The Black Bag Summer 2023

THE BLACK BAG

BRISTOL MEDICAL SCHOOL

Summer term Ed., 2023

The University of Bristol Medical Students’ Magazine

Est. 1937

Editor-in-Chief:

Anna Andrieu

Contributors:

Adewale Kukoyi, Aurora Cettato de Sabata

Charlotte Wood

Diyora Ilkhamovoca

Dolores Faucett Hill

Jordan Lin

Max Gerard

Molly Van der Heiden

Phoebe Barry

Wiktoriya Kotynska

Illustrations: Habib Ullah, Zin Htut

Editors: Safia Hussein, Victoria Frugone Clarke, Kate Rainsford

EDITORIAL

Dear lovely readers,

I would like to introduce our new Editor-in-Chief Anna Andrieu who will be taking over the black bag for the 23/24 year. I have so loved being editor for the last 4 years and hope I have continued the legacy of this very old newspaper well. My highlights have been weekly zoom meetingsduringCOVID-19whichgave mesuch light-hearted relief, editingone ofourwriter’s interviews with Matt Hancock as well as reading many lovely and interesting articles submitted by people who loved to write and wrote for us many times but also those from people who gave it a go and ended up producing some amazing stuff. I know we all laugh at art in medicine and other points in the medical school when we have had to write a poem or produce a painting, but I really do think that creative thinking is needed in medicine, especially in the NHS at the moment. Thus, I beg you to continue a little creativity throughout medical school, not only to develop your thinking but it will definitely keep you sane! I have written my final poem for the black bag below and it’s about this couple I met during my 18-week CMOP placement at Southmead. I think I expected geriatric care to be very depressing however I found a lot of wisdom and hilarity within it. Perhaps writing lots of these poems helped me process some of the not so fun bits of medicine and helped me slow down and reflect. This is definitely another hint to write for us! Thank you so much for reading the magazine over the last 4 years and for contributing.

M.van

der Heiden

Hello everyone,

I am delighted to take over as the Editor-in-Chief over the next year, and I welcome you all to a wonderfully long edition of The Black Bag, unrestricted by printing. The Black Bag is back, but I cannot say for sure if it will be better than ever, as it fully depends on my ghost writer, who is a tiny little mouse I keep chained to my stethoscope. (I promise he is not maltreated, I let him off once a year for CLIC) Over the next year, my main aim is to phase out all content which is unproductive and ‘fun’, and instead replace it with GMC regulation reminders and AI generated literature reviews for optimum performance. Jk. In a world where we do minimum wage unskilled jobs and robots paint and write poetry, we must try to not become obsolete and cross our fingers that GP practice does not evolve to a system similar to the McDonald's selfservice machines. It seems the world is on fire, but luckily the lecture theatre for Trevor Thompson's second year urinary EC is not (two years in a row - what are the chances?). As for introducing myself, I can normally be spotted in my natural habitat lurking at the back of E29 at around 9:20 every morning, biding my time so I can make the most disruptive late entrance to my lectures as possible. I’d like to make it clear this is not because I don’t care about my degree, but because I really really want to make friends with the cleaners who have their biscuit break in the corridor outside at the same time every morning. Any advice would be appreciated. Overall, I am very proud of the work produced by what may be our largest ever team of contributors. I hope you enjoy what we have put together, a great year lies ahead.

A. Andrieu

In sickness

I met this old couple on one of the wards, A few months ago

Amongst the caterwauling hospital bed cords. She was very ill; dementia’s death is slow

I stepped into her room, Almost aghast

At how different it was The stark bright contrast She was sat up, dressed and hair brushed, Far more neatly than the usual rush

He sat next to her neatly folded bed. A newspaper in hand and classic FM Bounced around. And I felt I had been misled, By the mayhem of love

He had made them bring in a bed It was neatly parked next to hers He stayed overnight since she’d been in All of the care, he’d taken on his chin

We wrote in the notes that we had no doubt, He was acting in her best interests, As he denied package of care Saying he could do it on his own back.

I often wonder how they are getting on. Whether they are still together, or she has gone Whether he’s alone in their big 4 storey house Or are they still having 5pm G+Ts by the greenhouse.

M. Van der Heiden

PRESIDENT’S ADDRESS

Being Co-Presidents has been a huge responsibility, but also a great opportunity

Each month has been packed with endless meetings and at times the emails felt non-stop. However, we are so grateful that we had this opportunity to support and represent medical students at the University of Bristol. A few things we are proud to have accomplished include Bristol Heroes, an increase in sober socials, an increase in pre-clinical events and the Stethoscope Bursary.

We really wanted to boost student wellbeing as well as help students feel part of a community. The Bristol Heroes scheme had over 40 students nominated by their peers and chosen by us as great examples of being great friends; people who help make our days easier and are a credit to our medical school. We wanted students to feel recognised for achievements that wouldn’t be seen at OSCEs or Progress Tests.

Inclusivity is really important to us and we understand that students might find a ‘traditional’ social unwelcoming for a number of reasons. We wanted to increase the number of sober socials, so created a competition to win funding for a sober social from our sub-societies. We were thrilled with the creative submissions and were pleased to choose three unique socials that we knew would be enjoyed by our members.

Joining Medical School can make you feel like a small fish in a huge pond, suddenly there are lots of new faces in lecture theatres, which is why we worked hard on having socials for our first years so they could have the opportunity to get to know their peers and enjoy a treat. We were able to host a highly attended coffee and cake social and were able to collaborate with Elsevier and create a scavenger hunt across the SU which was followed by free Eat-A-Pitta. We really hope our students enjoyed these events and loved meeting some of you!

Finally, we’re really pleased to have worked with the medical school to help create the Stethoscope Bursary. This is something that had been in the works for a while, but we were able to push for and create a formal process where students can apply for a reimbursement- helping reduce the financial barriers students might face.

Overall, we are proud of the work our committee has done this year and have enjoyed being your co-presidents. Thank you for having us!

Love, Veronica and Manisha

Introduction to Tilly - Hi, my name is Tilly, and I am a third year going into my fourth. I'll be at Yeovil and Bath next year, so do say hi if you're also there. I grew up in a small village in Derbyshire but soon became well acquainted with the Clifton Sainos and Jason Donervans. I may have faced my own personal challenges at University but clearly the medical school couldn't get rid of me that easily! So far, my experiences at Bristol have been enriching; a clear highlight would be CoDirecting CLICendales 2023.

Introduction to Walé - Hello readers of the Black Bag, a familiar name is back, but this time in a section I never thought I'd be in! For those who don't know, I've been writing in the black bag under the alias of Walé, and you've now trusted me to be your Co-President too. I'm currently an intercalator at Imperial, longing to return to Bristol and escape the London life (sideeye).

Our Goals and Visions for the Year

We broke down our vision into three values:

• Access and Inclusion

o So many things in medical school are passed down by word of mouth or gatekept in what can feel like a competitive environment. Our aim as Co-Presidents is, in part, to contribute to creating an accessible and inclusive culture.

• Medical Students at the Centre

o As Co-Presidents we find ourselves privileged to represent the voices of the community, we are a part of in meetings with Faculty. There's a growing number of you, and we want your voice to be represented and, importantly, at the centre of big decisions.

• Good Vibes

o Good vibes, simply put. Your mental well-being is essential, and we have the opportunity as a society to contribute positively to that.

This year we are incredibly luck to have a 24-person committee to deliver these goals! This is the largest the committee has ever been and is packed full of keen medical students (a rarity) who want to improve your experience.

~ GALENICALS COMMITTEE 20222023~

Co-Presidents: Walé Kukoyi and Tilly Gardener

Vice President: Sanam Chawla

Secretary: Conor Gibb

Treasurer: Kirsten De Escofet

Sub-societies Director: Charlotte Cayzer

Webmaster: Jacob Wilks

Social Media Director: Shakida Begum

Equalities Director: Ropsana Khanom

Welfare Director: Clodagh Thorpe

International Director: Adrika Iyer

Sports Directors: Joseph Holland and Zin Htut

Alumni Director: Ellie Harrison

Black Bag Editor: Anna Andrieu

Pre-Clinical Academic Rep: Anushka Goyal

Clinical Academic Rep: Qotaiba Jamal

Intercalation Academic Rep: Phoebe Day

Sponsorship Director: Stacey Kihumba

Events (ENTs) Directors: Elizabeth Brennan, Emily

Simpson, Connie Campbell-Gray, Camilla Knight and Georgie Hurt

Why I Ditched Medical School for Business School

Breaking news: Medical student abandons stethoscope for spreadsheets!

Yes, you read that correctly. I have indeed decided to take the plunge and leave medical school. But let’s not be dramatic; I’m only intercalating! However, instead of going down the traditional route of Global Health, Oncology or Clinical Science, I optedfor adegreein Management at Imperial College London, where I’m currently studying at their Business School.

I decided to switch to business school to gain a deeper understanding of healthcare management, leadership, and entrepreneurship. I realised early on in my medical training that if I really wanted to make a difference in patient care, I needed to understand more than just the micro-level stuff. I wanted to learn about the big picture - how healthcare systems operate, how policies are created and implemented, and how to manage healthcare costs. These topics were not covered in-depth in medical school but are essential for future doctors to be clued up on.

Lastly, I saw an opportunity to diversify my skillset and expand my career options beyond traditional medicalpractice. Forexample,with adegreeinManagement,Icouldpursueacareer in healthcare consulting or go for executive positions in the NHS and deepen my interest in MedTech. These fields were all areas where I could use my medical knowledge and combine it with business acumen to make a significant impact.

During my time in business school, I have so far covered modules such as Accounting, Global Business Strategy, Marketing (see the commercial we were tasked with making here), and Health Informatics (where we had to make a Python-coded chatbot from scratch!) These modules have given me a solid foundation in business principles and practices, which will be invaluable in my future career.

Honestly, if I ever get tired of diagnosing patients, I can always diagnose the financial health of a company instead.

I’m sure you’d be glad to know that I haven’t lost my medical touch. For example, I worked on a business case applied to a hospital in the Midlands, where we proposed the purchase of automatic ventilators in response to the high mortality in their neonatal intensive care unit. Through this project, I used my medical expertise to identify areas where the department could

be improved and then applied my business skills to develop a plan to make those improvements.

Moreover, the intercalated degree program has allowed me to network with other medical students with diverse backgrounds and interests. Being at Imperial College Business School (ICBS) has also allowed me to meet MBA and MSc students in various disciplines, further enriching my experience. Much like medical students, business students do firmly live by the ‘work hard, play hard’ mindset, and I have been in receipt of many socials, ‘mingles’ and free food after each deadline! ICBS rents out the Natural History Museum each year to host a free alumni social! I will definitely return next year (don’t worry, I’m accepting plus-one applications).

Furthermore,theheavygroupworkweightingforsomemoduleshasalsotaughtmetherealities of group work. When the stakes are high, you really do learn the importance of team dynamics.

My decision to pursue an intercalated degree in Management at business school was right for me. While it was an “out of the comfort zone” decision at the time, I know that the skills and knowledge I have gained so far in business school will allow me to be a better doctor. I am excited to see where this path will take me and am eager to use my unique skillset to make a difference.

Ultimately, healthcare is changing rapidly. With technological advancements and new healthcare legislation, hospitals and healthcare providers face unprecedented challenges. Medical students who pursue interdisciplinary backgrounds, like Management, could be at the forefront of these changes. By positioning yourself in a world that is more than just Medicine, you will undoubtedly have the skills and knowledge to navigate the complex healthcare business landscape and make a real impact.

Maybe one day, we'll see doctors with spreadsheets in one hand and stethoscopes in the other.

A. Kukoyi Intercalating Medical Student

How to disempower your medical students

Dearest colleagues,

So you’re running your medical school, and those pesky medical students are getting a bit too big for their boots. You’re wondering how you can narrow their horizons, bash them down, give them a few harsh home truths.

As an NHS consultant surgeon with over 40 years of experience in the field, I feel that it’s my job to offer you people some advice on difficult topics of this nature.

You’re thinking; the NHS is suffering, so why shouldn’t medical students too? Well, we’ve all been there. Here are a few simple things you can do as a medical school to get them back in line;

1. Strongly discourage them from attending strikes

Are medical students allowed to attend strikes? Yes. Should they? Absolutely not. How dare they exercise their right to protest something. They seem to have a shared delusion amongst them that one day, they too will become doctors.

This is a simply ridiculous proposition, a terrifying example of lefty liberal groupthink - what makes them think they might be working in the NHS? They’re at medical school.

Medical students have absolutely nothing to do with the NHS, and thus they should have no interest in how it is run, how much a doctor is paid, what patients think of things, and what the working conditions are. Simple.

2. Inspire your people with confidence

As medical school leaders, we must protect our students from the insane demands of junior doctors to be paid the same amount of money as we were when we were junior doctors.

The fact of the matter is, they’re being really crazy and silly and we just shouldn’t listen to them, ok. It’s really that simple.

Some will try to convince you with arguments about staff retention, the fact is, we’ll be fine, look around the ward - people complain it’s busy and cramped because of inadequate capacity. Nonsense! There are simply far too many doctors wandering around. We can afford to lose a few.

3. Join the Conservative party

These strikes are the work of far-left liberal elitists who have no business meddling with the NHS. Our beloved NHS leaders have done an outstanding job at paying everyone fairly and advocating for us to the government.

I love the government. They’ve done such a grand job of sorting us all out; I’m so glad that tonight, as we leave the hospital and drive in our Ferraris back to our 7 bed mansions in Clifton, we can sleep peacefully in the knowledge that every man, woman and child (in that order) in the country has enough food, money and warmth to keep them alive and well.

4. Speak in language they understand

In recent times the younger nurses on the ward have brought some rather wonderful ‘Tik Toks’ to my attention.

A common theme amongst them has been the key tenets of ‘Gaslight, Gatekeep, Girlboss’, and much in the same vein as ‘Live, Laugh, Love’, I really couldn’t agree more.

These powerful triads of the great English lexicon inspire me every day, and I think we can learn something from them when it comes to our medical students.

Gaslighting is the most important of the three, and that is why it always comes first. Whenever anyone brings anything to your attention, you must learn to gaslight them.

Medical students often like to ask if they are permitted to attend strikes. How should you deal with this? You simply tell them, “no.”.

They may ask for justification, and here is what you might like to say;

“Please note that as students you are not employed, and you cannot, therefore, join the strike - see notice from BMA below. You may support the strikers, for example, by taking them food or drinks, but you cannot stand on the picket line.”

From an email to Bristol University Medical Students from the medical school.

Does this mean you sort of contradict yourself? Not at all. The key is to use confusing statements which don’t fully make sense. In the example above, you tell them they cannot join a strike.

You then say that they can join the doctors to provide them snacks, but so as not to upset anyone, you emphasise that they cannot stand on the picket line. See what we did there? Probably not, and this is an excellent example of how you too can gaslight.

If anyone challenges you on any of this, simply say you are trying to support the picket by offering advice which adheres to the government’s fair and ethical strike laws, such as the one which allows a maximum of 6 members on the official picket line. You know, just so strikes don’t cause too much disruption. Yet another example of our wonderful government supporting everyone’s right to strike!

What does it mean to gatekeep? We’ve actually already seen an example of this in the above statement. By telling the medical students they’re ‘not employed’, you’ve indirectly told them they’re not part of the gang. This is gatekeeping, it’s absolutely fine to do, and it works. The key here is to make them feel really disempowered.

And finally, girlbossing. This is more of a state of mind, a way to conduct oneself whilst strutting through campus after a disciplinary meeting with a medical student about their attendance, or swooping in to place the perfect cannula where the juniors have failed. It’s more of a statement to the world, that they’re all shit, and you’re the fucking best.

5. Find inner peace

Now it’s time to go be that girlboss as described above. When delivering bad news to patients, don’t say it, slay it. Gaslight your students, juniors and subordinates - because you’re worth it.

Needless to say, all this advice is only to support you in not supporting the strike, not actively discouraging it. We must be subtle; we must ignore problems and not give our voices to these issues.

Never oppose things directly, just be really unhelpful by standing by quietly.

Next week I will be writing about the highly requested subject of ‘how to write intimidating negative and rude emails to your students’, focusing on a healthy mutual lack of respect which I feel needs catalysing.

Yours faithfully,

Dr M. Oron MRCS, PhD, MEd, IBS, ARLD

M. Gerard

2nd Year Medical student

Illustration by Zin Htut

The Fall of Bristol Bible - When “et al” Isn’t Enough

I found myself in my kitchen one evening, listening to my UWE flatmates complain about their lecturer grievances. It’s true, somehow, we thought that combining Medicine, Virology, Physics and Architecture in one house would be a good idea. Then, suddenly, out of nowhere my medic flatmate exclaimed: “WAIT, they took Bristol Bible down!”.

My heart skipped a beat, my throat tightened. I couldn’t quite believe it. I immediately took out my laptop and tried to access the website. A few pages remained at the time but have since been taken down. The crutch that 90% of 2nd years relied on was gone.

The chaos that ensued after I messaged ‘Juliet’s Medic Orchestra’ (if you’re not naming your massive year group WhatsApp something funny, you’re doing it wrong) could only be described as mass panic. We suddenly found ourselves back in the same deep end as 1st year. No more reading through summarised notes that made sense, were concise and specific to the exam ILOs; we instead had to return to the ancient art of learning to speak ‘lecturer’ alongside our demanding studies. It was the end of a glorious era of ease, and an uncomfortable return to making our own ankis and notes independently.

The 3rd year who founded Bristol Bible was ordered to close it down due to the university’s concerns of plagiarism and copyright. However, the content of the lectures themselves is taken from years of research and textbooks and is only cited at the beginning of some lectures. Therefore, one could argue that even the staff are not giving the information correct accreditation. Can one really copyright science? Bristol Bible never claimed that it was new information and referred to the university’s lectures consistently. The clue is in the name: “Bristol Bible”.

Another issue proposed was that the notes, questions and flashcards were on a public website, meaning any member of the public was free to access resources created through university

funding, which we pay fees for. However, while the university had this concern, the reality is that these notes are only relevant to fee-paying second year Bristol Medical students, therefore making this point redundant. The internet is otherwise saturated with non-specific medical school resources. The only people that come to mind are the like of prospective wannabe medical students who obsess over the med school Instagram aesthetic, got 3800 in the UCAT and spend their summer after A Levels “just preparing for university”; but even then, Bristol Bible is most likely flying under the radar. Even if public access is a problem, the university has spent thousands of pounds on Blackboard and Microsoft SharePoint. Bristol Bible could’ve been moved to these platforms, so that every pre-clinical student could benefit from it (once they learned to navigate the mess that Blackboard is, of course).

I asked medical students about what they thought: “That actually ruined my day. Bristol Bible was very concise and made sense, unlike some lecturers.”

“It’s a good resource. It’s someone’s own notes; are they not allowed to share them?”

The black market for notes and Anki flashcards continues to thrive around the country in many universities, but students at the University of Bristol are more cautious than ever after the Bristol Bible incident. Small friendship groups share flashcards, and if you’re lucky, you may be able to access the Kahoots and practice MCQs of other CBL groups. The question of how the university found out about Bristol Bible remains unanswered. Did a lecturer find it? Did a student rat someone out? Either way, we have all begun to accept that it is not to return. We can only hope that others are willing to share resources within each year group. My advice to 1st years is to find a 2nd year that you can rely on – it will SAVE you. And don’t forget to buy them drinks or food in gratitude.

(If you thought of the name for the 2nd year group chat, kudos to you, tell me who you are and I will buy you a drink at the end of the year.)

W. Kotynska 2nd Year Medical student

Should I chat to my GP, or can I chat GPT?

“Watch this TikTok,” my flatmate slid over her phone as we sat with our laptops propped open on the kitchen table. The protagonist of the skit responds to an interviewer’s cynical questioning with efficient answers. An applicant with supposedly little English skills buta job offer aboutto be secured.The gag line, we soon find out, is that the downward gaze of the interviewee is fixed on a phone with chat GPT open and running through answers. The TikTok ends as she stutters over pronunciation. Funny yes, but since then it is referenced all around me like a classic BaaderMeinhof phenomenon. My twitter feed is an endless cycle of commentary on chat GPT and particularly how this is being used in healthcare.

Chat GPT has recently been reported to have passed the US medical licensing exam (Granted, the questions do not feature application of ethics and empathy). The Radiology Society of North America Journal has recently published an article fully written by chat GPT with cautions added by a human author. Health professionals could learn from journal reviews published by artificial intelligence.

If I had to explain Chat GPT to you and its impact, where would I start? Though I would first question, how have you not encountered it already? The key process behind Chat GPT is the use of human-like language. There is no uncanny valley with its slick use of correct grammar and lack of overtly technical language. As I tried to feed prompts into the chat box, I realised quickly that I had met medical students prone to slot in more jargon in their speech than the AI did. So, AI is consistently accessible.

I have struggled to provide it a label, the many uses and functions defy that, which I suspect adds to the excitement and allure. It excels at producing drafts for you in different formats: article, email, or letter. But the problem solving is what has impressed me the most. Doctors and medical students, me included, have

attempted to pose it a question regarding patient management and assess how spot on the management is. I stress the word management, asthesequestionshaveadiagnosisplacedinthe prompt. “How would you manage a 55-yearold Caucasian woman with hypertension?” It provided a clear summary with the ease of a google search and no faffing about on NICE guidelines.

The #medproductivity influencers are alight with possibility. How can this make my life easier? I, the compassionate human, the AI, an extension of my brain. If it is not possible, just throw the whole doctor away. If Chat GPT can provide management and solutions whilst other health care professionals already have the caring aspect covered, what is your use?

The ease of a google search being the key phrase here, it becomes another efficient and succinct search summary, we still require the knowledge and research, (particularly evidence-based research) that guides the management algorithms we rely on in our learning and provision of healthcare. Our curriculum teaches us to value other very human factors that lead to changesand switches in management. The patient struggles with the side effects and wants to switch from sotalol to bisoprolol. Can an AI understand this and let it override the preferred management?

Illustration by Zin Htut

One image that occurs is that we are no longer competing and pushing for the extras expected without compensation from us in medicine such as publishing or performing audits. I can almost see that in the future we remove the competitive nature that permeates career progression. I am not pitted against my peer simply based on who is keener to plug in data into an excel sheet as this is a simple task done by AI!

Could it be that the brightest and the best are onto something when they employ artificial intelligence to tackle the mundane aspects like endless emails and academic writing?

Take the example of placement. You are on an anaesthetic block, and you are asked to write up a patient reflection.

A Bristol university medical student knows this is a task best accomplished after procrastination and a large chunk of time conveniently forgetting it was required at all. Bristol uni medics, particularly, are not accustomed to encounters with writing essays. Theoretically you could have a situation in which you employ Chat GPT in the McDonalds car park, a few hours before

Fighting Anti-Intellectualism: A defence of the MBChB

The UK is losing its Doctors, fast. With over 8000 medical vacancies in secondary care as of December 2022, this loss of staffing is one of the many straws cruelly tossed upon the camel’s back. At medical school, the idea of leaving is whispered, a taboo, the words “Australia’, and “Management consulting” murmured in hushed voices between trusted compatriots. However, this is the reality in which we live - a recent BMA survey suggesting 4 in 10 junior doctors plan to leave medicine as soon as they can find another job. The solution to this seems obvious, doesn’t it? Make medicine more appealing: pay us more, improve conditions, include some actual training in so-called specialist training, and fix the computers on the ward. Unfortunately, things that seem obvious to us, don’t quite appear to have occurred to those who make the decisions, their approach being to simply train

the end point review. The white letters pinging onto the phone screen with alarming speed, rattling off generic sentences. But we reach the issue with this quite quickly. The sentences are generic and at times, lacking a human’s natural flair that leaks into their writing.

No wonder anti AI tech is being both developed and used currently. Open AI (who are the creators of chat GPT) are watermarking the output. This means the words spewed, undiscernible to us, can be statistically predicted and will flag up when you start scanning for generated information.

Since writing this article, Chat GPT has since kicked me off and I am unable to log in. This seems to be a case of the server being completely inundated with users and traffic. A message even suggests that the service will start to offer a premium service. A paid service will be considered differently than a free, accessible service and so the assumptions written here could end up being simply that, an assumption.

D. Ilkhamovoca 3rd Year Medical student

more doctors and hope it all shakes out alright at the other end.

One of theseradical approaches was announced by HEE recently, who are piloting a Medical Doctor Apprenticeship scheme, involving a paid role in which local employers can recruit and ostensibly train those with appropriate qualifications, according to local workforce needs. These apprentices are able to ‘study flexibly alongside work, so they can put newly acquired knowledge and skills into practice immediately, for the positive benefit of service users and patients’ (Read: watch the geeky medics video on venesection and spend all afternoon taking blood from patients because the phlebotomist has Thursdays off - what could possibly go wrong!).

This notion that medicine can be learnt from practise alone speaks to a burgeoning wave of anti- intellectualism, a concept first actioned by totalitarian regimes of the 20th century, before bleeding into mainstream populist politics, a process catalysed by corporate mass media.

Anti- intellectualism describes a hostility and mistrust of intellectuals, and a dismissal of the study of art, literature, andimportantly, science, as impractical, unnecessary and frivolous. This is not to suggest that all Doctors are intellectuals, but that the theory and art of medicine as an intellectual pursuit needs to be protected.

Discussions around a similar tide of antiintellectualism within Nursing Education are highlighted in a 1976 article discussing paternalism and the role of the nurse (Ashley, 1976). In this piece, Ashley describes how medical administration used the natural caring attitudes of nursing students to not only economically benefit, but to morally subdue nurses via apprenticeship training models. These apprenticeships bolstered the idea that nurses do not need to be ‘educated’ but are instead trained in practise to be obedient and self -sacrificing. As medicine becomes increasingly more dominated by women, could this movement towards an apprenticeship model lead to the same economic and social pushback that nurses suffered?

Higher education institutions have a mandate to satisfy the labour market, which in UK healthcare is a sole entity, resulting in medical education serving the singular purpose of NHS service provision. The desire to fill as many roles as possible results in a ‘competency-based curriculum’ for job readiness, rather than forming the minds of learning studentssomething that is already creeping into medical education. Of course, competency in key clinical skills is paramount for patient safety, and most Medical Schools do their best to promote criticalthinking and analytical skills in students, but the new increased demands of the labour market may force universities hands towards more practical, and less cerebral methods of education.

This shift towards university education as a means of satisfying the labour market is seen not only in medicine, but with any degree now seen as a consumer item, that can be purchased with tuition fees and exchanged for access to well-paying jobs. Valerie Frunzaru (2018) made an important link between this sense of materialism and anti-intellectualism, suggesting that those with strong beliefs in materialism are likely to have a more negative

attitude towards their university education, stating that ‘It is as if knowledge for its own sake does not have an immediate practical utility in the labour market’. This distaste for the acquisition of knowledge is compounded by blended learning models, increased class sizes, and simplified assessments, with students choosing modules with minimal reading or written assignments required (Arum & Roska, 2011).

A potential psychological driving force behind these changes in attitudes is ‘The argument for an easy life’. Why would you put yourself through a classical education, challenging assessments, and long hours, when ultimately the day to dayexistence of a working individual is not improved by a deeper understanding of unrelatedsubjects?Whywouldyoutoilthrough 5 years of medicine, when you could instead be paid while learning? The answer to those questions is not simple, however, as university students we havebeenaffordedahugeprivilege - until very recently huge swathes of the population, especially women, would not have had access to the vast quantities of information and resources we now have, so to counter ‘the argument for an easy life’, embrace the joy and liberty of learning for learning’s sake. The proposed apprenticeship scheme seems appealing on a surface level, but at its root, it depends on the exploitation of people from underprivileged backgrounds, who will be paid substandard wages to work as untrained cover in underfunded and understaffed hospitals. If Britain needs more Doctors, it must train and retain them the old-fashioned way. Students from underrepresented backgrounds are slowly starting to make up more and more of the medical cohort, but more can be done. Rather than increasing student numbers for profit’s sake, recruit talented students from local schools, and provide solid financial support to those who need it, make the NHS bursary applicable to an even wider range of students, and make it truly liveable. And most important of all, nurture those student’s aptitude for science, exploration, and the pursuit of knowledge, making better Doctors for tomorrow.

Fawcett Hill 4th Year Medical Student

D.

Teaching empathy at medical school

Spending an afternoon playing a game of ‘yes, and’ and doing mirroring exercises was not how I envisioned teaching during my second year of medical school and was a stark contrast to the three weeks of placement in a district hospital I had just completed. Do you think you understand empathy? Do you cry at RSPCA adverts? Do you give up your seat on the bus for the elderly? Do you know when to nod and make sympathetic noises at the right time duringEC tutorials?Inrecentyearsmedical education has been pushed to teach empathy right from the start of medical education. Probably because it has been frequently proven that patients who feel empathy from their medical practitioners have better health outcomes and therefore it is considered a key skill of anyone wanting to work in healthcare. However, it some aspects we see a decline in empathy throughout medical school

The research

As a surprisingly little researched area, there have only been a few quantitative methods devised to measure empathy These studies looked at empathy score changes over a range of time periods, but what was shown to be most significant was that empathy scores of students sharply declined between the start and end of third year, where long term placements begin on the new UK integrated course. It also was made clear that medical students with higher scores on the empathy scoring system, and therefore were considered more empathetic displayed more clinical competence, leaving us with an alarming dilemma. Why does empathy decline?

There are many theories as to why empathy declines throughout medical school, despite growing efforts to devote teaching time (much coveted in a ruthlessly paced degree)

to it. The term ‘battered child syndrome’, usually in reference to victims of child abuse, has been used to describe medical graduates. Some argue that medical school does not treat students well; it dehumanises both the students as well as their patients and forces them to undergo a cynical transformation as the promise of an idealistic career and future disintegrates. This loss of faith in medicine and its practice is experienced by essentially every medical student, as they begin to realise the limitations of human intervention and the extent of institutional failures, notably in the NHS. This coupled with constant discouragement and disregard from doctors and supervisors in clinical settings such as placement leave students without good role models. An increase in apathy could also be linked to the encouragement of emotional detachment from patients, in the interest of clinical neutrality and preventing physician burnout.

Can empathy be taught at medical school?

Empathetic teaching at Bristol University begins from day 1, primarily in the form of effective consulting lectures, labs and placements but also highlighted when relevant alongside other clinical teaching. In addition to this, there are a range of oneoff specialist symposia, lectures and even creative projects developed to encourage empathetic consideration. These projects are centered around understanding patient perspectives and using various forms of art to put ourselves in the shoes of others.

On paper, this sounds great. A cohort of medical students who instead of being stressed out by details of the Krebs cycle, have been sent to paint and think about their feelings. Of course, for some students, this is a useful and reflective part of studying

medicine. However, some students can find it stressful and an unnecessary addition to an already heavy workload. I spoke to severalsecond-year medicalstudentswhich showed mixed opinions about how they were taught empathy. One student I spoke to thought that patient contact was the best way to teach empathy, stating that “GP and academy settings help us understand a patient’s background and see them as a whole person”. Many students deemed empathy-specific lectures to be ‘useless’. Two thirds of the survey responders said that the context in which empathetic teaching is delivered to them affects the extent to which they are able to engage with it, highlighting that perhaps there is an optimum time and place for teaching empathy, that perhaps is not yet being considered. As to whether or not empathy is something that can be taught, students appear not convinced. 90% of students responders claimed to understand empathy, but only 43% agreed that medical school had improved their understanding of empathy. “I’m not sure if genuine empathy can be taught.” says a second year medical student.

Should we try something different?

During my time on the theatre and empathy project, we spent three weeks discussing and analyzing various forms of artwork, including literature and theatre. We attended several talks and workshops exploring the use of theatrical teaching techniques in a medical setting, run by BLESMA, Osaka University Hospital, and theatrical professionals. We developed our own story telling techniques, and the project culminated in a short story telling performance. Many of the techniques and exercises we did in our workshops are commonly used in theatre groups as well as in social support groups, as an exercise that promotes bonding and healing

Although I was reluctant at first, the project grew on me and I feel I have come out of it with a revolutionized understanding of empathy. The other students who

participated in the project alongside me found the style of teaching refreshing and effective, agreeing it should be endorsed amongst all students. Two thirds of the medical students I surveyed agreed they wereopento tryingawork-shopbasedform of teaching, even if it required a new way of thinking.

Conclusion

The exact reason as to which empathy declines remains unclear and is likely multifactorial. One thing that becomes apparent, is that much of the research surrounding medical student empathy looks just at finding whether or not it is declining, as opposed to trying to find out why. Throughout the short period of time in which I was surveying my peers, it became clear that student perspectives on empathy and teaching are essentially never considered. I was surprised by the number of students who not only came forwards, but also wanted to be kept in the loop about this piece. Whether or not empathy does in fact decline, the way students, future doctors, interact and empathise with patients is largely influenced by the education they have received and the experiences they have gathered whilst at medical school. We cannot control individual variations based on personalities, nor can we control the changing climate of the NHS and working in a medical profession, but we can control what we teach our students. Perhaps, instead of focusing on quantitatively measuring student empathy as a marker of performance and response to teaching, we should redirect our attention to trying to give students the most appropriate resources possible. What remains clear from this is that students do appear to care about empathy, but it remains a struggle to have their voices heard.

A. Andrieu 2nd Year medical student

On junior doctors’ strikes: the perspective of a first-year medical student

As I’m writing this on a quiet Sunday evening, it occurs to me that tomorrow is the deadline for the junior doctors’ strike ballots to be received by the BMA. The outcome will determine whether or not their planned 72-hour walkout will go ahead in March. In order to be successful, over 50% of eligible BMA members must vote, and of those, the majority must be in favour. Not meeting these conditions would mean the strike action is not legal under UK law. The last time I remember discussing healthcare workers’ strikes was over a year ago, when I was preparing for my medical school interviews. We explored the ethics around striking where people’s lives are at risk. All strikes affect people’s lives to an extent – after all, that’s the whole point, right? People often don’t pay attention unless it affects them personally. However, there is a distinct difference in morality between striking as a train operator and striking as a junior doctor. One will make people late for work, and the other is withdrawing their labour from a system holding precious lives in its shaking hands.

Illustration by Zin Htut

Being a first-year medical student at this time is a little disheartening. I can only imagine how those about to graduate must feel. They’ve put in years of work, preparing to enter a profession with ever-decreasing morale. Doctors are leaving the NHS at an alarming rate, either to focus more on private work, due to better pay and working environments, or to leave medicine altogether – temporarily or permanently. Among the doctors currently working in the NHS, burnout levels are sky-high and willingness to remain in the system is rapidly declining. The disparity between the sacrifices made for the job and the respective pay and conditions is more evident than ever. I spoke to a clinical fellow who explained to me why she voted in favour of junior doctors’ strikes. In addition to the fact that junior doctors were excluded from NHS pay rises during the pandemic, the current inflation rate means that many young doctors are caught between a rock and a hard place financially. Add this onto four to six years of debt from medical school, and the situation that you find yourself in is dire. On top of this, the frequent relocation makes housing situations difficult and can prompt costly commutes to work. If they can drive instead, they are often charged for onsite parking during their 12h+ shifts.

A defining feature of junior doctors’ deteriorating working conditions is the staffing crisis. It has become the new normal to be understaffed on the hospital floor. Junior doctors often find themselves being the most senior member of staff responsible for a ward, and looking after far more patients than is manageable. The standard of care that we aspire to during training cannot be reached under these conditions, and the waiting times patients complain about will only increase. Many are pushed to their limits every shift, working more hours than they are meant to due to lack of staff to handover to. This results in more burnout, anxiety around coming into work and a greater

need for time off. The vicious cycle continues. It’s no wonder doctors are quitting for jobs that are both less stressful and better-paid.

A counterargument often made against doctors’ strike action is that working in medicine is a vocational profession, therefore they should not be seeking a pay rise. Given that junior doctors’ salaries have declined by 26.1% since 2008 (BMA), the term “pay restoration” is arguably more appropriate. A FY2 doctor told the BMA that remunerating all those hours and skills, without which people would’ve died, is essential. Junior doctors must be compensated for the ever-changing working hours, the constant moving around and the nights spent wide awake with overwhelm or worry. They must be shown that the years of training amount to something besides poor treatment and burnout. We need a greater incentive to keep doctors in the NHS; otherwise, we will keep losing them.

I must admit that when I began planning this article, I was undecided on whether or not I agreed with junior doctors striking, or if I’d strike myself in this situation. Even now that I’ve come down on one side, I could still argue very much for the contrary. I imagine that even those most adamantly voting to strike worry for the impact the withdrawal of their labour will have. The moral imperative of a doctor to provide care is not easily overridden. However, given the testimonies I have heard, it is with no hesitation that I say I support those striking. The government is not acknowledging how critical the work of junior doctors is, and they cannot continue to work in such straining conditions. They have asked for their needs to be met, and the government has refused. If a 72-hour walkout is what it takes to get those in power to listen, then so be it.

A. A. Ceccato de Sabata

Let them drink tea; a Fourth Year medical student’s perspective on the strike.

When we heard the news of the three-day junior doctors’ strike occurring in March, I must admit I was slightly overjoyed to have three days off to catch up with my Anki and visit my parents. However, I was also very keen to attend the picket line and show my support for the junior doctors.

As I was on placement at St. Michael’s in Obs and Gynae, I listened to a lot of women around me discuss the importance of the strikes. As a woman I am saddened by how our pay is consistently less than that of our male counterparts. Women who want to have children will inevitably spend longer training in medicine and therefore will remain in lowerpay gradesfor considerably longer than the men around them. I remember during my intercalation year, when university strikes occurred, I listened to a very impactful senior researcher in Public Health who explained to me why she was striking for young women to receive better contracts and pay.

However, my keen interest in showing my support was very rapidly curtailed when we received an email from the university stating that whilst we were not allowed in the hospital, we were also not allowed to join the picket. The only suggested involvement we could partake in was to “bring cups of tea to show our support” which seemed a very small amount of activism considering the junior doctors’ pay would be mine in less than two years. In any other job, if you were applying to a big firm and saw that their workers on all levels were striking, I expect one would becomeslightlywary aboutworking there. However, I know that once I graduate, in a year and a half - eeek! - that I will be working for the NHS and so it seems strange to be completely excluded from any say in our future. I want to support the individuals taking this decision in a way that exceeds providing a hot drink. Medical school itself is extremely financially draining. Most of my nonmedical university friends have graduated and have started earning. This is my fifth year of university; still living partially off my parents is becoming old. As well as

Illustrations made with AI by Habib Ullah

financial impacts, I have heard horror stories from recent graduates about conditions. One example is from an F1 working a nightshift; the hospital was so understaffed that they were unable to get to a patient suffering a heart attack resulting in the patient’s death.

It is clear that I support the strikes. I want better pay and conditions for doctors in the same way I want better pay for nurses and rail workers. However, I think it’s important to acknowledge that doctors are at the top of the medical sector, and they receive much more financial compensation for their work than most other areas. There is a small part of me that

feels the 35% increase is so utterly unachievable and, in a time where child poverty is on the rise and many people cannot feed their families, it seems strange that doctors would be at the front of the queue. I don’t come from a medical or scientific background and to me doctors have always represented a very middleclass group of individuals who most likely will eventually be in the top 20% of earners in the UK. That is not to say they do not deserve the pay but if it really came down to it perhaps nurses, HCAs and care workers should be first.

M. van der Heiden 4th Year Medical Student

IUD insertion: how can a clinician make it as minimally painful as possible?

The coil, also known as intrauterine device (IUD) or intrauterine system (IUS), is arguably the best contraceptive. More effective than the pill, more convenient and longerlasting than any alternative, the coil is vastly underutilised. Indeed, figures obtained by the Guardian show only 4.4% of women using contraception in England opt for the coil, in contrast to 28% who use the pill or mini-pill exclusively. So, why is this?

For many, it comes down to the common perception that IUD insertion is excruciatingly painful. Some describe it as ‘The most pain I’ve ever experienced’; and a few unlucky patients can even vomit or faint from the pain. It appears that nulliparous women (who have not given birth) are more likely to experience pain during the procedure. Other risk factors include a history of painful periods, greater anxiety and anticipated pain, and previous experience of painful gynaecological or obstetric procedures.

A 2005 study done in a Sexual Health Clinic in Liverpool looked at the experience of pain during IUD insertion. Out of the 113 women that took part, most described it as being similar to period pain, with around 30% describing more severe pain (see table). One woman could not endure this, and had the IUD removed 10 minutes after the procedure. The study concluded that, whilst IUDs have high long-term satisfaction rates, the widespread pain rates suggest a larger study looking at the effectiveness of local anaesthetic would be useful.

This leaves us with the question – if we were aware in 2005 that patients can experience significant levels of pain during IUD insertion, why haven’t we made greater strides in improving this?

Currently, women are not encouraged to explore their pain management options before the procedure. According to the NHS website, local anaesthetic is available on request, but it is not routinely offered. Further advice includes taking ibuprofen at least 30 minutes before the procedure, yet studies show no significant change when compared to a placebo.

Research done by the Margaret Pyke Centre (a sexual health service in London) showed that among more than 200 GPs and family planning clinics, less than a third use local injectable anaesthesia for the procedure. Many reasons were given, including that there ‘no time’ and the ‘pain doesn’t last long’. The centre then proposed that injectable local anaesthesia should be the default position for IUD fittings, favouring an ‘opt out’ system rather than the ‘opt in’ we have at present, which relies heavily on patients advocating for themselves.

Dr Roberto Leon, an OBGYN practicing in the US, proposed that pain occurs at three levels:

1. Central nervous system – due to anticipatory anxiety and fear of pain.

2. Cervical level – clamping the cervix with a tenaculum and dilating it during the passage of the IUD inserter.

3. Uterine level – mild to intense cramping once the horizontal arms of opened in the fundus.

Dr Leon then acted at all three levels to try and reduce pain and the observed difference was remarkable. To ease anxiety, he explained the procedure in detail to the patient, as well as sending them a PowerPoint they could then read at home. For his patients, this – together with ample analgesia, including prophylactic naproxen or ibuprofen, and a paracervical block

made a world of difference. Although ambitious for the UK given the time pressure on GP appointments, a detailed guide to the procedure that can be emailed or texted in advance could therefore be useful.

In an age where we have the resources and the ability to take away pain, we choose not to, furthering the constant disregard for women’s pain reflected throughout history, particularly that of non-white women. We as clinicians need to raise awareness and question spaces in medicine that are not achieving optimal pain management for women. We need to make this an open conversation with patients. In a time when information spreads incredibly quickly via social media, it is vital to avoid downplaying the pain experienced during the procedure to avoid misleading patients.

The most effective way of tackling the perceptions of the IUD insertion procedure? Tackle the pain itself and offer injectable local anaesthetic as the norm and not the exception.

Written by P. Barry 3rd Year Medical Student

How Being An Astronaut Affects Your Body

AsourlovelyEugenetaughtusinfirstyearrespiratory,humanscannotsurviveinextremeenvironments without adaptation. Much like a coastal dweller attempting to summit Everest only to experience fatigue, dizziness and nausea as a result of increasing hypoxia and hypocapnia; you can’t just make a day trip to space.

That huge, beautiful expanse above our heads is a hostile environment. Once an astronaut arrives on the ISS the first symptom of microgravity is space adaptation sickness - likened to the nausea felt on long car rides or boat trips. This is caused by the action of microgravity on our vestibular system. The vestibular apparatus, along with the cochlear and labyrinth, work to coordinate balance and spatial orientation. However, remove that constant of gravity and suddenly the vestibular system doesn’tknow what to do with itself. In most cases, these symptoms of motion sickness will last for 2-4 days before our inner ear has acclimatised.

The next symptom of living in space is a change in the fluid balance around the body. On our home planet we spend most of the day with our venous blood pooling in the legs. Any changes to this normal distribution of fluid sees issues regulating the dynamic homeostasis of our tissues and cells. For example, peripheral oedema is a sign of the heart’s insufficiency to pump blood around the systemic circulation. The fluid imbalance caused by weightlessness causes an increase in fluid retention in the face and chest, leaving you looking not dissimilar to the passengers on starship axiom in the legendary film WALL-E. If that wasn’t enough, the fluid that is now floating around our bodies has now found its way up to the head. Increased pressure on the eyes causes swelling of the optic nerve and visual problems, with some astronauts reporting blurry vision. All these issues pertaining to regulation of fluid balance can leave astronauts dehydrated and increasingly susceptible to kidney stones.

The action of microgravity on our cardiovascular system also means our heart doesn’t have to work as hard to pump blood around systemic circulation. This leads to reduced aerobic capacity and atrophy of the heart muscle as it learns to adapt to its new environment- so no, living in space won’t get you two hearts like the time-lords of Gallifrey. Similarly to this, the reduced need to fight against gravity causes atrophy of skeletal muscle and a loss of bone density of 1% per month. This predisposes our space venturers to osteoporosis and fractures. Our immune system also won’t be too pleased about being in microgravity either. Immune cells seem to be abnormally sensitive to microgravity and hence it has been reported that the immune system is one of the most severely affected systems during spaceflight. There will be an increased incidence of lymphoid dysplasia, reduced proliferation and activation of lymphocytes, inhibition of the phagocytic and oxidative properties of neutrophils and problems with the expression of cell surface molecules - and that’s just the tip of the iceberg.

Another impact of space that simply cannot be ignored is the impact of solar radiation. Our atmosphere protects us from the harmful rays emitted by the sun through fusion reactions. But leave that atmosphere,andsuddenlyyou’velostthatprotection.Weallexperiencelowradiationdosesineveryday life- whether it’s from aeroplanes, X-rays or bananas. However, the doses astronauts receive onboard the ISS are much more significant. Galactic cosmic rays are especially difficult to shield against and increase the risk of cancers and degenerative diseases such as cataracts and heart disease. If it weren’t for all the physical effects, space can wreck your mind too. Many astronauts, despite being specially selected, struggle with the isolation and confinement that comes from orbiting 408 km above the earth. Many people suffer from loneliness- which can in turn trigger low mood- but the difficulties an astronaut faces when they have left their loved ones on another planet is unparalleled. In addition to this, the alternating light and dark cycles, noise, stress and confined environment impacts our circadian rhythms. This can disrupt your sleep cycle and leave you more prone to fatigue.

Despite the above, the effects of space on the body aren’t all bad. For all the oompa-loompas out there, a stint in space might actually be something you’re considering for its height increasing properties. Astronaut Scott Kelley returned from almost a year in space in 2016 to find he was 2

inches taller than when he left. A constant battle against gravity just to stand up means that over our lifetimes we will shrink as the intervertebral discs retain less water and become more compressed. Living in microgravity had reduced the compression on Kelley’s spine and allowed his height to increase.

If the human race wishes to expand its horizons, to explore and colonise those great mysterious depths of space, it must adapt. If the people of the Himalayas can adapt their cardiovascular and respiratory systems to allow them to live where the air is much thinner, then is it so unreasonable that we could adapt to space? Yet despite these adaptations, due to the modernisation of our species, human evolution has grinded to a halt. With the technology we have, the only way to survive the harsh environment of space for extended periods of time is to accelerate human evolution.

With current gene editing technologies, there are possibilities to combat the ill effects of solar radiation on the human body. Melanized radiotrophic fungal species- such as cryptococcus neoformans- have beenfound to utilise harmful radiation in aprocess ofradiosynthesis, which actually accelerates growth. In other words they can convert radiation into chemical energy. While this sounds sci-fi, we do have technology such as CRISPR-Cas9 with the potential to edit human DNA- adding in that property of the radiotrophic fungito protectus againstthe possible complications of long term radiation exposure. That being said, we are unlikely to see space-mutant-humans in our lifetime, but it’s nice to know the possibility is there.

Our planet is huge, yet tiny in comparison to the hugeness of space. As humans we are always curious to explore more, so must be adapted to do so. In the words of the 10th doctor, from the day we arrive on the planet, and, blinking, step into the sun -there’s more to see than can ever be seen, more to do than can ever be done… wait no that’s the lion king.

C.Wood

A Quick Medical Student Guide to Modern Slavery

The Global Slavery Index estimates that there are up to 136,000 people living in slavery in the UK. This equates to a prevalence of 2 per 1000 people in the general population. Which, for reference, is the same as Parkinson’s disease. While many medical students have probably made their own flashcards about Parkinson’s disease, most probably won’t have even seen an MCQ (multiple choice question) related to modern slavery. In all likelihood, it probably isn’t even mentioned in their medical school’s curriculum.

Modern slavery is a crime that exploits people for personal or commercial gain. It can affect adults and children from the UK and around the world and can include: forced labour, sexual exploitation, domestic servitude, criminal exploitation and organ harvesting. Victims of modern slavery are often made to do difficult and high-risk work. While exploited people are often hidden by those exploiting them, the nature of the work they are made to do means that they often need to access healthcare. This gives healthcare professionals (including medical students) a unique chance to spot people who may be being exploited. Victims may not wish to disclose or talk about their experiences and it can take time for a person to feel safe enough to open up. But, “you have time to talk to patients while you’re a medical student” is something I have heard said more than once.

Modern slavery is a major health and public health issue and can have a massive impact on peoples’ physical and mental health. While victims of modern slavery can have any presenting complaint, here are some of the signs that you can look out for:

Timid/terrified/tense

Registration. Lack of registration with a GP/nursey/school

Accompanied by a controlling person

Fatigued/exhausted

Frequently moving location/no fixed address

Inconsistent history

Control. No control of passport/bank account

Kept isolated from support

Evidence of injuries left untreated

Does not attend appointments

This list is not exhaustive but may help to act as some red flag signs of modern slavery. It is likely that it would be a combination of these signs that may lead you to suspect something. But if you feel that something is not quite right then you should raise your concern with a senior or supervisor. Chances are they may have missed modern slavery off of their list of differential diagnoses. Direct confrontation is not advised, especially if the suspected victim has someone accompanying them. However, be vigilant next time you’re shadowing a ward round or sitting in on a clinic, and report any suspicions. Modern slavery is a safeguarding issue and a medical student would not be expected to know the ins and outs of what will happen next, but by talking to a colleague and expressing your concern you could save someone from modern slavery.

The modern slavery helpline is available 24 hours a day on 08000 121 700 and can be used to report something you have seen or are concerned about and can give advice on exploitation and modern slavery. If you want to find out more about modern slavery and human trafficking, VITA Network is an organization that aims to advance the health response to modern slavery who have a range of educational resources and blogs related to slaver and health

J.Lin, 4th Year Medical Student

Keep it in your pants – CLIC 2023

CLIC 2023 was the 30th Anniversary of the CLICENDALES event & our theme this year was ‘the only way is CLIC’ displaying a whole range of different reality tv themed dances! This year was the biggest CLIC ever with 17 dances including a choreographer dance! The dances included First Dates, Take me out, Great British Bake Off, Gran(nny)d Designs, Below Deck, Love Island, Married at First Sight, Airline, Cheer, Real Housewives, The Apprentice, SAS, Hell’s Kitchen, Eurovision, Strictly Come Dancing & finally the 5th years dance ‘I’m a medic, get me out of here!’ From 2002-22 CLIC has raised over £337,849 for young lives vs cancer, which could pay for a room in one of the charity’s ‘Homes from Home’ for 24 years and 3 months! We unfortunately don’t have fundraising totals prior to 2002 but this means the total is even higher over the last 30 years!

Everyone has worked super hard this year including all our amazing choreographers, dancers & committee members - as directors we couldn’t be more proud. Of course, we can’t forget to mention the amazing Maddy Lucy Dann who did an incredible job presenting the show, we were so lucky to have her involved. The 4 directors of the show were: Cerys Mack, Georgia Hall, Liam Carty-Howe & Tilly Gardener We were lucky enough to be joined by Pitch Fight, Eleen Inyat, The Lily Petals & our drag act Eva More as our wonderful support acts. The night culminated with a banging DJ set from X-fuse, our very own Bristol boys.

The only thing more sexy than the performances this year was the total amount raised. We’re proud to announce that the total is over £66,000, bringing it to our highest annual revenue so far! Every single slut drop brought us that much closer to our goal. Good news for all those feeling inspired after this spicy performance, CLIC will be back next year, with auditions beginning this winter. Keep an eye out on the bulletin!

To finish, here are some words from those involved:

“It’s just been so good for meeting and befriending medics in other years, I never would have otherwise”

“Highlight of my year”

“If you would have told 16 year old me I’d be stripping in front of more than 2 people with the lights on I wouldn’t have believed you!”

“Insane for body confidence”

“Very welcoming group of people and great atmosphere.”

“Great socials and a light-hearted relief from medicine.”

Ye Olde Black Bag

To celebrate 30 years of CLIC, I thought I’d put up some of my favourite CLIC photos from our archives. Agreatbigthankstoallthoseinvolved,clothedornot, we are all lucky to be able to come together in such a waytoraise moneyfor cancersupport.Icanonlyhope that we continue to touch the lives of those going through the most difficult parts of life.