had the potential to be brilliant, was chosen for their creative and disruptive inclination, and needs support and challenges to be the very best they can be. Of course, I do not get to speak to or see our students enough. My experience is that it is face to face conversations that most effectively let


MEDICAL SCHOOL NEWS

me know what you are enjoying and want more of, what you want us to pay attention to or try to change, and what makes being at UCLMS fulfilling and fun. So when you see me walking about in College, around Bloomsbury or one of the clinical campuses (or even in Sainsbury’s) – come and say Hello, introduce yourself, tell me how it is going and tell me what we need to do better.

UCLMS overseas Who knew UCLMS has a presence overseas? OK, we do not offer our degree at overseas campuses but we are very active in supporting other medical schools to transform their programmes. With established projects in China and the Middle East, we have just agreed a new project with the Chulabhorn Royal Academy (CRA) in Thailand to help them establish a new medical school in Bangkok based on the UCLMS programme. This work is important to the medical school in many ways. It is a way of sharing knowledge and expertise (a new dimension of excellence for

universities to be measured in the forthcoming Knowledge Exchange Framework), it helps us to keep our own curriculum and ideas fresh, it creates new elective opportunities for students and professional development opportunities for staff, and it brings in useful income for the Medical School. We look forward to working with the excellent and growing CRA team to develop a really excellent school delivering worldclass medical education in Thailand.

The national picture In previous updates I have described the medical education and healthcare field as buzzing with new activity and announcements. Since the last edition in the undergraduate education arena we have had: final confirmation of the timing and format of the new national Medical Licensing Exam (MLA), the announcement of the opening of five new UK medical schools as part of the expansion of medical undergraduate

Editorials

education, and the final edits to the updated national curriculum requirements, Outcomes for Graduates. The world of postgraduate training and work for doctors, shaken by the impacts of the junior doctors’ strike, the decline in doctors taking up general practice training, the appalling NHS crisis over the winter, and the recent Dr Bawa-Garba case is now in the spotlight and is overdue for change. I am delighted that many UCLMS graduates are in senior positions in HEE and the Medical Royal Colleges and will be at the heart of trying to put things right. With best wishes to all students and staff for the forthcoming term,

Deborah UCLMS

Gill,

Director,

Follow us on twitter @doctordeborah @UCL_MBBS

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RUMS Reports

Anush Shashidhara RUMS VP Yr1-3 Iram Hassan Welfare VP When I started as RUMS VP for Welfare, one of my overall aims was to increase awareness and access to student support services. This involved gathering information and establishing links within the Medical School and wider UCL. One of the first ways I tried to address this was through the introduction of first and fourth year lectures by RUMS Welfare and Medics4Medics. These are key transition years, where changes can bring about new challenges and so we wanted to first focus on them. I hope that these can continue next year and be replicated for other year groups. The New Year brought in another new initiative with RUMS Welfare Week! We continued to raise awareness about student support services, as well as promoting a dialogue about mental health and wellbeing through stalls, Medics4Medics’ events, and therapy animals! Hundreds of medical students got involved and I hope that this firmly put RUMS Welfare on the map. Behind the scenes, I continued to explore how the curriculum could better incorporate our own mental health and wellbeing with an increasing number of small group sessions in CPP. The Personal Tutor system also saw some changes with more feedback being relayed to the Medical School as well as a new lead, Dr Scott Rice, who I hope will continue to engage with our ideas, concerns and expectations... I would like to thank the RUMS Welfare-y Godmothers (copyright pending) for all their fantastic hard work and commitment, as well as Medics4Medics and the other executive committees. Teamwork does indeed make the dream work. I wish Prithika the best of luck for next year, I am sure she will do an amazing job building on this year and bringing about positive change. I am still however not quite ready to relinquish my powers so keep your eyes peeled for more RUMS Welfare Weeklies and another Welfare Day this term! Iram x

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It has been another busy year with regards to the academic representation side of RUMS - the Medical School always makes listening to student feedback a priority, with a great deal of working going on backstage to ensure that the quality of teaching is the best that it can be. Some of the most important changes that have been made this year have been related to learning resources - more of the recommended textbooks are now freely available online for students to access, and over 4,000 infrared detectors have been placed at UCL libraries (including our beloved Cruciform Hub), in order to give people an idea of where space is available. Another major issue I have been working on is integrating the iBSc representatives into the Medical School’s existing feedback structure; in past years, major issues with iBSc programmes have gone unnoticed due to the separation of students from the Medical School in third year, a gap that we have started to bridge this year. I hope this work continues into the next academic year, as two new iBSc programmes (Oncology and Maths, Computers and Medicine) are opened up to students. Some important changes have also been brought into years one and two. As of the next academic year, formative assessments will no longer include decile based rankings, in a move to reduce unnecessary stress to students, and summative marks for these two years will no longer count towards the iBSc. I would like to thank all the student representatives for their work this year, these changes would not be possible without them, and I hope Yousif builds on everything that has been achieved this year. Anush Shashidhara

Dan Ntuiabane VP for Events It has been another eventful (or some may say events-full) year for RUMS. Each event has come with its own challenges (the annual struggle that is Freshers’ Pub Crawl springs to mind), but it has been extremely rewarding to be at the helm of it all, and to build upon the successes of last year.    I have really enjoyed  all  of the events, but if I had to choose a favourite it would have to be my baby: RUMS Take Me Out. This was a new one, conceived way back in November and coming to term in February to an overwhelmingly positive reaction! It was fantastic to see an audience and contestant roster full of RUMS  members at different stages of the course, and it was a privilege to facilitate and bear witness to the birth of RUMS romance... I have heard on the grapevine that a few of the couples are still going strong!     For me, events are about bringing people together, and I feel very lucky to have played a part in that this year.  It has been a pleasure to extend my RUMS family by getting to know so many of you, as well as working with a fantastic team in order to put on events, old and new. A special mention goes to George Allen, Jonathan Au and the rest of the tech team for bringing RUMS Take Me Out to life, as well as to my incredible sub-committee for their hard work and support throughout the year. I would also like to thank the rest of the RUMS Committee 2017/18 for making this year a fun, successful and (most importantly) laughterfilled one. I am sad to see my tenure as Events VP come to an end, but I am also excited to see what  Dhivya  brings to the role, and to support events as a loving member of the RUMS public.  Keep dancing, and see you around! Dan


RUMS Reports

needs to the University and the Medical School. We have also launched an Instagram account, so go and follow @rums.medics for all the latest information! It has truly been a pleasure to work as your RUMS VP for Operations and Finance this year. The RUMS VPs and President this year have worked tirelessly on doing more than ever to represent and provide for medical students, and I am grateful to have had the opportunity to work alongside such dedicated individuals. I would also like to make a special thank you to my subcommittee, Yousif Ali and Moksh Sharma, who have both worked hard to help bring to fruition the changes mentioned above.

Aayushi Gupta RUMS VP Years 4-6 Being your RUMS VP Education for years Four to Six has been a fun experience that has also emphasised to me the vast amount of work that goes on behind the scenes at the Medical School. They are willing to listen to our views and act on them to implement the changes we need. For me, a highlight has been the introduction of Schwartz rounds for year Four and Five: an environment in which students can discuss the emotional and social aspects of working in healthcare. The traditions of year Four FAQs and year Five Question Time have been continued and changes to the curriculum made surrounding ABG teaching, publicising how to raise concerns, and there have also been improvements to DGH accommodation. UCL have extended Cruciform Hub opening times to 24/7 for weekends in July – a marginal gain for our fourth and fifth year students who now have the option of never leaving the library whilst everyone else enjoys the sun. Space availability across campus is available to view on the UCL Go! app, with the installation of 4,000 infrared devices under library desks. Next time you are in the Hub, be sure to check out the upcoming locker system and the creatively named café: ‘Dr Coffee’. The Cruciform library gates have also been replaced to save many an awkward unsuccessful swipe. The Whittington have expanded their collection of textbooks based on your recommendations and restocked their ‘OSCE supply box’, found in the Common Room. Importantly, the Royal Free have heard your requests regarding the slanted seats in their lecture theatres. I will leave you with a tantalising nugget of knowledge: UCLH have some exciting announcements in the pipeline... I would like to conclude by thanking all of the student reps for their hard work (this role depends entirely on them) and I have full confidence in George for next year. Aayushi x

Good luck to Anush for the role next year, I have every confidence that he will continue to make RUMS even bigger and better than it currently is.

Ankit Bhatt VP Operations & Finance

Ankit

It has been a short but sweet year in my role as RUMS VP for Operations and Finance. A major focus has been the financial support for the numerous RUMS Welfare and Medics4Medics events, which have all been well attended and very much appreciated. It has also been great fun working alongside the RUMS Events subcommittee, who will forever be remembered as the first to create RUMS Take Me Out. We continue to support RUMS Review and make sure hard copies are printed and available across all three main hospital sites. The RUMS events this year came to a close with Sports Ball, which was a resounding success and headlined by the MDs Ectopic Beats for a second year. We are also currently negotiating sponsorship for the Finalist Ball this year, an event which RUMS is proud to provide assistance with. Alongside this we are also negotiating the financial autonomy of RUMS with UCL Student Union. This has been an ongoing conversation for a number of years now, but we are looking forward to finding a solution that gives us financial autonomy without losing our executive abilities in the coming year. We have also been working hard behind the scenes to improve communication and transparency, making RUMS better connected with you. This year was the first time we hosted a hustings, or Q&A, with the candidates for RUMS committee positions next year. The myRUMS. com website has been revamped to act as a point of information for external parties about what we are and what we do. It has been developed this year by Anush, who will continue to work on it in his role as VP for Operations and Finance next year. We have been working on designing an anonymous feedback system that allows students to get in touch directly with the RUMS committee about problems they are experiencing and get answers to any questions they may have, whilst importantly maintaining their anonymity. This will not only provide students with the opportunity to better communicate with their committee, but it will also better inform the RUMS committee about what students want so they can more effectively campaign for your 11

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News

NEWS

Medic Mind:

Fourth Year Medical Students Win Award for Best Start-Up Emma Lewin In October two fourth year medical students, Mohil Shah and Kunal Dasani, won the esteemed award for the Best UK Medical Start Up in ACW’s Start Up Pitch Competition. Up against some fierce competition, the award recognised the progress the duo, with their passion and business acumen, had made with their company, Medic Mind. Medic Mind is student-run organisation aiming to transform the medical application process. They focus on helping students with two exams, the UKCAT and BMAT, and medical school interviews via their two products - an e-learning online course and a one-to-one tutoring programme. Launched in July 2017, after having witnessed students struggling with

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the UKCAT admissions test, Mohil and Kunal identified a gap in the market for affordable, student-friendly e-learning. Now, hopeful medical school applicants across the world are welcoming it. Despite only being eight months old, Medic Mind has already achieved a great deal, including teaching 5,000 students, collaborating with NHS Cardiff and over 20 UK schools, all whilst also releasing 16 books and four courses globally. It is these achievements, along with their widening participation initiative which Mohil believes gave them the upper hand. “we believe that the key factor was our combination of business success and company values. Of course, we had a very high customer uptake given our status as a student start-up, but a key factor was the ethos instilled in Medic Mind.” Recognising that a lack of affordable study resources can make it even more difficult for students from lower socioeconomic backgrounds to enter medicine, Medic Mind has developed a bursary scheme which provides free tuition to those who are unable to afford it.

friendly and affordable than the corporate material from established companies, and with very little investment it was possible to gain a huge market share.” Mohil provided some more insight, “don’t be afraid of being unoriginal. Lots of people think to have your own start-up it has to be a new idea or in a market which isn’t saturated – instead of making a new product, you can make an existing product better. If your product is good, you will get customers.” Ever the entrepreneurs, the hard work for Kunal and Mohil is not stopping here, they are now looking to expand into other countries, such as China and Singapore, as well as develop a partner company, Education Mind, which will provide online courses and iOS apps for a range of GCSE and A-level subjects. We would like to congratulate Mohil and Kunal for all they have achieved and wish them continued success with Medic Mind in the future! If you would like to get involved, Medic Mind is always looking to recruit tutors for their one-toone programme, entrepreneurs to help manage and grow the business with, and volunteers for their charity outreach schemes. Get in touch at www.medicmind.co.uk/contact-us.

Combining developing a start-up with a medical degree is no easy feat and the road to success has not been without its ups and downs. The first six months in the life of Medic Mind were particularly hectic as the pair had to set up the service, design their website (www.medicmind. co.uk), register their company and finally write their materials. To do this they scrutinised the BMAT and UKCAT exams to identify key tips for their books, and then sat down to write all 16 books in the space of three months. Once this was completed, they needed to market their product. Mohil explained, “we visited many schools to give free talks, invested in Google Ads, and launched a successful YouTube Channel (www.youtube. com/medicmind). On the YouTube Channel, we receive 75 hours of news per day and have over 100,000 views. There were no extensive YouTube tutorials so we found a gap in the market and filled it.” For those looking to start a business, the Medic Mind creators provided the following tips. Kunal placed an emphasis on confidence and find what works for you within your market, “don’t be scared of the big corporations. There will always be huge companies with offices, full time staff and established market share. You don’t need to try to beat them. We set up something more student-

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Articles

News

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Competing in Capital Bhangra!

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Summer Chan

No Likey, No Lighty

Emma Lewin On the 10th of February 2018, the most romantic event of the year was held in Cruciform LT1. Arguably more entertaining than the real show, RUMS Take Me Out saw nine eligible bachelors compete for the hearts of 13 lovely ladies (and also two late additions), all from different RUMS societies. Bringing the phrase “no likey, no lighty” to life, complete with light boxes and a witty host, George Allen, the audience were treated to a night of awkward flirtation, secret-revealing videos and cheesy one-liners. All the boys ended up with dates, even if the two late-addition ‘ladies’ had questionable hairstyles, and the girls who did not get a date received an arguably better prize of prosecco. As a result of the superb organisation of the RUMS events team and the creativity of the tech team, the night was professionally executed and full of fun and cheers. Who knows, maybe the match-making was a success? We hope to see it again next year!

Bursary Application Revamp

Rhonda Trotman

Over the last few years, there has been a marked decrease in the number of students applying to the Medical School for bursaries. As a result, some of the money potentially available to medical students has been left undistributed. If this continues, there is a risk that some of this funding might not be available in future years. In response to this, the Medical School has been working with a group of medical students to improve the bursary application process. As a result of this collaboration, the Moodle page (MBBS Bursaries) has been revamped and the entire application is now online. All students are automatically enrolled and applications are now open! The deadline for applications is in October 2018. Applications are assessed solely on the basis of financial need, and students of all years and all fee-paying statuses are invited to apply. In addition to these bursaries, emergency funds are available throughout the year from the Medical School, UCL and other external organisations. These are accessible by contacting medsch.student-support@ucl.ac.uk or dropping into G46 in the Medical Student Building to make an appointment with a Student Support Tutor.

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UCL Paediatrics Conference

Summer Chan

Third year medics Rohan Laav and Devjeet Bhomra, captains of the UCL Bhangra Team, took their team to Capital Bhangra 2018 here in London on the 31st of March. This was independently organised by the duo after having been an integral part of UCL Bhangra since first year. The competition saw them dance against seven other universities. The team is comprised of a number of other medical students from different years including Eksimran Malhi (first year), Navjeet Kaura (second year), Pavandeep Virdee (second year), Janvi Karia (second year) and Aman Singh (fourth year). They are very proud of having maintained their busy work schedule while enduring intense rehearsals for the past four months, and were even more excited to perform and show off their hard work.

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UCL Medics in New Year’s Honours Emma Lewin Four UCL Medical School staff and alumni have received awards in the New Year’s Honours, including a knighthood and a dame. Miss Clare Lucy Marx, a UCL alumna and the first female president of the Royal College of Surgeons, was awarded a DBE (Dame Commander of the Order of the British Empire). Professor Terence John Stephenson, Nuffield Professor of Child Health at UCL and 2015-18 Chair of the GMC, has been awarded a knighthood for services to healthcare and children’s health. Meanwhile, alumnus and Senior Clinical Research Fellow at the Centre for Evidence-Based Medicine Dr Ben Goldacre was awarded an MBE for services to Evidence in Policy, and Professor Timothy William Roy Briggs, Professor of Orthopaedic Surgery at UCL, has been made a CBE (Commander of the Order of the British Empire) for services to the Surgical Profession. All have made hugely important contributions to their respective fields and we would like to congratulate them on their awards! 

UCL Paediatrics Society hosted a successful paediatrics conference on the 13th of March at the Whittington Undergraduate Centre. The conference, open to both current medical students and sixth formers, had speakers from Great Ormond Street Hospital, Imperial College and UCL. The conference covered an impressive array of topics including child mental health, global health, and health inequalities. Sophia Hashim, Chair of Paediatrics Society, expresses personal highlights of Dr TudorWilliams’ inspirational talk on innovative healthcare services, as well as Dr Fertleman’s encouragement to reflect on patient pathways. The conference, which takes place annually, will certainly be as much of a hit next year as it was this UCL Paediatrics Sub-Committee who organised the conference year.


News

The Royal Free Association (incorporating the Royal Free Old Students' Association and Members of the School) www.royalfree.nhs.uk/rfa

President Dr James Dooley Tel: 07967 013810 e-mail: j.dooley@ucl.ac.uk

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Transplant Record for Royal Free Liver Transplant Team Emma Lewin In the space of 18 hours, three liver transplant surgeries, including two emergency procedures, were carried out at the Royal Free Hospital. In a surprising turn of events, three donors became available on the same day and transplant coordinators had to work quickly to ensure that the transplant procedures took place before patients deteriorated further. Liver transplant surgery can take up to 12 hours, and co-ordinating multiple surgeries in such a short timeframe required a great deal of speed and foresight. A number of staff members came into work to help out with the surgeries, despite not being on call. As a result of this demonstration of efficiency, teamwork and altruism, all surgeries were a success and the patients are now recovering well. It is inspiring to hear of the transplant co-ordinators, theatre staff and hepatology, anaesthetic, surgical and intensive care teams who worked together tirelessly to ensure that these life-saving procedures could happen. What an amazing accomplishment!

Treasurer/Secretary Dr Peter Howden Tel: 01205 260601 e-mail: peter.howden1@gmail.com

The origins of our association date back to 1929. It was then called “The Royal Free Hospital School of Medicine Old Students Association.” After a short lapse it reformed after the second world war and today has 4000 members. Following the merger of The Royal Free with University College in 1999 the name was changed to The Royal Free Association. As well as alumni of the RFHSM all hospital consultants are now members as well as some non medical staff connected with the Hampstead site. We have an annual clinical meeting and AGM held in The William Wells Atrium and all UCL medical students are welcome to attend. We support students in several ways. Each year we offer bursaries for electives in the final year of study and have funds available for students who find themselves in acute financial distress. In addition this year we are offering four Royal Free Association Awards exclusively for 4th year mature students. If you wish to apply for any of these please contact either Holly Riches (h.riches@ucl.ac.uk) or Deanne Attreed (d.attreed@ucl.ac.uk) Dr Peter Howden. Honorary Secretary and Treasurer The Royal Free Association.

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New Anaesthesia iBSc Modules Summer Chan In the forthcoming 2018/2019 academic year two new anaesthesia modules will be introduced as part of the Physiology iBSc: Anaesthesia, Surgery, Critical Care and Acute Physiology in ‘Essentials’ and ‘Advanced’ module options. This was introduced by Dr Robert Stephens, Consultant in Anaesthesia at UCLH and Honorary Senior Lecturer in Anaesthesia at UCL. UCL is one of only four universities to offer such preclinical modules in the UK. The modules will be grounded in interactive learning, using a range of teaching methods including lectures, tutorials, videos, theatre visits, clinics and on-call experience with the anaesthetic teams at UCLH. This is an excelled opportunity for those interested in Anaesthesia and Critical Care, and also a large step to integrating this pertinent specialty’s teachings into pre-clinical education. The aim of these modules is to apply learnt physiology and increase the confidence of students in preparation for the clinical years and clinical practice after graduation. To learn more, search ‘UCL student Anaesthesia’ or contact Dr Stephens directly at robcmstephens@googlemail.com.

Core committee and other team members

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UCL Surgical Society’s

iNUGSC Summer Chan The International Undergraduate and Foundation Surgery Conference (iNUGSC) is a key event in the Medical School calendar. Organised by UCL Surgical Society, this year it took place on the 20th of January. The Conference Director, Claudia Eichenauer, led the core committee of 11 other medical students from a range of years, who had been organising this event since last summer. iNUGSC hosted international, high-profile speakers this year – notably the

keynote lecture was given by Dr David Langer from the US about Vascular Neurosurgery and patient satisfaction. In addition to the talks and poster presentations, delegates were able to choose three workshops (out of a possible 13) to participate in. These varied from surgical airway management to tendon repair. Excitingly, the conference also featured new workshops this year – the maxillofacial workshop, how to be a surgeon workshop, and military trauma surgery workshop. As a large-scale event attracting over 200 medical students and sixth form students, the conference was a success. See www.nugsc.co.uk/gallery/ for photos of the day.

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Medics4Medics

News

Starting Conversations about Wellbeing and Mental Health By Emma Lewin and Kerry Wales At any one time, around 25% of the UK general population experience a mental health problem. As medical students, we are not exempt from this. In fact, research has shown that medical student populations have higher prevalence of psychological distress than the general population. Despite it being common, mental health in medical students and health professionals is often seen as a taboo subject. One group of students is trying to change this. This year has seen the resurrection of Medics4Medics, a student peer support group which aims to open up discussions about wellbeing and mental health in doctors and medical students. Originally founded in 2014, it provided fortnightly peer support wellbeing sessions which unfortunately lost momentum over the following years. This year, restructured and rejuvenated, it has made its much-anticipated comeback and is making its mark on the Medical School. Having joined the RUMS Welfare Sub-committee and inspired to tackle the issues raised in her iBSc research project, Kerry Wales, Director

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of Medics4Medics 2017/18, made the decision to develop Medics4Medics into a new Peer Support scheme, using the foundations of its predecessor. Kerry’s study looked into mental health help-seeking behaviours in UCL Medical Students. Some key findings from this included that UCL Medical Students with psychological distress experienced significant denial, isolation and stigma and had a lack of awareness of the support services and resources available. This clearly identified the need for a group such as Medics4Medics to help provide solutions to these issues. Alongside Kerry and her committee, Medics4Medics is made up of a community of over 30 medical student Peer Navigators from all years of the Medical School. The charity Rethink Mental Illness has trained these Peer Navigators to help signpost students to appropriate support services and help students feel able to seek support without fear or shame. Peer Navigators are supporting, educating and engaging RUMS students to invest in their own mental health and helping students to cope with the pressures of medical school. A key feature of this term has been the fortnightly events which provide a safe and non-judgemental space for support and conversation. These events also aim to give guidance and support to RUMS  students in developing and maintaining good personal mental health, especially in the context of a stressful environment. These events are speaker-led, to provide students with access to doctors who have experience of psychological distress or mental illness. They also have speakers who are psychologists, or who have experience of providing student support. The members of the Medics4Medics Facebook group select the themes of the fortnightly events, and so far, have included topics such as burnout, helping friends through difficult times, coping with being in a competitive environment, and perfectionism. Having events led by healthcare professionals provides students with relatable role models.

This helps to defy the stereotypes, stigma, and alleged career repercussions associated with mental illness within the medical profession. It is hoped that these Medics4Medics events will make attendees feel more able to talk about their own mental health. Everyone is welcome to attend the fortnightly-held events and everything discussed remains confidential. These meetings provide a large number of students with a platform to openly learn about and discuss well-being and mental health without fear of judgment and are helping to make UCL Medical School a more compassionate, open and supportive environment. It is no surprise, therefore, that the Medics4Medics events have been very well received by students and staff alike. In March a new committee was elected, ensuring that the scheme will continue supporting RUMS students next year. A number of plans to develop the scheme have already been put into place for next year. In particular, it is hoped that the Welfare Officers of the various RUMS societies will become Peer Navigators, which will increase the breadth of impact of the group. They also intend to start training some Peer Supporters, especially those with experience of mental health conditions, to provide one-to-one support. Medics4Medics will continue to work with the Medical School and the RUMS Welfare subcommittee to ensure that the communication of information about support services is a priority next year. From the first peer-support meeting to the fortnightly events, Medics4Medics has already developed so much this year and it will be exciting to see the direction in which it is taken next year and beyond. For more information or if you would like to get involved see www.uclm4m.co.uk and join their Facebook group www.facebook.com/groups/ UCLmedics4medics/.


The Library

News

Space availability As part of a project with ISD, 4,000 infrared devices have now been fitted to study spaces across the UCL libraries to help students locate an available study space. Live updates on seat availability in the majority of library sites can be found at www.ucl.ac.uk/library/sites/seats. This will be particularly useful for students during the exam period. The space availability information is also being made available on the UCL Go! app from Spring 2018. UCL Go! is aiming to make it really easy for students to see all the study spaces available across UCL in one place (including all libraries, learning spaces and computer clusters).

New pop-up learning space From Easter until the end of May 2018, the new pop-up teaching structure in the front quad will be transformed into a library-managed learning space, providing additional revision spaces during the exam period.

E-resource news UCL now has access to Visible Body Human Anatomy Atlas 2017. Visible Body is a 3D interactive anatomy visualisation and education tool. The Human Anatomy Atlas modules includes all body systems, gross anatomy, and select microanatomy. To access this resource, please go to www.ucl.ac.uk/library and search for “Visible Body”. For further information on how to download the app for mobile device access, please visit ovid.visiblebody.com/mobile/.

Intelligent lockers for students A bank of 44 intelligent lockers has just been installed in the Cruciform Hub. The lockers will be available for shortterm loan to UCL students in possession of a valid UCL ID card. The system is currently being tested and will be launched in the Spring.

Cruciform Hub café By popular demand, the Cruciform Hub café Dr Coffee now has extended opening hours: Monday, Tuesday and Thursday 09:30 - 18:00 Wednesday and Friday 09:30 - 17:00 Saturday 11:00 - 16:00

‘Dangers

and Delusions’? exhibition

The new exhibition in the Main Library considers perspectives on the women’s suffrage movement in the period leading up to the 1918 Representation of the People Act, including voices for and against legislative change, through materials drawn from UCL Special Collections. The exhibitions runs from the 5th of February to the 14th of December 2018.

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Vol.III No.III


Out of Hours

OUT OF HOURS Dr Robert Stephens

Consultant Anaesthetist

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Out of Hours

What first sparked your interest in medicine? My dad was a hospital biochemist and during the summers I spent with him I saw that he seemed to really enjoy his life in hospital. For a while I thought I wanted to be a vet, which would have been be a disaster because my wife is a vet, and they don’t earn any money! When I was 16 I shadowed a young doctor in a Cardiff casualty, I was doing some suturing and just loved it. I thought it seemed really fun and an amazing way to help people.

What did you study and where? I studied medicine at Oxford and then came to St Mary’s. Oxford was great; it was very liberal and there were lots of lovely people, but St Mary’s seemed to be quite restrictive, and the people weren’t very kind. That is what sparked my interest in teaching, because I distinctly didn’t want to be like that. I wanted students to feel that their teachers cared about them and had their interests at heart. Then I came to UCL to work with the intensive care team at the old Middlesex Hospital for a year. Just before finishing the intensive care job, a guy called Monty Mython, who was one of our professors asked me: ‘Do you want to do some research?’. I said ‘Yeah, what a great idea!’. So I did research with Monty and then I came to do the anaesthetic registrar rotation. From there I carried on being part of UCLH and UCL. I did a degree at UCL in immunology applied to medicine as well.

What are the best and worst things about teaching medical students? The best thing is that they always keep me learning and make me question what I do. The worst thing is when they irritatingly check their phones in theatre. Oh, there we go, I just saw one do exactly that! But seriously, the worst thing is when students feel despondent about learning; that’s really difficult for them and for me. I don’t want all my students to be interested in anaesthetics, or perioperative medicine, or critical care pain. But it’s good for students to get a chance to see the benefits of each specialty. You can take something from each specialty, whether you want to do global health, paediatrics or psychiatry.

What has been the highlight of your career? If I’m really honest, the highlight of my career has been receiving Teacher of the Year Awards, which are voted for by the students. I’ve been awarded for the past five years, and last year I got three awards: for years one, four and six. I’m the only person ever to have gotten three in one year according to the medical school.

What one person has most changed the way you think about medicine and science?

talking to patients, but talking with patients, because the patients are speaking as well. I think I’ve tried to follow the example of people who place the patient at the centre of their practice in a real, physical way. These people have taught me how to let a patient tell you what they are worried about, explain why you’re doing something and ask if they have any concerns – the real things.

What are your greatest ambitions for the future? To carry on living healthily and have a good relationship with my wife and children. To continue having a great relationship with my colleagues. To try not to be cynical at all towards patients. And to try and be even more patient centred.

Describe yourself in five words. Enthusiastic, music-loving, 49 (two days ago), kind (I hope). And one more, pain aux raisin lover!

What is your favourite way to relax after a long day? Alcohol.

What is your guilty pleasure? Pain aux raisins. Every Wednesday, my surgeon and I go for breakfast at The Wolseley, and I’ve had a pain aux raisin for the past five years.

What one piece of advice would you give to your students? Be enthusiastic. Second piece of advice, ask people within each specialty what they enjoy about their specialty; it’s a really good ice breaker and it is quite flattering, it causes them to think and lets you see the best in them.

Follow up question: what do you enjoy about your specialty the most? My specialty is weirdly social. You might think anaesthetics is not sociable because the patients are asleep, but actually you have to develop a very quick rapport with the patients. They have to feel your love for them and that you care for them, and that what they’re experiencing is important, because it is. The trainees are challenging, in a good way. You can do anaesthesia in an intellectual way, thinking about the drugs and how can we improve things, or you can do it in a one-two-three formulaic way, and both have their place. I also think my colleagues are amazing people that are kind to each other and to patients.

Crikey! I genuinely don’t know the answer to that question. I’ve tried to take the best of lots of people. There are a few colleagues of mine that are very, very good at talking with patients – not

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Vol.III No.III


Alumnus Interview

Dr Kevin Fong

Consultant Anaesthetist

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Alumnus Interview

RR: What prompted you to choose medicine after completing your astrophysics degree? I wanted to go to Medical School when I was in college, but did not get the grades, and probably was not mature enough to be honest. I studied astrophysics at UCL and I think we were working almost as hard as the medics on that course. I realised that if you want to do it enough, you can probably do medicine as a degree. Although I enjoyed studying astrophysics, I was learning for the sake of learning. I came to the end of my physics degree thinking I wanted to do something more practical that might help people. I was going to do a Medical Physics PhD but whilst I was working for the student newspaper, I went to Bart’s to do a piece and I ran into a medical student there. He had studied Physics and then done a Medical Physics PhD. He said that by the end of his PhD he realised it was medicine, and not physics, that he wanted to do. I realised that this was going to happen to me so I thought I would take a shorter route and go straight to medical school!

After initially pursuing an astrophysics degree before embarking on Medical School, Kevin Fong graduated from UCL in 1998. His career has led him to sit at the table with the brightest minds at NASA, chair meetings looking at British involvement in space exploration, and create BBC Horizon documentaries making science more accessible to the public. All while pursuing his career as a Consultant Anaesthetist at UCLH. Here he talks to us about how seizing the right opportunities has helped to shape his career.

RR: With your physics background, did you have an idea of where you wanted to go afterwards during your time at Medical School? When I decided to go to Medical School, I was absolutely certain I was going to do General Practice. I had quite a romantic vision of what that would be. I thought I would totally leave physics behind; I was done with gazing at stars and space exploration and I thought I had entered my new vocational life. As I was coming into medicine a little older it made sense for me to go into General Practice, which was the shortest route to finishing training. But all of that changed when I started Medical sSchool. Physics turned out to be a really useful preparation. All the topics that scared everybody else were fairly straightforward to me, such as the statistics and the physiology. I was surprised by how useful physics was.

asking “Why is this happening? Why is the blood pressure dropping? Why are they hypovolemic?”

RR: It is interesting because it looks like a perfectly planned out career, but it seems that opportunity has formed your interests? I just did the things I was interested in as well as I could. When I was in my final year of Medical School, I went on my elective. I did two of them. I did an elective at Southlands Hospital in Shoreham-by-Sea, and it was really eye opening to see how much gunshot trauma they received. I did an elective with NASA at the Johnson Space Centre, and when I came back, I realised that it would be cool if I could merge my medical life with my interest in space exploration. For me that was perfect, because it was everything I loved about medicine, and everything I loved about space exploration, all in one. When I did that elective, we were sitting around in rooms with astronauts and mission planners and engineers and rocket scientists who were all straight faced, talking about the “Next Big Thing”, which for them at the time was Mars. It was fantastic and the International Space Station of course was just about to be launched. I wanted to be sure I could keep doing that back in the UK and I spoke to what was then the British National Space Centre. I asked what was going on in the UK regarding space exploration and they said “Nothing, nothing is going on.’’ But they were about to have a review of the policy and they asked if I would help review it. I ended up sitting on civil service review panels for space policy which was an interesting experience for a very junior doctor. I organised a conference when I was a House Officer, which asked “What are we doing in the UK in space?” We have quite a rich legacy, a lot of British scientists had been involved in Apollo, so we had 150 people in the

RR: What was the path you took after you graduated? I graduated in 1998 when the traditional jobs involved six months of surgery and six months of medicine. But they were beginning to introduce pilots for new jobs, and I did six months of medicine, six months of anaesthesia, and six months of surgery. We had incredible training and great learning experiences. Anaesthetists were always nice people and I thought they did some interesting work. What I really liked about them was their fundamental understanding of physiology, and they had thought processes I recognised from physics. They were perpetually 21

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Alumnus Interview

Cruciform lecture theatre, with me chairing it! We had people from NASA, people from the ESA (European Space Agency), and people from the British National Space Centre, so it was a big deal. Off the back of that, we launched a course in Space Medicine, which is still an intercalated unit today (it has been running at UCL for 19 years).

“I did an elective with NASA at the Johnson Space Centre, and when I came back, I realised that it would be cool if I could merge my medical life with my interest in space exploration.”

RR: What is your advice for medical students who want to combine research and other interests with medical practice? I have had a very atypical career and at various points people told me that it was never going to work. But I guess you have to do what suits you; you do not know what lies in store in the future. You have got to do things that you enjoy, you have to do them well, and you have to believe in yourself. From the outside my career path looks nonsensical, I completely understand that. I have been very lucky - one day the Wellcome Trust turned to me and said “Do you want to do Public Engagement? We give away hundreds of millions of pounds a year for research but we never spend any effort trying to engage the public to tell them why this research is worthwhile or what they get out of it.” Indeed, research is still something being done to people rather than with them. So they started public engagement fellowships, which were an experiment to see if you could take scientists and clinicians off the front line and train them to become better at communicating science. In the first two years of the fellowship I learnt film broadcasting and how to be a better writer. Which gave me the freedom to go away and make documentaries on things I cared about. It was fantastic, I mean a dream fellowship! I think it was successful in its aims; there were a

lot of things that needed to be communicated and there were a lot of things I felt passionate making documentaries about. Most of this is luck, most of this is me being around the right place at the right time and making the most of it.

RR: What has been the most valuable experience of your career so far? It has all been valuable. And I could never not do any of it. The broadcasting, the bits of operational research at NASA, the medicine - I love it all! But I am glad I did not do any of them exclusively. For me the value is being able to observe different systems, participate in more than one thing and bring ideas that I have learnt from other areas to my current project. Nothing ever gets boring. I think having a different perspective is always useful wherever you are.

RR: What are you currently working on? I am currently working on a BBC Horizon documentary about palliative care. It is about our approach to end of life care in medicine.                                             

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Alumnus Interview

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Interview with

Research

Dr Suellen Walker UCL’s Centre for Anaesthesia, Critical Care and Pain Medicine runs over ten different research groups with leading researchers and clinicians. Each group is involved in cutting edge research with the common aim of improving patient care and outcomes. Dr Suellen Walker is the lead researcher for the paediatric anaesthesia and paediatric pain research teams. Working at Great Ormond Street Hospital (GOSH), she uses her clinical experience to guide her translational research. Here, she discusses her reasoning behind her choice of profession as well as offering advice to medical students keen on pursuing a career in translational research and/ or anaesthesia. Interview by Eng O-Charoenrat, Research Editor

Featuring Dr Suellen Walker Professor Mervyn Singer: Sepsis and the Known Unknowns

Research Round-up Anaesthesia


Research

medicine at RNSH, and also get involved in pain research at RNSH. From my paediatric clinical practice, I was mainly interested in developmental aspects of pain and analgesia in early life. Therefore I moved to London to do an MSc in Neuroscience at UCL and subsequently a PhD with Maria Fitzgerald. This then led on to my current clinical academic post at UCL GOS Institute of Child Health and GOSH.

Why did you choose to specialise in anaesthesia? I did an anaesthesia rotation as a House Officer and enjoyed several aspects of this: working as part of a team in theatre and intensive care, the procedural aspects and skills required, working in acute care with challenging physiology and needing to understand both the patient’s medical condition and the surgery being performed. However, it is not all about major surgery or potentially life-threatening scenarios. The simple things are equally important to me. Watching a child having a drink in the recovery room because they have woken up without pain and nausea and are now happily back with their family is a great source of job satisfaction.

What is your current main area of research and what projects are you working on? My research focuses on investigating the impact of pain, injury and analgesia at different developmental stages.

How has your career developed up to this point? My career has developed in three complementary areas: paediatric anaesthesia, pain medicine and translational research. I initially completed my paediatric anaesthesia training at Royal Children’s Hospital (RCH) in Melbourne. I had developed an interest in pain management during my training, and so also completed a fellowship year in pain medicine at Royal North Shore Hospital (RNSH) in Sydney. I worked at RCH in Melbourne as a consultant in paediatric anaesthesia and pain medicine for several years, and then had the opportunity to move to a post in Sydney which allowed me to combine clinical work in paediatric anaesthesia at Children’s Hospital Westmead and RNSH, pain

One of the projects I am currently working on examines the long-term impact of neonatal surgery. In clinical studies, I have evaluated pain and somatosensory function in children and young people following preterm birth. Our laboratory studies use a rodent model to understand the mechanisms of long-term alterations in injury response and evaluate prevention by different analgesic and mechanismbased interventions. Another of my research interests is neuropathic pain in children. Neuropathic or ‘nerve-injury’ pain is difficult to treat, and can be due to different causes in children (e.g. rare genetic diseases) or can vary with age (e.g. response following trauma or surgery). We are collecting data related to clinical history, patient-reported psychosocial outcome measures, and quantitative sensory testing to understand more about this condition in children. We are now expanding this project to include further research methods in additional patient groups.

How would you recommend students who are interested in research get involved? Make a note of the lecturers who speak about research that captures your interest, or that you hear speak during grand rounds, meetings or conferences. If you have a specific area of interest, see who is working in that area by looking at publications. Do some background reading, and then get in touch. Most researchers will be happy to chat about their work and let you know if they have capacity for observerships, summer placements or roles in research projects. If you are emailing a researcher looking for a project or wanting to discuss research, it will make more of an impact if you can make it clear that you are aware of the field they are working in, and have a specific interest. There is a training handbook for Paediatric Anaesthesia trainees that can be downloaded and includes chapters about audit and research, including suggestions and links to research information that are also relevant to other fields. www.apagbi.org.uk/professionals/educationand-training-trainee-section/trainee-handbook

What is one future development or project that you think will change your practice? More specific mechanism-based medications for managing neuropathic pain.

If you could give one piece of advice to yourself as a medical student, what would you say? Be open to learning about as many fields as possible before choosing a specialty, and keep time for the friends you will meet at this stage as they are likely to be important for years to come.

Dr Suellen Walker Reader and Honorary Consultant in Paediatric Anaesthesia and Pain Medicine Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust We would like to thank Dr Suellen Walker for taking the time to contribute to this piece.

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Research

Sepsis and the

Known Unk Sepsis has been recognised for over 2000 years. However, the definition of sepsis has changed over time, even in the last two years with the introduction of a new scoring system. Read on to gain an insight into the knowns and unknowns of sepsis, with valuable input from Professor Mervyn Singer. Words by

Andrien Rajakumar, Research Editor

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Research

knowns Introduction In the 14th century, a Franciscan friar and logician named William of Occam expressed his law of briefness: ‘More things should not be used than are necessary’. The work of philosophers such as Newton and Bertrand Russell built upon this idea, developing the principle that a simpler hypothesis (one which

Image by Grace Navin

makes fewer assumptions) is more likely to be correct. However the application of this ‘Occam’s razor’ in medicine is in some ways paradoxical. As future doctors our role will be to formulate hypotheses based on a history and examination, using our findings to develop a list of differential diagnoses. How we investigate the patient is then based on which of these diagnoses involves fewer assumptions. However, it is often our assumptions which drive us towards a particular diagnosis. A patient in a certain demographic showing the ‘classical’ signs of a certain disease can often be assumed to have that disease unless proven otherwise. It seems that it is necessary to use both simple hypotheses and basic assumptions to arrive at the correct conclusion, since how else are we to interpret the intricate machine that is the human body?

I spoke recently with Mervyn Singer, Professor of Intensive Care Medicine at UCL, a Council member of the International Sepsis Forum and the first UK intensivist to have been awarded with Senior Investigator status by the National Institute for Health Research. During my interview with Professor Singer, the conversation turned to how there is a great deal we do not understand about the body. This incomplete understanding sometimes leads to a failure to recognise even common critical conditions such as sepsis. ‘We have numerous reflexes and compensatory responses which make even a very sick patient, on a superficial glance, look normal. The problem with sepsis is that when it’s easy to recognise, it’s obvious. But when it has a non-specific presentation it’s so difficult to identify that actually 20-40% of patients diagnosed with sepsis end up having something else,’ says Professor Singer. Here is a fundamental flaw in the medical application of Occam’s theory: how can we avoid assumptions to diagnose and treat a problem when the very nature of sepsis eludes us?

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Research

Defining sepsis In the fourth century BC, Hippocrates defined sepsis as a process of decay or decomposition of organic matter. In the eleventh century, Avicenna coined the term ‘blood-rot’ for diseases associated with purulent processes. The first international consensus for defining sepsis, Sepsis-1, came in 1991 to help drug companies to design trials to detect sick patients. Initially, sepsis was defined as infection or suspected infection which lead to the onset of systemic inflammatory response syndrome (SIRS). If this was further complicated by organ dysfunction, it was termed severe sepsis and if there was sepsis-induced hypotension unresponsive to fluid resuscitation, it was termed septic shock. However, there were some problems with these definitions. Firstly, the criteria used to define SIRS are somewhat non-specific, consisting simply of hypo- or hyper-thermia, tachycardia, tachypnoea and leucocytosis. When two or more of these criteria are satisfied, a patient is diagnosed with SIRS. The problem is that if a patient has a common cold, has undergone surgery or has been involved in trauma, they will often satisfy at least two of these criteria. This does not necessarily mean that they have sepsis, although we should not exclude it. Secondly, there was no clear means of describing organ dysfunction using these criteria.

render its usage impractical in emergency settings. For this reason, the 2016 taskforce described a simplified quick SOFA (qSOFA) score which uses respiratory rate (≥ 22 breaths/ min), altered mental status (GCS <15) and low systolic blood pressure (≤100mmHg) as a tool for clinicians to quickly identify patients with a higher mortality risk, rather than as a method for diagnosing sepsis.

In 2001, a taskforce recognised the limitations of this definition of sepsis, but could not offer an alternative given a lack of supporting evidence. Instead, they expanded the list of diagnostic criteria, resulting in Sepsis-2, a guideline which suggested that patients should have at least two SIRS criteria and a confirmed or suspected infection in order to be diagnosed with sepsis. In 2016, another taskforce, of which Professor Singer was a member, came up with the Sepsis-3 definition. This established the use of Sequential Organ Failure Assessment (SOFA) scoring to assess the severity of organ dysfunction and mortality in a potentially septic patient. This proved to be more sensitive than the previously used SIRS criteria. ‘In this new definition of sepsis, we moved away from the idea that sepsis was simply systemic inflammation and more towards a dysregulated host response that can trigger downstream pathways to lead to organ dysfunction,’ says Professor Singer.

Professor Singer notes that ‘two years ago in England, where we have a population around 55 million, 33 million prescriptions of antibiotics were handed out by GPs. Looking at hospital discharge coding records, 1.3 million patients had a coding of infection or sepsis. Of those 1.3 million, there were 33,000 patients who died, yet only a third of those people actually came through intensive care.’ We have established through Sepsis-3 that sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. The next step is understanding how this process occurs— and this is where we need to explore the realm of known unknowns.

The SOFA scoring consists of measures of different bodily systems: the respiratory system (partial pressures of oxygen), hepatobiliary system (liver bilirubin), coagulation (platelets concentration), cardiovascular system (mean arterial pressure) and renal system (creatinine and urine output). These allow clear identification of organ dysfunction and eliminate the concept of sepsis without organ dysfunction. However, SOFA scoring requires numerous tests which

The unknowns of sepsis The dysregulation of host processes in sepsis involves countless subtle interactions between

Operationalisation of Clinical Criteria Identifying Patients With Sepsis and Septic Shock Patient with suspected infection

qSOFA≥2?

No

(see A )

Sepsis still suspected?

No

Yes

Yes Assess for evidence of organ dysfunction

SOFA≥2?

Monitor clinical condition; reevaluate for possible sepsis if cinically indicated

A

No

(see B )

Monitor clinical condition; reevaluate for possible sepsis if cinically indicated

qSOFA variables • • •

Respiratory rate Mental status Systolic blood pressure

Yes Sepsis

Despite adequate fluid resuscitation 1. vasopressors required to maintain MAP ≥65 mm Hg AND 2. serum lactate level >2 mmol/L? Yes

B

SOFA variables • • • •

No

• • •

PaO2/FiO2 ratio Glasgow Coma Scale score Mean arterial pressure Administration of vasopressors with type and dose rate of infusion Serum creatinine or urine output Bilirubin Platelet count

Sepsis shock The baseline Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score should be assumed to be zero unless the patient is known to have pre-existing (acute or chronic) organ dysfunction before the onset of infection. qSOFA indicates quick SOFA; MAP, mean arterial pressure. Vol.III No.III 28


Research inflammatory mediators, hormones, metabolites, neural signalling, changes in oxygen delivery and use by bodily tissues, and a variety of adaptations and responses made by different cell phenotypes. Taking into consideration the uniqueness of each patient, their individual response and their inbuilt functional organ reserve, one may begin to realise that there are numerous pieces which make up the sepsis puzzle. For instance, one of the tell-tale signs of sepsis is a notable fever, but the pathophysiology behind this is unclear. Whilst patients may shiver to increase their bodily temperature, most patients who are critically ill do not exhibit this. Looking under the microscope at dysfunctional tissues following their failure in severe sepsis, there are very few structural changes. It is likely that a combination of factors such as those stated above are involved in causing organ dysfunction. Professor Singer notes that ‘It is likely there is a metabolic issue underlying sepsis, perhaps these cells are reverting their energy into survival rather than normal function’. Interestingly, the measured levels of oxygen at the tissue level in sepsis are higher than in normal physiological conditions, indicating that oxygen may not be used by the cell. It was these initial observations which led to the hypothesis that there may be some level of mitochondrial dysfunction during sepsis. Indeed, studies looking at human and animal mitochondria in the context of sepsis showed swelling which corresponded to overall cell dysfunction. From an evolutionary standpoint, why does the human body resort to organ failure in sepsis? Although we have defined sepsis as a dysregulated host response, surely the purpose of such a response is not to simply hasten one’s death. A possibility is that organ failure could be a protective mechanism, acting to temporarily reduce cellular metabolism to allow long-term recovery of the body in response to an infective insult. Our lack of understanding has been further emphasised by the negative outcomes of several theoretically sound interventions, such as soluble tumour necrosis factor receptors and nitric oxide synthase blockade therapies. This begs the question, are some of our interventions helping or harming our patients? For example, in septic shock where there is sepsisinduced hypotension, management often involves fluid resuscitation and the use of inotropic agents. Interestingly, Professor Singer describes how there may in fact be a Jekyll and Hyde relationship with the use of these drugs. ‘Very high levels of catecholamines which have been introduced into the body can actually result in eventual immune suppression. They of course also influence metabolic efficiency, and they can damage the myocardium. Adrenaline, for example, is also a potent procoagulant and so really there are various harmful effects in the use of these drugs but because we are oblivious to many of them, we don’t really know what kind of harm we are having on our patients’.

Conclusions At this point, it is fair to say that we have more questions than answers regarding the pathogenesis of sepsis. However, with a clear

definition of sepsis and research now exploring the mechanisms involved and the effect of our management strategies, perhaps we can start piecing together parts of the puzzle. Technological advancements are likely to help future clinicians in identifying patients at risk and deliver personalised care appropriate to each patient. Professor Singer describes how at UCLH, research is being conducted to find a means of looking at tissue oxygen tension (rather than having to use arterial levels of oxygen) through a catheter. Such technology has been trialled successfully on animal models and will soon begin to be used in human participants. The information provided at the tissue level would prove immensely useful for a clinician, not only in the context of sepsis but in a variety of other conditions where tissue perfusion and oxygenation may come into question. Another device which is being developed by Professor Singer and his colleagues, fondly named ‘the Happy Cell ‘O’ Meter’, quantifies the redox state of a cell and may tell a clinician if a cell is provided with enough oxygen substrate. Donald Rumsfield, former Secretary of Defence for the United States, once stated that ‘there are known unknowns… we know there are some things we do not know. But there are also unknown unknowns – the ones we don’t know we don’t know’. No doubt, this statement is readily applicable to our understanding of sepsis. With so much left to explore, will the simplest explanation really prove to be the right one?

Professor Mervyn Singer

Careers advice

How did you get to where you are now?

In addition to our discussion on the unknowns of sepsis and the latest advancements being made in the field, Professor Singer also provided some insight into his career path. In doing so, there are certainly experiences he shared which no doubt brings one to ponder what the future holds for us budding medical students.

Through serendipity! It goes back to what I was saying before, I think my personality type would not have suited certain medical specialties. At the time of my training there were a few intensive care posts which were physician-based rather than on anaesthetics. I liked diagnostic conundrums and I gravitated towards sicker patients. As a medical registrar, I didn’t really know what I wanted to do. I was interested in cardiac output monitoring and I got in contact with a consultant at St George’s to do some research into this. As I finished, there was one training post for a physician in intensive care which had to be at Middlesex and UCLH. It’s very much being at the right place at the right time, you know: chasing the dream. For me, that dream was research, but it can be anything. I think a lot of it was stubbornness and persistence, getting your legs kicked out underneath you. You just dust yourself down and start over again. If an opportunity presents itself, go for it, or just persist with what you’re doing. If you enjoy something, you will love your job, and hopefully your standards of care will also be better.

How did you know intensive care was a specialty you wanted to pursue? Medicine has so many different areas; there is something which fits everyone’s personality. When I was a medical student, seeing a cardiac arrest was eventful to say the least. I mean I didn’t know what to do, but I was fascinated to watch events unfold. As a junior doctor, I was a bit of an adrenaline junkie, I liked looking after the critical patients and that’s what made me gravitate towards intensive care. It’s demanding and very gratifying. A problem with medicine, if I could say that, is that it’s becoming specialised to the point of overspecialisation. The ‘-ologist’ knows a lot about their ‘-ology’ but forgets that there’s the rest of the body attached to that ‘-ology’. You forget that at your peril and sadly, holistic wholebody medicine is less common now. The problem is that organs tend to interact with other organs, as do the various drugs we use. As an intensivist, one of the exciting parts is that we have to understand how everything functions and piece it together.

Is there anything you would change in your medical career? I have faced some setbacks in my career, for example, I didn’t pass my membership exams straight away. Eventually I learnt it better and perhaps it’s the knockbacks which make you a better doctor in the end. So, I think it’s just about learning to change the negative experiences into positive ones. We would like to thank Professor Mervyn Singer for taking the time to contribute to this piece. 29

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Research

Round-up: The research arm of the UCL Centre for Anaesthesia, Critical Care, and Pain Medicine incorporates a wide range of specialties including perioperative medicine, extreme physiology, pain, and critical care medicine. Researchers therefore work in a variety of settings, from exploring the pathophysiology of multiple organ failure in intensive care units to conducting experiments in hypoxia all the way at the summit of Mount Everest. All this research is patient-focused, with every finding being translated into bettering patient care. A few recent publications from some of the major research groups have been summarised. More information on clinical trials and researchers can be found at www.ucl.ac.uk/ anaesthesia/research/. Words by Eng O-Charoenrat, Research Editor

Centre for Altitude, Space, and Extreme Environmental Medicine Results from Xtreme Everest: The Role of Hypoxia in Developing Sarcopenia Hypoxia is one of the leading complications for patients who are admitted to intensive care units. As many of these patients are critically ill, it is difficult to perform research experiments in these limited circumstances. Therefore, projects such as Xtreme Everest allow clinicians and researchers the opportunity to conduct experiments at high altitudes that stress normal physiology and can then be translated to novel therapies to improve patient survival. One experiment recently looked at hypoxia and its role in developing sarcopenia, the involuntary loss of skeletal muscle. Sarcopenia has been associated with increased mortality and disability, with processes such as altered hypoxic signalling and oxidative stress being implicated in its pathophysiology. A group of 24 researchers were analysed in London as a baseline and then ascended from Kathmandu (1300 m) to Everest Base Camp (5300 m). Changes in body composition were measured as well as biomarkers for oxidative stress and markers for metabolic and inflammatory processes. Many other traits were also measured throughout the process to show change as the researchers were exposed to more extreme hypoxic conditions. One of the novel findings found was that changes in glucagon-like peptide 1 (GLP-1) were significantly correlated with and significant predictors of fat-free mass loss. GLP-1 is involved in the bodyâ&#x20AC;&#x2122;s response to eating and appetite regulation. Other biomarkers such as those for oxidative stress and inflammation were also found to be significantly increased. The novel discovery that GLP-1 was the strongest predictor of sarcopenia when analysed in a multivariate model will help future researchers investigate the use of GLP-1 analogues to reduce body mass loss under hypoxic conditions.

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Research

Perioperative Medicine Intraoperative Heart Rate and Systolic Blood Pressure and Myocardial Injury: Results of the VISION Study Researchers have recently published the results of a study investigating the effect of intraoperative heart rate (HR) and systolic blood pressure (SBP) on the development of myocardial injury after non-cardiac surgery (MINS). The VISION study (Vascular Events in Noncardiac Surgery Cohort Evaluation) was a prospective, international, multicentre cohort study looking at patients undergoing non-cardiac surgery under general or regional anaesthesia. A total of 16,079 patients from 12 hospitals in eight different countries were recruited for this study. The measured outcomes of these patients included the rate of myocardial injury, myocardial infarctions, and mortality in this population. The impact of high or low intraoperative HR or SBP on these outcomes was then assessed. Out of the patients with outcome data, 1197 out of 15,109 patients (7.9%) sustained myocardial injury, 454 out of 16,031 patients (2.8%) sustained myocardial infarctions, and 315 out of 16,061 patients (2.0%) died within 30 days of surgery. Looking in detail at the relationship between the intraoperative HR showed a maximum intraoperative HR of > 100 BPM was associated with an increased risk of MINS (p < 0.1), myocardial infarctions (p=0.02), and mortality (p<0.1). The effect was most significant in patients who had a SBP of < 100 mmHg as well. The results of this study showed that a combination of tachycardia and hypotension during operations resulted in the highest likelihood of developing MINS, myocardial infarctions, and mortality. Further research will go into more detail into establishing thresholds for HR and BP.

Surgical Outcomes Research Centre Surgical Outcomes Research Centre Projects and Translational Tools The UCL-UCLH Surgical Outcomes Research Centre (SOuRCe) is a research unit that analyses data from surgical specialities to provide a better understanding of risk adjustment and outcomes from operations. Part of their work involves risk stratification to predict adverse outcomes such as complications and mortality in patients undergoing surgery. They are also involved in the development of tools that can be used to help clinicians assess outcomes post-operation and improve quality of care. One of their projects is the development of the Surgical Outcome Risk Tool (SORT). Developed in conjunction with the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), the SORT is a pre-operative risk prediction tool that looks at the likelihood of mortality 30 days after surgery. Data from 16,788 patients were analysed and used to create the SORT criteria of preoperative variables. These include the procedure type, severity, the ASA-PS scoring (American Society of Anaesthesiologists Physical Status classification), age, and urgency. SORT also looks at whether the procedure is thoracic, gastrointestinal, or vascular in nature and whether it is surgery for malignancy or not. Since its development, SORT has been used by anaesthetists and surgeons at UCLH to help explain to patients their risk of mortality before surgery in an easy and convenient way.

Paediatric Anaesthesia Persistent Changes in Peripheral and Spinal Nociceptive Processing after Early Tissue Injury Researchers into paediatric anaesthesia and nociception are discovering that neonates and infants exposed to major painful stimuli are at an increased risk of changes in their long-term pain sensitivity. Within UCL, researchers have been actively involved in elucidating the causes behind this phenomenon. A recent experiment conducted by researchers from UCL involved looking at a mutation implicated in neuron excitability and the development of pain. NaV1.7 is a sodium channel that plays a major role in pain signalling but its exact mechanism was unclear. Using electrophysiology, researchers showed that its mechanism involved a massive depolarisation of dorsal root ganglion neurons in an atypical manner. The atypical mechanism of hyperpolarisation could then be used to explain the phenotypic picture seen in those with a NaV1.7 gain-of-function mutation. Other studies have used neonatal rodents to inject noxious substances into their hindpaw and analyse any centrally mediated changes or changes in nociceptive signalling. These studies have shown that the response to noxious stimuli as an adult was directly related to any hindpaw inflammation that occurred during the neonatal period. Future studies will continue to look at the role of early noxious stimuli as well as possible mechanisms to prevent their effects using analgesia or other means.

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Features

Xtreme Everest:

The Lab at the Top of the World In 2007, UCL researchers pulled off an incredible feat – sending a research team to the top of Mount Everest. Braving the harsh and barren surroundings, they performed ground-breaking studies that have greatly informed our understanding of hypoxia and critically ill patients.

Xtreme Everest: The Lab at the Top of the World UCL MedSoc Anaesthetics and Critical Care Women in Medicine: Celebrating the Women of RUMS

Image by Rebecca Mackenzie

Words by Ian Tan, Features Editor

H

istory is rife with stories of brave people putting their bodies on the line for the advancement of science. Take Marshall and Warren, for example: these two Australian doctors famously ingested H. pylori to prove that peptic ulcer and gastric cancer could be caused by bacterial infection. Last year marked the tenth anniversary of a similarly heroic endeavour – the first Caudwell Xtreme Everest (CXE) expedition, organised by the UCL Centre for Altitude, Space and Extreme Environment Medicine (CASE). Critically ill patients are predisposed to hypoxaemia (low oxygen levels in the blood), often resulting in tissue hypoxia. Organ failure and death frequently ensue. Treatment is centred on maintaining cellular oxygenation, but in the past, there was little evidence regarding optimal inspired oxygen levels. There was also no explanation for the individual variation in that response. In some patients, increasing oxygen delivery has no effect and may even be harmful. At altitude, people react differently to reduced oxygen levels – counter-intuitively, this has little to do with age or fitness. The CXE team believed such variations in the ability to adapt to hypoxia could be explained by individual variations in metabolic efficiency. To test this theory, investigators could look to animal models as a starting point, as is commonly done with studies of human diseases. Owing to the complexity of human physiology in acute illness, however, highly simplified animal models may not be valid. How about studying human patients, then? In a hospital environment, patients become critically


Features

ill for myriad reasons, making it impossible to tease apart the effects of hypoxia from a whole host of other pathophysiological events. Coincidentally, oxygen levels at the summit of Everest are the lowest tolerable by humans. The unhospitable heights of Everest – “death’s door”, truly – therefore presented the perfect opportunity to study healthy volunteers at various oxygen levels as they made their way up. To be sure, medical studies on Everest had been done before. While previous studies contributed greatly to our understanding of adaptation to chronic hypoxia, CXE’s aim was to investigate how that adaptation differs among individuals. At the same time, the CXE team hoped to establish links between individual genes and environmental factors. Compared to previous similar studies, CXE had a much larger subject cohort and better field research infrastructure. Importantly, all subjects adhered to a strictly consistent ascent profile and hence identical levels of hypoxia. This allowed the team to study individual variation solely due to physiological differences without interference from environmental differences. The research team recruited a large cohort of 222 volunteers, divided into two groups: trekkers (comprised of members of the public) and investigators (including doctors, scientists, allied health professionals and medical students). Such a large undertaking, unsurprisingly, required a gargantuan effort to ensure the logistics were in place for field testing. Most equipment had been tested in three pilot expeditions to the Alps and the Himalayas in the two years leading up to the CXE expedition. As baseline studies were being performed on the participants back in London, Sherpas and yaks carried about 25 tonnes of equipment and 80 tents up to Everest Base Camp.

Field laboratories were set up in Sherpa lodges, specialised field shelters and high-altitude tents at multiple locations such as Kathmandu, Namche Bazaar, Pheriche, Everest Base Camp and beyond. When the time came for the actual expedition, all 222 participants were flown in to Khumbu and made their way to Everest Base Camp on foot. Both study groups completed the journey to Everest Base Camp in slightly under two weeks. Along the way, they stopped at each field laboratory for a battery of tests: expired gas analysis and near-infrared spectroscopy on brain and skeletal muscle at rest and during exercise; plasma samples for inflammatory markers; nitric oxide metabolites and organ injury markers; and various neurological tests. Some investigators were subject to more invasive tests such as arterial cannulation and skeletal muscle biopsies. After testing, the trekker group returned to Kathmandu whereas the investigator group remained at Everest Base Camp, 14 of whom ascended to the summit that May for further testing and blood sample collection. The expedition was not without its fair share of drama. On 22nd May 2007, Usha Bista, a 22-yearold Nepalese climber, was found unconscious near the summit by another group of climbers. She had been abandoned by her own team after falling ill and collapsing. The climbers who found Usha brought her to the CXE lab at South Col, where she was diagnosed with hypoxia-induced cerebral oedema. Thanks to the care she received and subsequent treatment in Kathmandu, Usha made a full recovery and went on to conquer the summit later that year. The first CXE expedition was a resounding success, completing more than 90% of planned tests and generating a wealth of unprecedented data concerning microcirculation, nitric oxide and mitochondria. The team were able to assemble epigenetic profiles of the participants, which provided valuable insight into the interplay between genes and environment in the context of hypoxic adaptation. Data generated during

the expedition informed many subsequent studies. For instance, Tibetan highlanders display enhanced nitric oxide formation, leading to the belief that this is a unique genetic trait borne by evolutionary forces. Findings from a CXE study dispelled this notion: when lowlanders climb to high altitudes, more nitric oxide forms, suggesting that nitric oxide formation is an innate physiological response to hypoxia. These findings and the resulting questions spawned a second CXE expedition. Data from the first CXE expedition had demonstrated higher erythropoietin, nitric oxide and cGMP levels in experienced climbers compared to inexperienced climbers, suggesting that previous exposure to high altitudes improves adaptation to hypoxia via epigenetic mechanisms. This time, the team recruited volunteers living close to sea level and Sherpas. The latter, with their long ancestry in the mountains, may have developed adaptive mechanisms not seen even in experienced climbers. The second expedition allowed a direct comparison of these two populations, as well as a large biobank and phenotype database for translational research. Xtreme Everest is a celebration of human ingenuity and collaboration. Such an astounding feat could not have been achieved without the hard work of the CXE team and the volunteers who gave up their holidays to take part. It is also a prime example of how expedition medicine can lead directly to personal fulfilment outside of medicine. Professor Monty Mythen, who led the field laboratory at Namche Bazaar, urges medical students who are considering a career in expedition medicine: “Go for it! If you want to do it then don’t overthink it. Life is too short. Find a good team with a great safety record - ideally the Xtreme Everest Research Consortium and the UCL CASE.” We would like to thank Professor Michael (Monty) G Mythen for for taking the time to contribute to this piece.

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Vol.III No.III


Features

Anaesthetics and Critical Care T

he UCL MedSoc Anaesthetics and Critical Care section has enjoyed an exciting year thus far with plenty going on for our members! We kicked off in December with talks by two consultants at the Royal Free exploring why anaesthetics is such a great specialty and the career routes that will get you there.

Dr. Mervyn Singer, a Professor of Intensive Care Medicine at UCLH, brightened up a dark January evening by sharing some challenging ethical and medical cases he has faced in his career. This got us debating about the right thing to do and thinking about how we will personally deal with similar situations in the future. All in all, this was an enjoyable evening for everyone who attended.

To take us back to the grindstone after Christmas, we held an anaesthetics revision talk by Dr. Rob Stephens. This event was highly relevant to finalists, who were able to revise everything they had forgotten and to ask questions in preparation for finals.

The biggest MedSoc event annually â&#x20AC;&#x201C; free for all members! â&#x20AC;&#x201C; was the InspireMed Conference on the tenth of March looking at healthcare in 2050, and asking big questions about the future of the NHS. The last event specifically from the Anaesthetics

and Critical Care section will be a revision lecture in the summer term, given again by Dr. Rob Stephens. We strongly recommend that all fourth and fifth year medics attend, as this is the perfect opportunity to address any burning questions and find out all you need to know for the upcoming exams. Stay updated by checking our website (https:// bit.ly/2qAusEi) and Facebook page (https://bit. ly/2qyFDOw). Katie Chapple Co-Chair, Anaesthetics and Critical Care UCL Medical Society

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Features

Women in Medicine:

‘Women in Medicine’ was a photographic exhibition of historical and contemporary female icons in medicine, held late last year at the Royal College of Physicians in London. Medical institutions across the UK nominated a current female representative of their specialty, who in turn paid tribute to historical women who have inspired them. Words by

Tharani Ahillan

2

018 is a historic year for women in Britain, marking a hundred years since the women’s suffrage movement won the fight for the right to vote. Fast forward 150 years and it is estimated that female doctors will outnumber male doctors in the NHS within the next five years. Today, women play an increasingly central role in medicine, leading the majority of the medical colleges. The Royal College of Physicians recently ran an exhibition celebrating internationally acclaimed

women in medicine, many of whom graduated from UCL Medical School or one of its many iterations. Among the long list of honoured icons were Diana Beck, believed to be the first female neurosurgeon in the world, and Dame Josephine Barnes, the first female president of the British Medical Association. Did you know that the first female president of the Royal College of Physicians trained at UCLH? Margaret TurnerWarwick was a pioneering thoracic physician who died, sadly, just last August. She was described as “intellectually formidable, personally generous … leading the transformation of the treatment of lung disease … a shining example of excellence to the generations that follow her” by Dame Sally Davies, chief medical officer for England and chief medical advisor to the UK government. Many other RUMS alumni were featured in the exhibition, such as Professor Jenny Higham, now principal of St George’s Medical school, and Dr. Gillian Hanson, a trailblazer in the field of intensive care medicine. Jane Dacre, current president of the Royal College of Physicians (only the third female president in its venerable history), was also the director of UCL Medical School and is one of the Health Service Journal’s 100 most influential people in health.

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“The Women in Medicine Project is a much-needed celebration of remarkable female doctors and the women who had inspired them.” Moonesinghe, who graduated from UCL Medical School twenty years ago, is also a council member on the Royal College of Anaesthetics and a board member of the National Institute for Academic Anaesthesia. She is dedicated to researching risk prediction in surgery and evaluating postoperative outcome measures; she teaches doctoral students in her capacity as Honorary Senior Lecturer in Anaesthesia. The Elizabeth Garrett Anderson Wing at University College Hospital

One name that should be familiar to every UCL medical student is Elizabeth Garrett Anderson, the first female in Britain to formally qualify as both a physician and a surgeon. Growing up in late-Victorian Britain, she was encouraged by the Society for Promoting the Employment of Women – still in existence today – to pursue a career in medicine. For Garrett, getting into medical school was the easy part. Less well-known are the struggles she faced as an unwelcome presence amongst the male students. Event though there were many other outstanding females students at the time, Garrett alone was able to qualify because of loopholes in the system. In fact, immediately after she qualified, the Society of Apothecaries amended its rules so that no other woman could follow the same path, preventing many female doctors-to-be from qualifying. It was only 21 years later that the new Medical Act allowed all eligible applicants, regardless of gender, to obtain a license to practice. The Elizabeth Garrett Anderson Wing at University College Hospital, founded by Garrett herself, is a testament to her fantastic contribution to women’s rights in medicine and society at large. UCL Medical School has a proud history of encouraging women to study medicine. In 1877, the Royal Free Hospital allowed students from the London School of Medicine for Women – the first medical school in the UK to train female doctors – to complete their clinical studies there. The London School of Medicine for Women, along with the Royal Free Hospital and University College Hospital Medical School, eventually merged into the Royal Free and University College Medical School, the precursor to the UCL

Vol.III No.III 36

Medical School of the present. Just think: you’re studying at an institution whose predecessor was the first medical school in Britain to train women as doctors! You can still see the building at 33 Hunter Street, now the Hunter Street Health Centre of the UCL Institute of Neurology, only a stone’s throw from Great Ormond Street Hospital. We have a particularly interesting track record of producing female anaesthetists. It started with Dame Louisa Aldrich-Blake, the first British woman to obtain a Master of Surgery and who served in the First World War. Aldrich-Blake was also the first woman to hold the positions of surgical registrar, consultant anaesthetist and lecturer of anaesthetics. Her devotion to medical education led to her become the dean of the London School of Medicine for Women in 1914. You can see her statue at Tavistock Square, a memorial to her pioneering work. She also worked at the Royal Free Hospital, so remember that the next time you walk along those corridors! Another towering figure in this field is Dr. Katharine Lloyd-Williams, who was a highly respected anaesthetist at the Royal Free Hospital. She oversaw the transformation of the London School of Medicine for Women into the Royal Free Medical School, the first co-educational medical school in the UK. Aside from being an accomplished violinist, she also served as president of the Anaesthetics section of the Royal Society of Medicine and published many books on anaesthesia. Her legacy has inspired the current crop of female anaesthetists, one of whom is Ramani Moonesinghe, a consultant in Anaesthetics and Critical Care Medicine at UCH.

The Women in Medicine Project is a muchneeded celebration of remarkable female doctors and the women who had inspired them. However, it is evident that the state of gender equality in medicine still leaves much to be desired. Despite what the general figures suggest, women are still under-represented in surgery and medical specialties such as anaesthetics, ophthalmology and gastroenterology. Every step should be taken to widen access to these specialties by introducing more flexible working patterns. The decision to raise a family should not affect women’s chances of landing a job in any specialty. While there are further issues to address in the struggle to empower women in medicine, a time when doctors are judged on merit and achievement, rather than by their gender, does not seem too far off. Elizabeth Garrett Anderson would have settled for nothing less. See Perspectives opposite for an interview with Dr Ramani Moonesinghe.

Elizabeth Garrett Anderson


Perspectives

Perioperative Medicine:

Perspectives

Words by Cheh Juan Tai, Perspectives Editor

Perioperative Medicine: Is this the future of Anaesthesia? “But I won’t wake up in the middle of the operation, will I?”

A

lthough anaesthesia is the largest single hospital specialty, it remains one of the least well understood. A significant proportion of the work the anaesthetist does is perioperative and involves an excellent understanding of the aetiology of complications. Despite this, a vision document produced by the Royal College of Anaesthesists in 2013 states that anaesthetists are rarely given the time to review patients on the general surgical ward before and after the surgery. In this interview, we discuss the emergence of perioperative medicine as a new specialty with Dr Ramani Moonesinghe, who graduated from UCL Medical School in 1997 as President of the Medical Students’ Union, and was the first medic ever to be made a life member of the UCL Union. Dr Moonesinghe is the Director of the National Institute for Academic Anaesthesia (NIAA) Health Services Research Centre and Associate National Clinical Director for Elective Care for NHS England. She is currently a Consultant and Honorary Senior Lecturer in Anaesthetics and Critical Care Medicine at UCLH and has been awarded the Royal College of Anaesthetists Macintosh Professorship for 2018.

for three years to help me get this off the ground; it is being led by the Royal College of Anaesthetists’ Health Services Research Centre, which I have the privilege of leading (www.niaa-hsrc.org. uk).

theatre or critical care bedside, and the longer-term decision making of the preoperative assessment clinic or family consultation. POM incorporates all of these.  

4. As Associate National Clinical Director for Elective Care of NHS England, what is the most challenging aspect about your job?

3. You’re currently leading the development of the RCoA/HSRC National Perioperative Quality Improvement Programme. Can you tell us more about this programme and your role?

Working within a constrained financial envelope is a challenge for everyone in the NHS. This role brings that into sharp focus - everyone wants to give their patients the best care, the question is how we can achieve that, when everyone feels stretched and is already working flat out.

PQIP (www.pqip.org.uk) is a national research study which aims to improve the care we give to high risk patients before, during and after surgery. Patients are currently being recruited in 85 hospitals in England, Wales, and Scotland, and we hope to achieve nearcomplete coverage across the NHS over the next few years. Through collecting patient data, local clinical teams are supported to identify areas on which to focus in order to reduced postoperative complications and improve longterm patient outcomes. We have been running for a year and are already getting some interesting results, which indicate towards real opportunities to improve patient care. For example, we know we could improve the management of anaemia and diabetes before surgery, ensuring that each patient has an individualised prediction of risk communicated to them, and enabling the patient to participate in decision making. A charity called the Health Foundation supported my salary

5. Do you have any stories to tell us from your time as a medical student at UCL? Lots. I’m not sure that I should though… I definitely spent more time doing student politics (I was Med School Union President) or involved with the Manic Depressives than perhaps was good for my grades. I have no regrets about that at all though - they were halcyon days. 

6. Finally, what advice would you give to a medical student who might be interested in this field? POM is the future. You are surrounded by great people, great technology and a huge diversity of work. Go for it. We would like to thank Dr Ramani Moonesinghe for taking the time to contribute to this piece.

1. What is perioperative medicine (POM) and how is it different from anaesthesia and critical care medicine? POM is an evolution of anaesthesia. As anaesthesia itself has become extremely safe, patients have become higher risk, and surgical treatments much more widely available. Therefore, our challenge as anaesthetists is not to keep the patient asleep and ensure that they wake up safely, but to help choose the right procedure for the right patient and ensure optimal preparation and longterm recovery. That is the role of the perioperative physician.

2. What drew you to perioperative medicine? As an anaesthetist and intensivist, it was a natural progression. I enjoy both the acute physiology of the operating

Dr Ramani Moonesinghe

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Perspectives

CH 3

HC

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“But I won’t wake up in the middle of the operation, will I?”

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Advances in surgical technique in the early days were of no practical use until general anaesthesia was brought into play. Because of the invasiveness of many procedures, the ability to ‘flip a switch’ to alter a patient’s consciousness has now been the perfect commodity in surgical practice. With millions of major surgeries carried out each year, it is astounding to see how safe and commonplace general anaesthesia has become despite the fact that no one really knows how it works. What, then, do we do when things go wrong? In this issue, we take a glimpse into what happens when general anaesthesia does not quite hit the mark. Words by Cheh Juan Tai, Perspectives Editor

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-year-old Donna Penner recalls feeling relaxed as she groggily woke up from the anaesthesia she had received for her explorative laparoscopy. She had been under general anaesthesia before, so she knew the drill – the operation was finally over. She heard the medical personnel moving about in the operating room, but the next two words she heard changed the rest of her life.

“Scalpel please” Donna froze and realised that the operation had not even begun, but the anaesthesia must have worn off somehow without anyone noticing. The paralytic, however, was working fine. This left her in a position where she was fully alert and fully paralysed at the same time, unable to alert the medical team that she was awake. Accidental awareness during general anaesthesia (AAGA), also known as anaesthesia awareness, is something anaesthetists often get asked about at preassessment, according to Dr Jane Lowery, Undergraduate Perioperative Medicine Lead and Consultant Anaesthetist at Royal Free Hospital, London. AAGA occurs when general anaesthesia is intended but the patient either remains conscious or regains consciousness prematurely. Over a span of three years, the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland recorded and studied three million general anaesthetics from every


Perspectives

public hospital in the UK and Ireland. In 2014, this study was published as the Fifth National Audit Project (NAP5) after having studied over 300 new cases of AAGA in the UK. Having identified an incidence of around one in 19,600, AAGA is no doubt rare – yet one cannot help but shudder at the sinister thought of having to wake up to what must feel like a real life horror movie. In the NAP5 report, a woman identified as ‘Sandra’ recalls her experience with AAGA as a twelve-yearold.

“Once I had gathered my wits a little; I said, ‘I woke up in there! I woke up during the operation!’” She continued to repeat this for the rest of her time in hospital, but her complaints were brushed aside. She was told all sorts of things, from claims that it probably was just her imagination, to the ‘fact’ that it simply could not be true. “When I related surgically-related conversations to the theatre team, they went a little white, but continued to deny what had happened. They denied it to my mother, and in doing so, left me alone to deal with the decades-long fallout of my putative near death experience.” The lack of comprehension we have about the way general anaesthesia works means that sometimes there is a temptation to be doubtful about patients’ accounts of AAGA. What causes some patients to respond to anaesthesia in a completely predictable manner, while others seem to not respond to it at all? Since the theory of general anaesthesia cannot be pinned down to a single, generalised, scientific process, this means that it is almost impossible for us to understand exactly why anaesthesia sometimes fails. From first principles, AAGA could arise as a result of either failure of delivery of sufficient anaesthetic agent to the patient, or individual patient resistance to an otherwise sufficient dose of anaesthetic agent. Regrettably, most reported cases of AAGA belong to the former group. Be it due to drug errors, incorrect dosing, or other technical failures, such incidences are highly preventable. Other associated risk factors, although poorly understood, include being female, obesity, having a difficult airway, and the use of neuromuscular blockade. The intriguing prospect of possible genetic predisposition to AAGA remains debatable, but evidence remains largely anecdotal for now. In a review in 2016, Dr Mike Sury, who leads anaesthesia research at Great Ormond Street Hospital for Children and UCL Great Ormond Street Institute of Child Health recorded that most children with AAGA recalled tactile experiences, and more than half of them recorded hearing things during the surgery. However, a considerable number of these children were not distressed afterwards despite describing their experiences as “scary” or “painful”. In fact, very few of them spontaneously report their AAGA

Figure One. Plan of action recommended by NAP5 for dealing with a report of AAGA. Adapted from “Accidental Awareness during General Anaesthesia in the United Kingdom and Ireland”; Report and findings of the Fifth National Audit project, September 2014.

Face-to-face Meeting

• •

Accept patient’s story as their genuine experience Express regret that the event occurred

• •

Seek cause of AAGA Check details of patient’s story with monitoring details and with staff

Check for flashbacks, nightmares, anxiety, and depression in first 24 hours Follow up at two weeks Referral to psychiatric/psychological services if required

Analysis

Support

• •

experiences. The paper Dr Sury published suggested that this may be because children may have difficulty distinguishing between real or imagined experiences, in addition to limited memory formation and communication in young children. Carol Weihrer, 67, told CNN in 2014 that she has had to sleep in a recliner ever since her AAGA incident during her eye surgery almost two decades ago.

“If I lie flat, I get flashbacks of the operating table and I start violently thrashing.” Weihrer believes that the lack of support she received was one of the reasons why she continues to be traumatised by the event after so many years. “None of the doctors thought it was a big deal. My anaesthetist told me, ‘At least you weren’t hurt, don’t worry.’ We place so much emphasis on PTSD among our veterans, who witness death on the battlefield. But many patients with anaesthetic awareness have near-death experiences and feel like they died over and over again. Where’s their support?” Common experiences during AAGA include hearing voices or noise of surgical equipment, being unable to move, and feeling helpless due to the inability to alert the staff. Severe reactions to experiences of AAGA range from re-experiencing the event through nightmares and ‘flashbacks’,

to developing phobias of being in hospital or meeting medical personnel. An important risk factor for long-term consequences is distress at the time of AAGA. Most patients recorded that they understood what was happening while they were awake. The most common sensory experiences involve touch and sound, and up to 46% of patients experience pain. To the horror of many doctors, many of the patients who experience AAGA are able to recall salient auditory information, hearing things like “It’s a boy!”, “How can a man be so fat?”, and even “This woman is lost, anyhow.”. Psychological consequences of AAGA can be mentally damaging, and much of the literature on AAGA regards it as a traumatic event. It is not clear what proportion of patients develop posttraumatic stress disorder (PTSD) after AAGA, but many of such cases have been reported, in addition to an increased suicide risk. It is particularly distressing to the patient when the medical team dismisses or does not believe a patient’s report of being awake during surgery. Early detection and psychological intervention are known to play a huge role in reducing damaging after-effects. An NAP5 Awareness Support Pathway (Figure One) has been created to guide doctors on supporting patients with suspected AAGA. We would like to thank Dr Jane Lowery for taking the time to contribute to this piece.

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Vol.III No.III 40

Demystifying Exams

Demystifying Medical School

Itâ&#x20AC;&#x2122;s exam season (not that you were in any danger of forgetting) and medical school exams can be best cracked by lists. Lists of drugs, lists of possible OCaPE/OSCE stations, lists of pathologies, lists of mechanisms. So, in honour of list season, let the RUMS Review make your life easier with a few little lists of its own. Let the exam countdown begin! Words by Tanya Drobnis , Demystifying Medical School Editor


Demystifying Medical School

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places to revise around Bloomsbury (off campus) The three requirements for an off-campus revision space are: good coffee, good wifi, nice clean bathroom. Here is your definitive guide to the best combinations of the power three.

Bloomsbury Coffee House

BMA Members’ Lounge

This cosy underground haven combines an impressively light and airy feel with delicious coffee and a hugely diverse menu (which includes cracking vegetarian and vegan options). Roomy communal tables are usually crowded with students busily typing away, so you are unlikely to get the coughs and stares which can sometimes hound those trying to have a five-hour revision session in a café, having bought only one cup of tea. (Picture right)

This may well be the worst kept secret in the whole of UCL medical school but excluding it from this list would be a true crime. Sink into the comfort of an armchair, bask in the glory of a ‘free’ coffee whilst completely forgetting that your membership paid for it, and relax (whilst completely ignoring the much more productive ambience of the library upstairs). (Picture below)

Wellcome Collection Reading Room It is important to note that this is the only place to make it onto the list that doesn’t have coffee readily available. This is testament to the calibre of the reading room. Artfully arranged, cosy, and filled with fascinating curios to entertain you during those necessary study breaks. Escape the chanting hordes at the Cruciform and study in peace at what feels like a well-furnished library at one of the wealthier country houses. (Picture previous page)

Store Street Espresso

Dillon’s

Don’t be deceived by the modest exterior – once inside this gem you will be surprised by the spacious and leafy feel. You can pick up eduroam as well as the café-provided wifi giving you that most valuable of things: a choice of wifi. Never live in fear again! Store Street is a little pricier than the other options listed here, but the quality of the coffee makes it well worth it as an occasional revision-time treat. (Picture above)

(Otherwise known as the Waterstones on Gower Street for the less pretentious among us) Bright and airy (sometimes excessively so in the winter months) there is nothing to beat the sense of productivity that Dillon’s seems to bring out in even the laziest of students. Conveniently located within a few minutes of the main campus, it is the ultimate place to see and be seen – you are sure to bump into someone you know and those quick five-minute catch ups help to make the hours of studying seem more bearable. (Picture left)

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Demystifying Medical School

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places to revise away from Bloomsbury For the pre-clinicals reading this, the idea of leaving zone one may seem bizarre and unproductive. But for the older and wiser, a small journey can provide a more peaceful alternative to the hordes milling around the Cruciform. So, if you can bear to tear yourself away from Bloomsbury – here’s the best of the rest. Photo courtesy of Ajinkya Karmarkar

Timberyard

National Art Library (at the V&A)

Let’s not forget that most of us originally came to London so we could live in the ‘culture capital’ – before our dreams were buried under piles of lecture notes and flashcards. Why not revive your fantasy by studying in Timberyard, which was recently voted ‘Europe’s best independent coffee shop’. A workspace first and foremost, this place has the highest concentration of sockets per square metre of any other café in London, and smiles benevolently on those tucking themselves in for a whole day of work with only one coffee ordered. (Picture right)

So, you’re not at Oxbridge – but you can still feel like you are by heading to the National Art Library to study. One of the most aesthetically pleasing libraries in all of London, it’s grandeur will doubtless satisfy even the most discerning of snobs. Take the chance to head southwards and immerse yourself in regal surroundings. (Picture above)

Royal Free Hospital (Student Hub) The main attraction of this comfortable, modern space is undoubtedly the presence of not one, but two, microwaves. It’s the perfect day – head over to M&S food and start the day with a pastry and a coffee, do some studying, have a nap on a sofa, move to the outside terrace to soak in the sunshine, head back to M&S food to buy a ready meal, pop it in the microwave, do some studying, then finish off the day with a pastry (now reduced price) and another coffee. (Picture right)

The Barbican Centre and Library Perfect for reminding yourself that there is a future beyond university and exams, this is the ideal place to get away from students. Boasting numerous studying spots, including a café for those who like to study in the company of caffeine, an outdoor terrace for the sun-starved, and a library for the conscientiously silent (you do have to join the library to use it but it’s free and easy to do online). Coming here is a lovely way to see more of London without feeling needlessly guilty. (Picture above)

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Demystifying Medical School

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pre-exam breakfasts Picture this – you have an early morning exam you’re jittery, already running late with the tube or bus already being delayed, exhausted, and worried that you’ve not taken enough pencils. So, you skip breakfast. But actually, eating the right meal just before your exam is likely to do you much more good than a 15th spare pencil. Read on for delicious and nutritious options.

Porridge topped with Honey The ultimate in comfort is a warm, sweet bowl of porridge. Feel your worries swirl away as you drizzle fun honey-based pictures into your bowl. The combination of carbohydrates that you get from the oats and the glucose rush from the honey will make your exam seem ridiculously easy – you may well feel the urge to go and run a marathon on getting out of the exam hall just to get rid of your spare energy.

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sneaky tips

You’ve heard all the usual tips – you know not to overdose on coffee, not to pull all-nighters, not to worry, to read the question carefully. You’ll probably do all these things anyway (there’s really no help for you, is there). So, instead, here are two tips that you might not have heard before, for you to take into consideration and probably add to your mental ‘ignore’ pile.

Start a visible countdown Maybe you’re not a wall calendar person (or maybe you are, no-one’s judging) – but buy one anyway. Stick it up somewhere really visible. At the end of every day, put a big, smug cross through that day, and wave goodbye to it forever. You’ll feel a sense of achievement, or at least progress, and remember to think that however badly (or well) exams are going, at least they’ll be over soon.

Yoghurt topped with Fruit and Granola This, on the other hand, could not be easier to make. Buy all the ingredients in advance and throw them all together. You can even do this the night before and then shove the whole delicious concoction in the fridge. It’s light and fresh for those sweaty summer morning when you can’t face anything that seems too solid or real.

Organise one nice thing to do each week No-one can revise 24/7. No-one can revise 12/7 either. And no-one should. Instead of fretting away your time with guilty Netflix marathons, schedule one nice thing to do each week (like going for dinner with a friend) and commit to taking that time off.

Smoked Salmon and Scrambled Egg Bagel This may take a little time to prepare, but the benefits are undoubtedly worth it. The brainboosting effects of oily fish (our friend the salmon) are preached by every single nutritionist, and this filling meal will stop you from falling prey to the deafening stomach rumbles that plague us all in the deathly silence of the exam hall.

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final thought:

“Remember – the future lies ahead”

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Careers

Anaesthetics and Critical Care Medicine Vol.III No.III 44


Careers

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ow do I become an anaesthetist or critical care doctor and what does training involve? Those who train in anaesthetics complete a medical degree - not always recognised due to historic practices and TV programmes! - and the Foundation Programme, followed by choosing either the Core Anaesthesia or Acute Care Common Stem (ACCS) training programmes. ACCS includes an extra year of training to allow coverage of all the acute specialties and following completion, doctors will continue training within their chosen specialty: anaesthetics, emergency medicine, intensive care medicine (ICM) or even any specialty within the Joint Royal College of Physicians Training Board. There are only a few specialties which a trainee would not be able to pursue at a higher level after completing the three years of ACCS. Overall, completion of anaesthetics training generally takes between seven and eight years following the Foundation Programme. Anaesthetics is the largest specialty in the hospital, with anaesthetists working in a variety of locations besides operating theatres. As an example, there are over 70 consultant anaesthetists and over 40 trainees in UCLH, some being joint appointments in ICM or pain medicine. Except general practice, anaesthetics is the most common specialty in the UK with 11832 doctors on the GMC specialist register.

“Ten, nine, eight, seven…”, When people count down from ten, they may think of events such as welcoming the New Year or building up to the launch of a space shuttle. However, another situation that comes to mind is when anaesthetists ask patients to count down as anaesthetics take effect. Hopefully, you will not fall asleep whilst reading this Careers, focusing on anaesthetics and critical care medicine! Words by Izabella Smolicz, Director of Medical Journalism

Anaesthetists may specialise in particular areas when at an advanced level including cardiothoracic anaesthesia, neuroanaesthesia or paediatric anaesthesia. However, all anaesthetist trainees undertake time in these subspecialties during training, in addition to others such as obstetrics. There is an increasing focus on perioperative medicine and specific units have been integrated into the anaesthetics training programme. Other areas of special training include ICM, pain medicine and pre-hospital emergency medicine. The Royal College of Anaesthetists offers the option of Dual Certificates of Completion of Training in both anaesthetics and ICM. There are also many clinical-academics who have pursued research in addition to the clinical aspect of the specialty.

How can I find out more about anaesthetics and critical care medicine? There are opportunities throughout medical school to find out about this diverse specialty, from student selected components to electives. In addition, there are many resources out there to provide information on anaesthetics and critical care medicine, some of which are outlined below. The Royal College of Anaesthetists website provides further information on the training pathway and curriculum. www.rcoa.ac.uk www.rcoa.ac.uk/accs www.rcoa.ac.uk/perioperativemedicine www.facebook.com/ RoyalCollegeofAnaesthetists/ twitter.com/RCoANews MedSoc has a section dedicated to anaesthetics and have kindly contributed an article in this issue in Features. www.medicalsociety.org.uk/sections/ anaesthetics/ Last but not least, there are an amazing set of resources for students on the UCL Centre for Anaesthesia, Critical Care and Pain Medicine website including a curriculum summary for UCLMS fourth year students, sixth year SSC information and many ‘How To’ guides. The main anaesthetics placement takes place during fourth year, Integrated Clinical Care Module B, and is an optimal opportunity to practise clinical skills such as inserting cannulas and setting up an intravenous fluid bag and drip. There are also two modules being launched for UCL intercalated BSc students in the next academic year providing an insight into anaesthesia and critical care. See the website and YouTube channel for ‘UCL Centre for Anaesthesia’ for more information: www.ucl.ac.uk/anaesthesia/ StudentsandTrainees/students www.youtube.com/user/ Centreforanaesthesia

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More medical history than a hardcore detailing of the development of anaesthesia, Blessed Days covers the majority of the changes in the 19th century that brought about modern understanding. This is a much more readable book than the dry medical tomes that normally explain the history behind drugs, however it is not particularly extensive and certainly does not cover many of the agents we use today. This book is a good adjunct if you are interested in anaesthesia, but it is quite basic and provides more of an insight into the history and understanding of consciousness as opposed to the drugs themselves.

Blessed Days of Anaesthesia by Stephanie J Snow

The Story of Pain by Joanna Bourke follows the ideas and interpretations of pain throughout the past three centuries, as well as different responses to what is considered ‘painful’. This book is not a chronological account of pain and its management, but rather a look through the different ways in which pain can be considered – its relations to religion, estrangement, diagnosis and role as a metaphor to mention a few. Throughout, Bourke mentions multiple experiences of pain from a variety of sources including poems, diaries and patient accounts, as well as the opinions of scientists and philosophers. The different ways in which people describe and understand the pain that they are feeling are subject to the influences of the time – whether that be religious, cultural or simply due to upbringing – as well as the treatments and pain relief available.

The Story of Pain: From Prayer to Painkillers by Joanna Bourke

Not only does it cover the drugs, but there are sections on adapting anaesthetics for obese patients, fluid management, anticoagulants and various technologies. It’s detailed enough that it would be a good text for those studying for anaesthetic exams, but also functions as an excelled day-to-day reference, should it be needed as such.

Like all Oxford Handbooks, it is small enough to fit in your pocket, detailed enough for your exams and has some weird and wacky anecdotes to keep you amused. With more detail than would be needed at the medical student stage, this book is a good reference text for anyone who struggles with anaesthesia or has more than a passing interest.

Oxford Handbook of Anaesthesia by Keith Allman, Iain Wilson, Aidan O’Donnell

Book Reviews


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It covers the introduction of nitrous oxide (laughing gas), ether and chloroform and how they were accepted into medical practice. There is a lot of social history involved with stories of obstetric anaesthesia and how doctors were hesitant to test anything on pregnant women. Given how we perceive pain now and are so quick to take a paracetamol for a simple headache, it was interesting to read how doctors used to believe pain was helpful and even necessary for good healing, and just how that affected the introduction of anaesthesia into common practice. Religion and the monarchy also played their part. This book is an easy read for those interested in social commentary and anaesthesia.

The Story of Pain is written in a fairly academic style which is perhaps not the easiest to get into, and each chapter is densely packed with arguments and counter-arguments. Nonetheless, it is deeply thought-provoking and an interesting alternative to the generally clinical ways in which we currently learn about pain. Bourke writes of how ‘pain-narratives’ are becoming usurped by more modern diagnostic tools in treatment of pain, but this book encourages us to consider patient stories in such a way that contributes to identifying the needs of each individual, and treating accordingly.

This is the major theme throughout The Story of Pain – that the pain felt is in “negotiation with social worlds” which is perhaps a more subjective interpretation than we are used to as medical students. Fundamentally, it highlights the fact that experiences vary, and a single definition or treatment of pain cannot be applied to everyone. It also encourages the reader to consider the inequalities of pain treatment, particularly in the last chapter on pain relief where this was given in differing amounts (lower socioeconomic classes and women were assumed to have a lower sensitivity to pain).

BOOK REVIEW


Sports and Societies

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Sports and Societies

Sports and Societies VP Editorial

Charlie Travers

I

t has been an absolute pleasure being your Sports and Societies VP for the last year. Things started off a bit rocky - with the Union’s attempt to change Sports Night and rumours of a small fresher population, we were a bit nervous about what RUMS was going to look like. However, our clubs remained optimistic and we have had a fantastic year off the back of it! RUMS have plenty to be proud of over the last year, including the Boat Club’s cycle to Paris for Anthony Nolan, Women’s Hockey securing the triple (Cup, League, and Varsity), and and Rugby getting to the UH final and winning! Our fresher intake this year has been one of the largest: across the board our clubs are boasting some young sporting excellence as well as big social characters. These are the two pillars of RUMS Sport, and we will be doing our best to make sure that they are well-preserved! There was plenty of hype around Sports Ball this year, and with the MDs and Music welcomed in the Colours scheme, it was certainly a night to remember.

I have every confidence in my successor, Josh Bryan. He has plenty of exciting ideas that he will be looking to introduce during his term. Josh will be a great addition to the RUMS Sports and Societies Hall of Fame and is more than capable of carrying on the good work that has come before him. Sports and Societies VP is a special role that I am grateful to have had the opportunity to fulfil, and so it is goodnight from me and good luck to Josh.

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RUMS WOMENS FOOTBALL JUDITH ROSSEY This year has been a great success for RUMS WFC, both on and off the pitch. I can’t believe it has already come to an end! Both our firsts and seconds made it to the quarter finals of the LUSL cup. Our seconds have had a couple of wins in the bag and have grown lots as a team! Our firsts may have ended at the bottom of the league but it wasn’t without putting up a good fight. Socially we’ve been buzzing as well, with lots of successful sports nights, RUMS Dine with Me, Zorb football and President’s Day! The firsts, led by our fantastic captain Anita Jiang, also put in a great effort winning second place at Varsity this year. Thanks to everyone who came out to support us! We can’t wait to face GKT Women’s Football Club again at the UH Final for some payback... Plus, we still have more fun to look forward to at NAMS in Manchester. Thanks for the amazing year and best of luck to the new committee!

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RUMSFC BEN BARKER As the season and academic year draws to a close, it’s time to look back over a busy few months for RUMS FC, both on and off the pitch. With games left to play, the final league standings are still undetermined. With the first, third, and fourth teams currently battling to stay out of the relegation zone in at least one of their leagues, and the second team looking to secure a top three finish in their Saturday league, it’s all to play for. On March 15th both RUMS FC and WFC took part in the second annual London Varsity Series Medic Football games. Although the team (and the fans) battled hard, we sadly lost two to zero to GKT Men’s and had to give up the trophy – till next year at least! Off the pitch, the club is looking forward to Sports Ball, and to sending off its Sixth Years in style at finalist’s sports night. Our Annual General Meeting was followed by End of Season Dinner at RUMS Men’s Football’s Official BYOB curry establishment Sheba, with a chance to reflect on the season: particularly fellow team mates and any horrendous mistakes they might have made. AGM has given us a stellar new committee for the 2018-19 year, to be led by President-elect Chris Cooper, and we’re all looking forward to what the future holds for RUMS FC in their promising hands. It remains to say good luck to all our preclins heading into revision season, and we’ll see you on the other side.

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RUMS MENS HOCKEY FRED VIVIAN

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RUMS WOMENS HOCKEY CHLOE HALL Women’s Hockey have gone from strength to strength this season, starting early in September with our inaugural Sports Day and curry. We then recruited our largest set of Freshers yet, went on two huge tours, had numerous curries, and still have our NAMS debut to look forward to in April. This has been one of the most successful hockey seasons for the club, with the firsts getting the triple of a BUCS League win and promotion, Varsity title and LUSL Cup win in a riveting defeat over UCL to take the crown of best team in London. Our charity work also deserves a special mention as we continued our fortnightly soup kitchens, did a huge blood drive with over twenty members donating, danced with old people at an Age UK Valentine’s party, raised nearly £500 at a Ceilidh, and collected sanitary products for Islington Foodbank. As the year draws to a close we are preparing to celebrate the achievements of all of our amazing members at our annual EOSD, though it is with sadness that we say goodbye to our wonderful finalists - Emily Croft, Brogan Rudge, Rebeca Wilkinson and Maya Huby – thanks for an incredible six years!

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RUMS Men’s Hockey Club have had an outstanding year of fun. With the biggest fresher intake ever, the club has never been so large and so active. The first team sadly lost out to GKT in varsity, but put on a great show. The highlight of their year was undoubtedly the four-two victory over UCL firsts. The seconds have had a strong season getting to the UH reserve cup final and coming third in their BUCS league. The huge influx of freshers has made a weekly selection headache for Matt Solomons, third team captain. It is amazing how far those who picked up sticks for the first time in October have come in just six months. Volunteering has been another very strong area this year: AGE UK tea dances, soup kitchen serving, blood donations, carol singing in aid of Medic-to-Medic, and a wonderful Ceilidh raising almost £500 for St Mungo’s. Our packed social calendar culminated in our End of Season Dinner at the delightful Holiday Inn, Camden. Congratulations to the award winners: James Shuttleworth (Players’ player), Hamish Miller (Most Valuable Player), Jonah Stott (Most Improved) and Simon McAlpine-Scott (Fresher of the year). I look forward to our Alumni Day in June, before passing on the reigns to the very capable hands of Henry Sergeant.

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MEDICS4MEDICS KERRY WALES This year Medics4Medics has sent a clear message that personal well-being and mental health are issues that we need to start talking about, invest our time in and support each other with. Medics4Medics has made fantastic progress in developing and growing into a name that everyone knows and a support group for everyone, regardless of what they may be going through. We have established a large, supportive community from every year of the Medical School and are actively raising awareness of support services, myth-busting and engaging in conversations about mental health. Medics4Medics has done great work this year in supporting and engaging RUMS students to invest in their own mental health. Our event themes have been chosen and voted for by the RUMS student population and address hugely relevant issues that many of us face. We have also been collaborating and networking closely with other mental health advocates and services to become increasingly integrated. Through the activities of Medics4Medics, and the increasingly wide-spread awareness of these activities, I believe Medics4Medics are beginning to change the culture around mental health in RUMS. We’ve taken a huge step forward to empowering medical students to feel more comfortable to open-up about their personal mental health and to seek support without fear or shame.

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RUMS TENNIS RISHI GUPTA

RUMS BOAT CLUB TINTIN LARSSON Term two is filled with social events and racing for the boat club. In our first weekend back, the club ventured to Birmingham for our Mario and Sonic themed social tour. Racing began the weekend after, and social tour seems to be the ideal way to prepare for UH Winter Regatta. We brought home medals in the men’s novice, men’s intermediate, women’s intermediate and women’s senior categories! In preparation for UH Head, our biggest race of the year, the club went to Maidstone to nail our rowing technique and bond as a crew. With the Beast from the East appearing the week of UH Head, it was touch-and-go whether we would be racing or not. Luckily, the weather cleared up for us and the race was on. All crews put on an excellent performance, really showing our domination by coming first in five of the eight categories entered, and coming second in all other categories. In addition to UH Head, seven RUMS crews travelled to Newcastle to participate in BUCS Head, competing against a wide array of British universities. We also raced in the Tideway Heads, which is the Boat Race course but in reverse from Chiswick to Putney! With racing now winding down and our focus shifting to revision, we still have the Bumps races to look forward to at the end of May. All of RUMS are invited to come down to the boathouse on May 27th, to watch a fun sprints race where crews chase each other with the aim that a crew ‘bumps’ up before they get bumped! Afterwards, a party is held at the boathouse. Drinking by the river as the sun sets is the perfect way to end the year.

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I’m writing near the end of what has been a great year for the club. With the standard of tennis ever improving, the standout team of the year have been the Women’s first team, led by Pia Borgas. They are still in with a chance to win the league, and with it, promotion, with one more match to play at the time of writing. Good luck to them, they really deserve it! Our Men’s first team did their bit too, making the quarter-final of the BUCS Cup and only losing out to much higher ranked opposition in a tense tie-breaker. As for the Men’s second team… it was nice that they turned up to all their matches. Shout out also to our development team, led by Sagar and Martha, who performed admirably in their first ever season in LUSL! On the social side, our stellar first tour in Leeds during term one was matched, if not bettered, by our first ever tour abroad in Madrid. Many memories for everyone that came - I’m not sure some of the big stories from tour should be published, so if interested, please ask Zosia and Parinaz for more details. Finally, I just want to say a massive thank you to everyone in RUMS Tennis who has made this year so great! After a hotly contested AGM, I am very happy to be passing the presidency on to the very safe hands of Alex Orbaum, with Calum Jack taking the role of treasurer. Looking at the full committee line up for next year, I can say with confidence that RUMS Tennis is well set for another incredible year!

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BADMINTON PATRICK MAN RUMS Badminton has had a fantastic year! We have had a strong intake into all of our teams, helping all of our players to elevate their games, and in turn, our teams have all finished in very respectable positions in their leagues. Likewise, our social side has been as strong as ever, with the biggest tour we have ever run and the return of karaoke being special highlights. Dedication to our weekly events had also been strong, with committed members consistently turning up to sports night, social practice and development squad. Special thanks to those who have braved the cold for carol singing, fundraising in support of North London Cares, as well as those who have generously given up their time to help our younger members with their studies. To our final years, we wish you all the very best for the future and remember that you are always welcome to visit RUMS Badminton. Thanks again to everyone who have showed continued support throughout the year and we’re sure that next year’s committee, headed by Tapan Parikh, will take the club even further than before!

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Vol.III No.III


Sports and Societies

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RUMS NETBALL FRANKIE KACKETT

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SPECTRUM KHUSHBOO KHATRI Spectrum links UCL medical student volunteers to children with disabilities in Camden. This year, we recruited many new volunteers who have been visiting their linked child once a fortnight, doing various activities like swimming, cinema trips and more. We had our annual residential trip in February where all the children and volunteers went away to an activity centre. We spent the weekend enjoying outdoor activities like archery and zip wire, providing our children with many new experiences and independence away from home. It was also an excellent opportunity for the volunteers to socialise and provided a weekend of respite care for the families. Looking forward, we have a summer picnic planned with our children and their families. Spectrum’s AGM was also a great success and so we have a committee full of fresh blood, ready to bring us another brilliant year. We rely entirely on grants and fundraising to maintain the work we do in the community, so if you would like to donate, please visit: https:// mydonate.bt.com/charities/spectrum. Moreover, we always welcome new volunteers at the start of the academic year, so if you are interested in joining Spectrum next year, contact us at: spectrum.rums@gmail.com. Thank you!

Currently being one member away from breaking the 100 mark, there’s no doubt that RUMS Netball has had an historic year. Our fresher intake has been second to none and all of our seven teams look forward to AT LEAST one league promotion (BUCS and/or LUSL) going into the 2018-19 season. We started the year strong with lots of freshers, many socials, and our wonderful tour exploring outer space (I mean Cardiff) in our spacesuits in November. After a lovely break over Christmas, and win after win for every team (check out the Insta for colourful evidence), we took on RUMS Dine With Me - founded by yours truly - and also the brand spanking new RUMS TMO, featuring many a Netball gal searching for their knight in shining armor. Note to self: medical school is not the place to find such knights/nights. Our Volunteering Sec Davina has made some wonderful links with homeless shelters throughout Camden during this bitterly cold winter term, leading to some rather rogue cooking and much more impressive bed-making. Our hospital corners are second to none! We had an amazing time in some beautiful churches in the community and can only thank Davina for the hard work she put into making it all happen. We followed this with many more promotiondeciding matches, winning them all. Need I say more? The annual Chi cup saw our second years avoid the ‘double losers’ title by claiming the trophy, albeit in three individual pieces. RUMS Netball entered a team to NAMS for the first time in history in March with a team varying from firsts to thirds, and finished in the top half of

the tournament in Birmingham. We can’t wait to win more matches next year! Hannah as Education and Welfare Sec revolutionised the RUMS Netball Facebook page for a whole week as she ran the Humans of RUMS Netball (HORN) feature to highlight different peoples struggles with mental health issues and also access to services available to our club. It was a wonderful way to celebrate not only the RUMS Netball family, but also the RUMS welfare family, and demonstrate the multiple support systems available to our members as well as medics in general. Thank you so much to Hannah for this innovative and wonderfully professional work! To our RUMS crew, please keep your eyes peeled for some Netball news next term in the form of the Lumsden cup. A gargantuan RUMS charity event matched by none and not to be missed, come and show us what you’re made of (and also your extensive knowledge of the footwork rule) come May when the sun is shining and the ownbrand Pimm’s is flowing!! A final note from me… I apologise for being able to get so little of this out at AGM (for many reasons hehehe). You guys have been my absolute world this year and I couldn’t have asked for a more awesome club to lead. The committee you all chose last year has led our wonderful club from strength to strength and I hope to see RUMS Netball continue to blossom in the coming years. I know every one of you have given RUMS Netball your all this year, and I couldn’t be prouder of what we have achieved; as individuals, as seven huge, hardworking teams; and as a whole club family. Thank you also much for making this year the biggest, best, most crazy year ever for RUMS Netball. Congratulations to the incoming committee, and best of luck in your roles. You know where I am if you need me. President out (mic drop). Frank xxx

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Sports and Societies

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RUMS CRICKET CLUB DHIRAJ PATEL What an unbelievable start to the term we have had! The amazing intake of freshers got everything going and has pumped a lot of energy into the club! Fresher’s fortnight was packed full of amazing events and created loads of great memories! One of the highlights of term one was social tour to Barcelona where the club toured famous sites from The Sagrada Familia to Jamboree. This year’s edition of the amazing sRPL was won by Hasan’s Mafia - giving the franchise its second title as ‘champions’. Will anyone ever beat them? The BUCS indoor team absolutely smashed round one, winning all their five games - which included giving St Mary’s first XI an absolutely smashing! This year, the club has been very fortunate to have had three female members who have all been heavily involved, both in terms of cricket and socially. We hope that this can form a strong foundation for future years to build upon. The talent on showcase at nets has been very encouraging and hopefully this puts us in a strong position for the season ahead. We were very proud of our very own James Groves for being the first ever RUMS CC member to be awarded SPOTY! We have a lot coming up and are looking forward to the coming season. Our main marquee event, RUMS t10 day, will be taking place in May and is our annual cricketing event bringing together RUMS in aid of charity. RUMS CC is more than a club - it is an entity and a family. I am so proud of all our members, and fundamentally this club brings everyone happiness and great memories which is the essence of what we are about. This club is a true blessing as more than the memories, the laughs, the ‘fines’ and the cricket - this club creates lifelong friendships. I am proud to be a member of RUMS CC.

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RUMS SQUASH DANIYAL JAFREE As we come to the end of another great year for RUMS Squash Club, we look back at some of the highlights of the season. One of our greatest moments belongs to the Men’s First V, who served a hearty five-zero thrashing to London School of Economics. RUMS Squash Club also made its annual appearance at the national NAMS squash tournament held at Birmingham this year. Though the Men’s First V had a flop, the Men’s Second V fought valiantly to the Semi-Finals. However, we now face a dilemma. Many of our current members are finalists, about to set off on their journey to join the medical workforce. So, will RUMS Squash Club be able to fill the (arguably unreasonable) quota of thirty members next year, or will we have to pack our bags and bow out? If the former is the case, then look forward to more exciting updates. If the latter is the case, then I would like to leave the below message to our members, particularly the finalists: Karan, Sri, Tom, Louis, Samir, Emma, Basil, Jen and Sophie. It was a total pleasure being your President (excusing my substandard job due to questionable career choices). In the thirteen years I have been playing squash, I have never met such a dedicated and committed group of players, who, during this short time at medical school, have developed from plucky beginners to formidable competitors. I thank you for all the squash, the teaching and mentorship (without which I, and several others, would probably be resitting fourth year…) and most of all, for the friendships and memories forged over the last several years. After this year, though our club may be divided, we will always be around for a knock-up on court, followed by a cheeky curry at Dar’s Tandoori. Your Pres.

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UCL WILDERNESS MEDICINE SOCIETY TOM DURHAM After a quiet start to the second term, UCLWMS have had a busy end to the year. An excellent talk from Dr Ali Blatcher on her time spent as part of Channel Four’s social experiment Eden was followed by our AGM. Congratulations to all next year’s committee. To finish the term UCLWMS travelled to the Lake District to take on the Fairfield Horseshoe and visit Ambleside and Langdale Mountain Rescue Team. With the best weather the Lake District had seen for a number of months, we had the perfect conditions to enjoy the amazing views and the snow higher up on the mountains. The Mountain Rescue Team gave a fascinating insight into the realities of dealing with medicine in hostile conditions. Sadly, we had to return to London and the reality of upcoming exams/ a sixday Easter holiday! Look out for more events coming soon.

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MDS

Second term for the MDs is a term of relaxation, reflection and rehearsal/circle-withdrawal symptoms. Fortunately, our lovely Social Secs have provided the society with much-needed fun-filled events to drag us through what has been a very, very long winter. A particular highlight was the big UH shindig, which saw cohorts from London’s med school MD-equivalents come together for a Brick Lane curry and some questionable dance moves. This was a great way to mix with the other med schools ahead of our UH Comedy Revue competition on Friday 23rd March, where we hope to bring home the trophy for the fifth year in a row. Other exciting upcoming events include our celebration evening hosted by RUMS Alumni on 13th April, bringing together past and present MDs for a night of self-indulgent reminiscing. We also need to give a shout out to our unbelievably attractive band, The Ectopic Beats, who nailed their Sports Ball gig and continue to make the rest of us feel very aesthetically average.

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Sports and Societies

Fresher Of The Year: Where Are They Now? JOSH BRYAN After another memorable Sports Ball and two new additions to the ‘Fresher of the Year’ hall of fame, we look back at some of our previous titleholders and ask where are they now? This issue, I speak to Josh Bryan, our upcoming Sports and Societies VP, about his experiences.

Most of my mates are from either RUMS Football or Rugby. It may feel quite intimidating to get involved with a big, well established group, but it doesn’t take long to feel like you’re a part of the community.

What is your favourite thing about RUMS?

What did you do to warrant the title Fresher of the Year? It took me completely by surprise when my name was read out at Sports Ball. I was in the first team for football and was one of the only freshers to go to most of the socials. I had played a bit of rugby by then too, so I think I just got the backing of two clubs when it came to the voting process.

What is your favourite moment from fresher year? There are lots of moments to choose from. Beating the second years five to two in John’s Cup in front of a huge crowd of fans is right up there. I also got to play for the Boars (rugby second team) in the UH plate final, which we won against GKT.

What advice would you have for a fresher starting this September? Get involved in a club or society early on. There is something for everyone. Being involved in RUMS means you have a great network of support, with older years always looking out for younger years. Vol.III No.III 54

The social side of RUMS is, in my eyes, a necessary distraction from the hard work of medicine. Of course, Sports Night isn’t for everyone, but there are other huge benefits. Most clubs run tutorials for all years and there are various other socials. Personally, I love the competitive side of RUMS, and playing in the big matches like football Varsity and rugby UH final are what I look forward to most. Events like John’s Cup and Bill Smith’s are also highlights of the RUMS sports calendar.

Do you have any role models within the RUMS sporting community? It would be wise not to choose anyone from RUMS sports as a role model. You’ll find out too much about them. I find it is best to identify things not to do and use your own moral compass as a guideline. A famous philosopher once said, “never meet your heroes, and never choose anyone close to you to be your role model”. Wise words to live by.


Sports and Societies liked to have gone for captain sooner, and then maybe president. As it is, I’ll be RUMS Sports and Societies Vice President next year and I look forward to that being an exciting challenge.

What has been your most memorable sports ball moment? Sports ball is one of the highlights of the RUMS calendar. Congrats to Travers for pulling it out of the bag at the last minute this year… Although I’m sure a lot of people without tickets won’t be saying the same thing. My first sports ball was just after winning John’s cup and we were all on a high from that. Meeting big dog Prof Dilworth was a highlight too.

Is there anything you would go back and change?

What has been your favourite RUMS fancy dress theme or costume? Dressing up in a flowery vest, beach shorts and flip flops to go out in Brighton for football fresher tour in November was one of those imaginative, well thought-out ideas that everyone craves in a fancy-dress theme. I can’t say I enjoy dressing up though, and this was one of the easier themes.

What have you achieved within RUMS since earning the title of FOTY? To be honest, being fresher of the year is probably going to be the highlight of my RUMS career and I don’t have anything else worth bragging about. I’ve since broken into the rugby first team and we were in the UH final. Beating GKT in Varsity last year was definitely one of the sweetest moments, even if I missed a penalty in the shootout.

Bristol tour 2017. I crashed my bike about a week before and I was all wrapped up with bandages on my hands and knees and a plaster on my face. On the second night I somehow lost all ofthe other boys on the way to the club, having had a little too much of Angry Webb’s “Woody B” cocktail from a watering can… Long story short, the people who helped me (who clearly were the type of people who wanted to watch the world burn) managed to call my dad from my phone at 1 am. I woke up to “disappointed” texts from my mum and a lot of explaining to do.

Talk me through your preand post-match rituals. I’ve never been one for pre-match rituals. As long as I’m properly warmed up and fit for a game, as soon as that first whistle goes I’m ready to play. Afterwards, on a Wednesday, meet up with everyone at the Huntley for a couple of beers and a good social.

What do you think about other RUMS sports teams? All the teams get on really well, as far as I know anyway, and the RUMS dine with me event, where all the sports teams went to a curry house together, is testament to that, as is the atmosphere at the end of sports night when all the teams mingle.

Do you have any aspirations for your club? I’ve been social sec and treasurer for RUMS FC, and I’m planning to go for first team captain in my fifth year. Playing two sports has its benefits, but it has meant that I have had to sacrifice a little in terms of commitment to football - I’d have 55

Vol.III No.III


RUMS Review Vol.III No.III The Anaesthesia & Critical Care Issue  

The Anaesthesia & Critical Care edition of the UCL Medical School student magazine.

RUMS Review Vol.III No.III The Anaesthesia & Critical Care Issue  

The Anaesthesia & Critical Care edition of the UCL Medical School student magazine.

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