Nottingham Medical Students’ Journal - New Beginnings by mzyimw

NMSJ Nottingham Medical Studentsâ&#x20AC;&#x2122; Journal

New Beginnings

Cover Image: Issy Walker

Within this issue: New Beginnings Freshers Interview Our Unique First Year Doctors’ Orders Advice to our First Year Selves Lockdown leavers – Raisa’s experience An Unconventional A Level Summer Surviving your first year

5 6 11 13 14 17 20 22

Societies On being a UoN First Responder Starting a new society Derby Anatomical Art Society

23 24 27 30

Advice and Wellbeing Tips for Research Publication Have you washed your hands? Meditation Reflections on Dealing with People Studying at Home Mind the Gap

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Stories and Views The problem with Evidence Based Medicine I want to do medicine to help others. Being an Interim FY1 during COVID-19 The Perfect Medical Student DA Diary Last Day of CP2 A World Turned Upside Down Can you run a YouTube channel when studying at med school? Controlling COVID-19

52 53 58 62 64 66 68 71 78 81

Creatives

With contributions from: Ahsab Chowdhury Alisha Gupta Alison Hird Ananya Bhardwaj Anjali Mehta Arthur Joustra Catherine Bent Catherine Himsworth Ellie Reid Emma Midgley Erica Colwill Haya Rahman Ibrahim Mutlib India Capper Issy Walker James Bluck James Conlan Jasmine Plummer

Jaya Patel Karis Harbertson Karen Moran Krish Shah Laura Owler Michael Starkie Natasha Harris Pradipta Debnath Prashamsa Manchiraju Raisa Jaffer Ria Bhandari Rushan Vellani Simon Matthews Talia Patel Tanvi Mungale Tom Le Tissier Yasmin King

Editors’ Note

September 2020

Issy Walker This second issue of this journal was never meant to exist. The first issue was planned to be a one-off, a lockdown project which we didn’t expect many people to want to contribute to or read, but we were proved wrong. The minute the first issue was published, we had people emailing to ask if they could contribute to ‘the second issue’, which was odd seeing as we had never suggested that. So, we went with it. At time of writing, “The Corona Cohort” has had over 4000 views, which was completely unexpected. So, in this second issue, “New Beginnings”, the name has a dual meaning. First, it’s the start of a new term and new cohorts of medical students are arriving into the A108, A100 and GEM medicine courses. The featured articles in this publication reflect this idea of a new start at uni, and give some reflections and advice to those starting, as well as some stories from our current Y1’s. The second meaning, however, is that it’s a new beginning for a new society at Nottingham – our plan is to try and get SU afflicted and build up a team to keep termly editions of this publication going, to give an insight into a life of a medical student outside lectures, as so much more goes on behind the scenes than people expect. In order to do this, we will be needing to recruit a larger team to help us edit, proof and publish the journal, as, although it was possible for 2 of us to do during the lockdown when there really wasn’t that much else to do, it’s a bit harder when we are back in lectures and on placement – it takes longer than you might think!

The process of getting a single article to be published is lengthy – first we need to contact people to actually write something. They then need to think of an idea to write about, and find the time to do so. Before submitting to us, they send a ‘consent/ permissions’ document for any names mentioned or people pictured within the article, and confirming they are not mentioning anything they shouldn’t be – like explicitly mentioning interview questions, OSCE questions, opinions that could be seen as offensive, the list goes on (and on and on). Then, the article is proofed twice more. And then, finally, it’s edited into the publication itself (i.e. we battle with Powerpoint to let us do the format we want, easier said than done). Repeat that 20 times over. So, we will be imminently setting up a ‘committee’ of sorts to be able to keep producing this content. If interested, keep an eye out for announcements in the near future! I hope you enjoy reading through this and the work the cohorts across the medical school have taken the time to produce. 4

New Beginnings Starting medical school, and advice and the experiences of older years from their own first year Freshers Interview Our Unique First Year Doctors’ Orders Advice to our First Year Selves Lockdown leavers – Raisa’s experience An Unconventional A Level Summer Surviving your first year

Fresher interrogation interview Ria Bhandari and Prashamsa Manchiraj, A100 Y1 I had the idea of getting freshers involved in this journal early (they haven’t even started medical school yet..!) as I wanted them to be involved in at least something which hadn’t had its running changed since COVID… as this journal was set up during the COVID period, we don’t know any different! Ria and Prashamsa got in contact, and I sprung 8 questions upon them: I very much enjoyed reading through their responses and hope you will too - Issy

Where are you from and how old are you? Why Nottingham? Ria: Born & raised in the ‘Land of Luxury’, Dubai, my name is Ria Bhandari. I’m 17 years old & Indian at heart! When I visited Nottingham, the heartwarming nature of the people & their affable demeanour really charmed me. The fact that the university offered a dual degree in a period of 5 years, along with its reputation for research, its state-of-the-art facilities & opportunities for full body dissection made me want to choose Nottingham. The diverse range of teaching methods that suit different learners & the placement opportunities are also what led me to choosing Nottingham. On a lighter note, who wouldn’t want to study at what is a historically rich city, built on caves & home to the renowned legend Robin Hood! Prashamsa: I’m from London and I’m 18 years old. When we, as kids, used to hear about the then far away prospect of university, we envisioned the sprawling lawns and massive buildings that we were constantly shown in entertainment media, when in reality most find that such a thing exists only to entertain on screen and not educate real time students. Well, Nottingham proved them wrong. With one of the most beautiful campuses I have ever seen, an unrivalled course structure and a myriad of societies and support for students, I was immediately drawn to it!

What are you most looking forward to learning about and why? Ria: I’m not sure if it’s too early, but I’m really looking forward to the practical aspects of the course along with the full body dissection. I think interacting with patients and learning how to perform procedures are things I’ve always wanted to do. I believe I’ll enjoy anatomy, cardiovascular medicine and I also can’t wait to begin case based learning sessions. Prashamsa: For me I think I’m most excited about the dissections and anatomy lectures as well as well as the integrated medicine module. I would hopefully be able to aggregate my knowledge of different areas of the course and apply it to a scenario, thereby challenging myself to broaden my thinking and make links between the various different modules.

Thoughts on full body dissection? Ria: I’ve been intrigued by surgery ever since I was a middle schooler & I reckon full body dissection is the closest I could get to really exploring the insides of the human body, at this point. It’s really matter of experiences, skills and finesse that develops when you have to perfect your dissection skills and it’s your responsibility to best learn the relevant anatomy. It also brings you really close to reality when you see the structures of the human body on a cadaver. I love that at the end of the year, there’s a respectful cremation ceremony which allows that you develop a bond of respect with your cadaver throughout the year just as you ideally should with your patients. Prashamsa: When I was researching medical schools, I must admit, full body dissection played a huge role in my choices. The prospect of learning anatomy of the whole body through practical means is something that’s very appealing to me as I learn best by applying theory into practice.

What do you think life will be like when you are due to graduate in 2025? Ria: An interesting question that’s always asked during interviews is “Where do you see yourself in 5 years?” Or “How do you think the industry would be in a span of 5 years?”. However, I believe at this time, it’s so uncertain to even determine how the next 5 months would play out & that’s exactly how I believe the world would be 5 years from now. It would still be in a state of uncertainty. I hope and envision that we would be able to ease the pressures off the healthcare systems of the world & administer at least the most Vulnerable parts of the population with a COVID-19 vaccination. Aside from the pandemic, equal healthcare opportunities is also an important problem that the world must fight in the course of the next 5 years, to avoid a chaos if we are ever faced with another pandemic. By 2025, we might see a change in the trend of economy and it’s really two ways that the world can go - People may grow more resilient, tolerant and compassionate, knowing the value of life - post pandemic, or in a bid to bounce back, we may create bigger problems for ourselves environmentally & diplomatically. Prashamsa: If the last few months have taught me anything, it’s that life rarely does what you want it do. However it’s also taught me to adapt and advance if things did go askew. As for 2025, I don’t what would happen in terms of COVID-19, climate change or the political climate but I would love to see changes to the above that would better society. As for the medical profession, we’ll no doubt see advancements in key research areas and medical equipment. I am really excited to be able to graduate in such an environment and hopefully make a difference in the lives of patients.

“I’d say that starting medical school is a very unique experience in itself, but to do so in a year that has been different from any other seen before is even more unique, so I’m very excited to see what comes next.”

Any idea of what sort of doctor you want to be? Ria: Because I absolutely love challenges, as a young student, I searched up the toughest speciality one can get into & decided Cardiovascular Surgery it is. However, as I’ve grown now, I’m also leaning towards Trauma / Emergency Medicine & Intensive Care. I really enjoy a fastpaced environment, where even seconds matter & Id like to specialise in such a specialty that works round the clock! (I know this is something a lot of people don’t want) I really wonder if I’m the only one, but having gone into internships, I’m more sure of the specialties I would not want to go into than the ones I’d want to consider. Can’t wait to look back and see if this opinion changes! Prashamsa: I’ve always thought of medical school as a big tree, with wide reaching branches in many directions. What drew me towards medicine was it’s versatility, the chance to learn a wide assortment of things and enrich my knowledge of various specialities. As a result, I don’t think I’m drawn to any one speciality over another just yet, but I am excited to find out!

Are you worried about anything in particular? Ria: I’m an international student, so yes, I do have a plethora of things I’m thinking about. I’m not really worried about anything in specific, because I’m sure I’ll be able to make friends & pull through. However, I do have the very natural thoughts that anyone would have relocating for the first time in years & settling into a whole new culture and organization. Prashamsa: As a rule of thumb starting in any new place or environment (especially one so fraught with uncertainty regarding COVID-19) will evoke a slight sense of apprehension and I definitely am not exempt from this. However I’m sure it’ll wear off as the year begins and things start to familiarise.

What is your aim for your first year of University? Ria: I’ve heard that the first year of university, especially Medicine, is one where you can relax to a certain extent. However, I’m hoping that I can stay at the top of my modules regardless because it sets the tone for the rest of the degree. I’m also looking forward to getting involved in societies, both sports and volunteering & hopefully creating a great group of friends! Prashamsa: I want to really push myself out of my comfort zone. Be it challenging myself in terms of academics or getting involved in new societies that I haven’t before. They say that every person you meet knows something you don’t and I’m so excited to meet and make lots of new friends from many different places, with many different ideologies. In short, the aim isn’t to reinvent myself completely but instead to reinvent - and expand - my horizons.

Our Unique First Year Tanvi Mungale, A100 Y2 My first year was quite atypical with it being cut in half, but I really enjoyed it nonetheless! It started off with the classic first year week – freshers, and then following it was freshers’ flu and before I knew it we were stuck into our first semester of medical school. This all ran quite smoothly, getting past the bucketload biochemistry in MED 1 and then the even larger boatload of anatomy in MED 2, until that was cut short by COVID-19 come early March where we were all unexpectedly thrown out of university into lockdown – and so here are my experiences!

How it made me feel The first thing that kicked in for me was the demotivation. Having left university with a few weeks of learning left in the second semester, we still had quite a few lectures to get through. The university uploaded recordings of these lectures so I wasn’t left to completely bewilder myself, and I started to work my way through them one at a time. Sitting at home in your room as opposed to a large, packed, busy lecture hall full of your friends and other medics was quite a difference, and as the list of lectures to do got shorter, my demotivation grew. I felt a little as though I was working for only for the exam, not necessarily to study medicine. Through a mix of FaceTime to university friends and regular breaks, I was able to get through revision and the exam and into second year, but one thing is for sure – I will never take in person lectures for granted (when they start again that is).

Online anatomy In addition to lectures being online, we also had dissection sessions online. This consisted of using the anatomy textbook and atlas and the videos of prosections the university had provided. Whilst this was indeed the second best option the dissecting room itself, it did involve a lot of independent learning (and Googling). On the topic of independent learning, that has kind of been the learning lesson this lockdown whilst at online university. Especially with the exam being online, I felt as if there was a certain leeway with how much I needed to memorise. But learning the anatomy, the content of the lectures and the clinical skills actually goes way beyond the exam at all, so pushing myself to complete the syllabus and learn it for everyone’s best interests has been a really important learning curve this lockdown.

Looking forwards As I am writing this article sitting in my house for second year, with my friends moving in downstairs, I’m realising how much I’ve missed university, and how much I’ve missed Nottingham. I’ve missed seeing everyone, I’ve missed the trams and many colours of buses I will never understand, I’ve missed the monstrosity of a building we call QMC, and I really wish I did get to complete first year (even the exams). I wish I got to celebrate the end of exams, and say goodbye for the summer properly. Hopefully this year will make up for the last for everyone.

Doctors’ Orders Dr Erica Colwilll, Dr Laura Owler and Dr Michael Starkie We asked some Nottingham graduates for their top advice for incoming students, be it UG or GEM, and their advice stands true for people of all years. They’ve been it all, and know what they’re talking about! Laura and Erica are FY1s (2020 graduates) Michael is a FY2 (2019 graduate)

Laura: Perfectionism and comparison will be your biggest downfall. Medicine needs more individuals who know what they want and will fight for the little guy. We are a caring profession not an academic profession. We need to care for ourselves first but in our own way at our own pace. It's OK to "fail" and it's OK to take your time.

Erica: My advice is to enjoy every opportunity that comes your way as a medical student. Most doctors are more than happy to teach you about things, and no question is a silly question... we are all still learning. Look forward to placements, and attend everything if you can! Being in the clinical environment really sets you up for foundation programme.

Michael: Everyone starting in medicine should know that they have already come so far! From here on embrace the new experiences and learning opportunities. My advice is that this is going to be a marathon not a sprint. Ensure you look after yourself and peers and enjoy the ‘normal’ uni experience as it has so much to offer. If in doubt ask for help, all doctors are always willing to go the extra steps for students.

st 1

Advice to our year selves Anjali Mehta and Ananya Bhardwaj, A100 Y3 Ananya If I could travel back to the day I first started med school, an eager 18-year-old walking down the spiral staircase leading to LT1, the one thing I would say to myself is “Stop comparing yourself to others”. Now, I know this is often easier said than done; however, it would have saved me a lot of time. Being surrounded by high achieving, seemingly perfect students, it’s difficult not to feel insecure. It is imperative to remember that getting into medical school is an extraordinary achievement. You need to trust in your abilities that have brought you this far and continue to build your skills throughout your career.

Ananya, Anjali, Alisha and a friend at INSPIRE medical conference

Every student has different study methods, interests, and hobbies. I remember trying to follow what my friends were doing to get the same results. Just because someone can memorise a whole textbook doesn’t mean you should. I wish I focused more on figuring out what works best for me before I tried to imitate others. It’s a learning process, and even now, in the third year, I’m still adjusting. However, this time I am looking at myself and my journey, finding out more about myself along the way.

Anjali As I embarked upon my journey through medical school, many people around me said things like ‘University is the best time of your life’ or even ‘I’m sure you’ll love every second of it’! With this idea of other-worldly life waiting ahead of me, coupled with complete freedom and independence, my expectations were already set so high. I soon realised that in reality, the transition is a lot more challenging than I anticipated. Living away from my family was hard: I missed the daily hugs from my parents and even (dare I say it!) the silly arguments with my sister over who has to empty the dishwasher that day! With regards to making new friends, I absolutely loved my friends from home, and was searching for the same friendship within the new people I was meeting at University. In retrospect, I now understand that forming friendships is a process that takes time and energy, and that you have something to learn from every person you meet. University is a period of big changes; and yes, it can be very exciting but it can also sometimes get tough and lonely. Don’t get me wrong, I’ve really enjoyed my experience at University so far and have met some of the most wonderful people here. However, I feel that it is important to address that not every aspect of this ‘new life’ is always as ideal or as ‘perfect’ as it is often shown to be. When everyone around you seems to be having the best time, it is so easy to feel overwhelmed and put even more pressure upon yourself in the attempt to ‘fit in’. The truth is, everyone is on their own journey- with their unique ups and downs, and beautiful in their own rights- so you are never alone in this. If I were able to go back in time, and give advice to my younger self, this is what I would say: “It is okay to not always know what you are doing. It is okay to make mistakes. It is okay to ask for help.” There are plenty of people here to support you and who want the absolute best for you, so please, if you are ever struggling, do not hesitate to reach out.

Taken (with permission) from DMA and NMLS’s ‘How to Survive Medical School’ booklet

Alisha Make the most of your first year to find out about the different specialties and career paths that are available. There are lots of societies who put on talks and events where professionals come and talk about their work and you have the opportunity to ask questions. Through such events, I have learnt about various training pathways and have had the opportunity to take part in shadowing days and gain hands on experience. Specialties like academic medicine and sports and exercise medicine were new to me in first year and now they are both pathways which I am seriously considering. I would say keep an open mind and volunteer yourself to new things as this is the best way to learn and develop as a person and future doctor!

Lockdown Leavers – Raisa’s experience Raisa Jaffer, A100 Y1 Wednesday 18th March. A pretty unremarkable day in the normal school calendar, for Year 11s and 13s it is the time for final polishing as study leave and exams loom ever closer. 18th March 2020 however was a day that turned school careers upside down and was the day as a Year 13 student that I found out my school was to close imminently and my A-level examinations were to be cancelled. It seemed a lifetime away from 2 days prior when the Head had encouraged us that it was ‘business as usual’ even though the evolving situation in Europe told us the exact opposite. The rumours flying around during lessons regarding when and whether schools would close as though there was snow forecast, were all answered in that eagerly awaited 5pm announcement by the Prime Minister. The onslaught of emotion began straight away together with the most activity on our year WhatsApp group we had seen that year. I must admit excitement and relief were the first emotions I experienced. No revision needed, no exams – it seemed like the best bargain ever!! As a stressed Year 13 student trying to juggle A-levels, applications, and extra-curricular commitments, it seemed what we would have wished away in a heartbeat had actually come true.

“We think now that we must apply downward pressure, further downward pressure on that upward curve by closing the schools. So I can announce today, and Gavin Williamson is making a statement now in the House of Commons, that after schools shut their gates from Friday afternoon, they will remain closed for most pupils – for the vast majority of pupils- until further notice.” - Boris Johnson, 18/03/2020 5pm Coronavirus Briefing

Slowly the relief turned to worry as it dawned on me that I would still need my grades to go to medical school and I wondered if I had jumped the gun and I really would still need to sit the exams at some point. Theories flew around on our WhatsApp group about how we would get our grades and whether the government really could stop an entire cohort from progressing to higher education. The nervous energy continued through the evening and the random realisations that the exams really were – cancelled. Everything we had worked for over the two years was to culminate in the strangest possible way. What had the world come to?! The impromptu assembly with our Head the following morning, felt nothing short of apocalyptic. The shock and surprise on teachers and students faces’ and utter sense of disbelief filled the room as it was reiterated that the school was to close the next day and May/June exams were cancelled. The revolving conversations and what felt like a day of frees ensued, knowing that the next day was our last ever day at secondary school. The evening was spent organising our ‘prom’ which was to take place in the school hall as our actual prom would have to be cancelled. Friday 20th March was supposed to be the day of my second biology mock but that was quickly forgotten as we all seized the opportunity to make the most of our last ever day at school. Pizza, a photo wall, mood lighting and History by One Direction on repeat- our school hall was unrecognisable as we held back the tears of sadness and confusion and said our goodbyes. It was for a lot of people the last time we were going to see or speak to all those people who had been part of our school journey but weren’t necessarily the friends we would keep in touch with.

Faced with the prospect of 6 uncertain months it seemed like the strangest holiday ever but also a blank canvas to do those things that during school time weren’t possible. Obviously within reason- the catch was that we would be living through a pandemic. At first, the time off seemed to be exactly what I needed; a breather, some time off without any commitments and responsibilities and for me to not have to be in a routine with a constant to-do list and impending stress. The phase of lagging video calls, zoom quizzes and echoes of ‘you are on mute’ signalled the unchartered territory we called everyday life. Lockdown was plagued with ups and downs as everybody reached breaking point or several and longed for some normality. While I tried to keep myself busy, at the back of my mind was always the question of what would happen in September and whether I would be able to get used to going back to education, having been out of it for so long. 12th August 2020- the eve of results day and another day of swirling controversy and confusion as this ‘triplelock’ was announced which seemed part of this new Covid-19 language together with ‘furlough’ and ‘Rnumber’. Having seen the situation in Scotland and with only one day remaining to find out our grades, it was a long 24 hours. The day finally arrived and whilst there was no opportunity for us to go into school, I waited for the email. Unlike with the familiar brown envelope there was no delaying possible once you clicked on that email… I was over the moon to have got the grades I needed and my place at university was officially confirmed!! The day felt strangely anticlimatic, as though we hadn’t done anything to get those grades and dealing with it all still from home. It signalled the closing of our final chapter at school as I was not going to start another year there but instead would have to navigate starting university in the strangest of circumstances. It seemed after results day as though somebody hit fast forward and moving into university became a very real and close prospect. As I look ahead to starting, it seems the last 6 months have absolutely flown but the opportunity to meet new people and have a new focus is definitely something I am ready for. If the pandemic has shown us anything, it is that no matter the circumstances, we can adapt and whilst it is still astounding that this situation has changed our definition of ‘normal’, it proves that when faced with something different, before long it will just be another ‘new normal’.

An unconventional A-Level summer Jaya Patel, A100 Y1 Exams will no longer take place in May and June.’ It was this announcement on March 18th that set into motion the domino effect on education caused by COVID-19. From this point on, I along with many of my peers were confused, anxious and nervous about what would come next. Would it be a summer filled with revision, just waiting for our A-Levels to be sprung upon us? Or would we be the first year group in A-Level history to not take any exams? Both initiated a multitude of questions that ultimately could not be answered. So, we were left in the lurch for the next 2 days until Gavin Williamson announced that we would not be taking A-Levels at all, but instead we would be awarded grades based on our teachers’ predictions and a national moderation. This would in turn give rise to one of the biggest, most controversial exam results fiascos, which would not be resolved until August 17th, 152 (very long) days later.

5 months seemed like enough time for me to exhaust Netflix, and still be bored out of my mind, so I decided I wanted to play my part, do something to help. I knew I couldn’t be on the frontline, so I signed up to be an NHS Volunteer responder, albeit too late and I was unable to take part. I contacted local hospital trusts about volunteering with them, in the hope that one would get back to me and ended up working with the Workforce and Redeployment team at University Hospitals Coventry and Warwickshire.

One of my first tasks was assisting in the induction of Medical Students who were being re-deployed as healthcare support workers. I spoke to some of these students, who were able to give me an insight into life as a medical student, as well as getting them to fill out a survey about their motivations and concerns about working in the NHS during the COVID-19 pandemic. From this, I worked closely with one of the academic SpRs at the hospital, and we put together a paper on it which is due to be published in ‘Clinical Medicine’ Journal within the next few months! COVID incidence at the hospital started to decrease, and as a result, Recruitment activity within the hospital needed to increase. I was fortunate enough for the Recruitment team to ask me to stay on with them over summer, so I was soon trained up in both Recruitment and Medical staffing. I enjoyed the medical staffing aspect the most, as it gave me an insight into doctors’ recruitment and training pathway- something I will be on the receiving end of in 6 years’ time as an F1. An invaluable part of this, albeit slightly chaotic at times, was planning and executing two Junior Doctors rotations, both in August and September. It made me realise that there would be a lot more to my Junior doctor rotations than just showing up at the hospital to start work! Despite the business at work, Results day soon crept around. It was something that I had tried to put to the back of my mind over summer, as realistically, 5/6 months was an awfully long time to be stressing and worrying about something I can’t control! But just over 1 week before results day, the news of Scotland’s results day and the unjust grade moderation caused anxieties to rise as we were still none the wiser as to how our grades would be calculated. Several stressy/panicky facetimes and sleepless nights later, it was time for ALevel results day. 4 hours was spent looking at medical schools in clearing to find their numbers and 0 hours of sleep ensued that night; constant refreshing of UCAS was to no avail (it crashed, as expected) so I arrived at school at 7:45am (the earliest I had been in my whole 7 years there!) to form a socially distanced queue outside and take our place on hazard taped lines around the corridors. A nerve-wracking 15 minutes later and I had a sheet of paper in my hand that could determine my future. I was one of the lucky ones- my grades were enough to get me into Medical School, and my first choice- Nottingham. It still seems surreal, and I don’t think it will feel like I have actually got into Medical School until I move in and get started. But until then, I will be frantically packing, and the usual pre-freshers nerves of making friends and settling in will be in the back of my mind. Despite a very unconventional A-level summer, I am now looking forward to starting as a fresher at Nottingham Medical School, and I can’t wait for Uni life!

Surviving your first year Ellie Reid, A100 Y3 Congratulations and welcome Freshers! The first year of medical school is so exciting, but, it can also be quite overwhelming. I wanted to help you all out and tell you all the things I wish I had known in my first year. First and foremost, prioritise your mental health and know that there is always someone to turn to for help. Eat well, exercise, keep in contact with loved ones and try get enough sleep. If you are ever worried about your mental health, ask for help. Talk to your personal tutor, a senior tutor or even contact our student-led support systems (Peer mentors, MedSoc Support and Nightline to name a few). Medical school can be really tough, especially in the current circumstances, so don’t wait to talk to someone and remember no problem is ever too small. Another important thing to remember is, don’t compare yourself to others! Be prepared for other students to tell you how much work they’ve done and how they’ve already read all of Gray’s Anatomy (if that’s even possible..). That’s okay, be happy for them, but don’t compare yourself to them. We all study in different ways and at different paces. Similarly, studying at university is very different to at school and it can feel quite overwhelming for the first few months. I would recommend talking to your peer mentor and asking them about their experiences and have a look at the study resources page on the university website. Work out what learning style works best for you and accept this might take a while – I have only just discovered mine! Also, celebrate the little achievements! Whether you took your first history from a patient, got an answer right in anatomy, or came second in a Kahoot quiz. Be proud of yourself and think about how far you have come! Finally, make time for and do the non-medical things you love doing. Whether that is art, music, sports, volunteering or even just reading a book. It will help you destress and enjoy university life more. It might even help you meet new people, I met some of my closest friends while I was climbing at the David Ross. I hope you all have an amazing first year! Have fun, learn lots, but most importantly look after yourself and remember to ask for help whenever you need it.

Societies On Being a UoN First Responder Starting a new society Derby Anatomy Art Society

On being a UoN First Responder James Conlan, CP2 By Your Side I've dressed your bloody wounds Held your hands and kept you warm When we stepped in the prognosis looked poor Medicine is complicated but CPR is simple and that time you got a second chance We help triple immobilise, sometimes medicate, forever dedicate ourselves to our patients. Patience is our virtue, but we know when urgency is of the essence You may be in mental health crisis or hypotensive crisis But it was a family crisis when your boy passed in your arms which stays with me You respond with humanity and gratitude, at times youâ&#x20AC;&#x2122;re impatient or even abuse us Socrates often can't get to the bottom of it and 15 litres isn't always enough But these are our tools - the simple things often make the biggest difference We make mistakes but make no mistake that we do our best for you My colleagues, my friends, help both of us through it To you, to them, to us - we are by your side

Hopefully, this poem gives some insight into what UoN First Responders do on the 999 front line. We are in a privileged position to be able to enter the lives of patients in their own homes at their time of need. Around 70% of the time we get to the patient before the paramedics do, and act with independence and autonomy outside of the role of a healthcare student. We are founded, led, and fuelled by students eager for more experience. I have gained more exposure from responding for the last six months than through any placement. In January of this year, our incredible team did 220 jobs and volunteered for enough hours to cover Nottingham 24/7 for the entire month. The scheme is full of energy and I am excited for the directions we will take in the future. Below is what a busier shift might look like, although there is no such thing as a 'typical' shift. All of the jobs are based on incidents I attended with my mentor during my first 3 shifts with the Scheme. Check out our website and social media @UoNResponders for more of what we do.

A typical shift *Pins, timings, and job demographics anonymised for patient confidentiality* 1700: I change into uniform and make my way over to Portland Building to meet my shift partner. 1705: Kit check - Defib battery OK? Oxygen cylinder full? Salbutamol in date? 1715: Car check - Tyres inflated? Lights working? 1720: Book on with control. "Good evening. James 17362 and Amanda 43837 booking on duty. Level 3 amber cover please.â&#x20AC;&#x153; 1730: We drive to a central standby location - Forest Rec is always a good spot. 1745: First call comes through. "Cat 2. Trauma. 91 year old, fall and cut to head. CFR17 allocated". 1800: We arrive first on scene, assess the patient, take a set of observations and brief history. We examine and dress their wound which looks like it might need closing.

1830: The ambulance crew arrive and we give them a handover before they transport the patient to hospital. 1845: Cleared for another call. 1900: Our second call is to a 57 year old with vague chest pain. The paramedics arrive soon after us – a crew we have met before and have a good relationship with – and let us carry on with the history and involve us in their investigations including the patient’s ECG, which doesn’t look too menacing. 2100: Time for dinner. We head to McDonalds for a burger and student McFlurry. 2130: Our third call of the shift to a 77 year old with red flag sepsis. We are able to improve their low sats with nebulised salbutamol and high flow oxygen. Paramedics arrive 15minutes later to obtain IV access and begin fluid resuscitation. We help to stretcher the patient to the ambulance and they are blue lighted to Queen’s. 2215: As soon as we clear from this job we are sent just a few minutes around the corner to a cardiac arrest. We walk in to one paramedic on the chest, the other inserting an i-gel, whilst the family stand in the corner of the room. We immediately take over CPR and bagging the patient whilst the paramedics begin their ALS algorithm. After three shocks, we watch VT transform into sinus rhythm on the monitor and everyone is relieved. Unfortunately, the patient’s GCS never improves as we travel with them in the ambulance to resus. We help unload the patient and observe the team in Queen’s for a while as they take over care, knowing we were a part of their chain of survival. 2350: It’s been a long evening. I debrief with my crewmate, which is always an invaluable exercise. We sign off with control and make our way back to campus. I get to bed before placement tomorrow, ready to do it all again in a few days.

Starting a new society Pradipta Debnath, A100 Y3 When I first thought of making a new society regarding Medical Leadership, I thought it would be something very difficult and time consuming to do. After going through the entire process, I can say with confidence that it was in no way difficult despite the added setbacks due to COVID-19. What you need is just a new idea and some patience!

What is Medical Leadership and Management? Before I dive into the minutiae of how to make your own society, I think it might be useful to you to have a general idea why Medical Leadership and Management is important! Research has shown that proper medical and management has led to better clinical outcomes in patients. For context, most of the managerial and leadership positions in hospitals are taken up by nonmedical professionals. In order to get more doctors involved in running the health service, the Academy of Medical Royal Colleges formally endorsed the creation of the Faculty of Medical Leadership and Management (FMLM) in 2011. Its main objective is to improve the standard of patient care by improving medical leadership. Similarly, Nottingham Medical Leadership Societyâ&#x20AC;&#x2122;s main objective is to increase the awareness of the field from an early stage in our careers. We have a series of talks planned out with some experts in the field and we canâ&#x20AC;&#x2122;t wait to see all of you virtually (and in person when the time permits) at our events.

How do I set up a society? Before, you fill out anything, you need at least 2 other people to start the application and they need to be the General Secretary and Treasurer. I asked a couple of my friends and they seemed pretty interested in helping me set it up. So, after expanding your committee (if required), you need to write a constitution and fill out an application form with details of your society. At first, it seemed really complicated but they have a sample constitution that you can go through for assistance.

After you fill out the paperwork, someone from the SU will get back to you to organise a meeting to present the ideas in person. It’s not like a job interview or anything and the person who asked me the questions was really nice. I also got one of my fellow committee members to join me to back me up if I made any mistakes! After all of this you need to wait as the staff in the SU will go through your application and approve it for provisional affiliation. Just make sure that there isn’t a similar society as yours before applying since that is the most common reason for rejected applications. After we got provisionally affiliated, we needed to get 25 paid members and the committee had to do mandatory training. In terms of training, it’s just a few articles on each role on Moodle with a short quiz at the end. Don’t worry too much about it since you can give it multiple tries! After all of this was done, we got fully affiliated with the SU in July 2020. It was a 4 month process but honestly it did not feel that long since all of us were having a great time working together to set something up from scratch. The sense of achievement that you feel after getting that final email is honestly very satisfying! Hopefully when the pandemic subsides, the time needed to approve an application would be much less.

Our plans for this year. In terms of events we have in mind, we are thinking of hosting the Dean of the Medical School (Prof Brigitte Scammell) herself in Mid-October. Later on, we will also be having Prof Mayur Lakhani (current Chair of FMLM and the former president of the Royal College of General Practitioners) to talk about his journey in Medical Leadership. We will also be bringing in Dr Benjamin Janaway, a junior doctor who will be talking about the importance of MedTwitter and how it is a brilliant way to network and know about cutting edge research. We have also teamed up with Dharma Medical Association to create a guide on â&#x20AC;&#x2DC;How to Survive First Year of Medical Schoolâ&#x20AC;&#x2122; answering frequently asked questions by new students. We will also be hosting a webinar for them to alleviate the stress and anxiety of starting Medical School in the middle of a Global Pandemic. We are thinking of bringing in other speakers in the future to talk about Quality Improvement projects, Clinical Commissioning Groups, Human Factors, etc! In the past 50 years, the Medical School has given rise to some fantastic societies in fields ranging from academics to culture to sports. That does not mean we should not have more societies! We have over 50 active societies in the Medical School right now and maybe that number could double in the next 50 years!

Derby Anatomy Art Society Jasmine Plummer, GEM2 DAAS (Derby Anatomy Art Society) began as a fleeting idea between Catherine Bent and myself, the only two people who had turned up to an introductory talk on the role of art and medicine, following a realisation that we had a passion for creating things that bring joy to ourselves and others. Around this time, we had been newly introduced to the daunting world of anatomical terms, images and specimens which required a way of thinking and studying that was new to the majority of us. Anatomy is fundamentally visual and this has been recognised historically by the likes of Henry Vandyke Carter (right), the anatomist, surgeon and artist for the renowned book Gray’s Anatomy. Inspired by this and the famous words of our anatomy teacher echoing in our heads (“draw it to learn it”) we decided to put together a society combining anatomy and art. Although art societies society exist on the main Nottingham campus, we were determined to set up camp here in Derby to save ourselves and our peers an arduous weekday return journey on the hopper bus after a full day of lectures and workshops. Some may assume that an intense, accelerated medical course for graduate students would be the last place you’d find people with the desire and time to spare to dedicate to creative activities, but it was quite the opposite. We quickly discovered that our cohort was full of creatives and hobbyists who jumped at the chance to combine anatomy learning with all sorts of mediums in a peaceful environment where they would have the opportunity to explore specimens and models of structures at their own pace. The low-fi ‘chillhop’ playlist set the tone for a relaxing exploration of the human body, a welcomed break from the fastpaced working day.

Unfortunately, the global pandemic brought in-person sessions to a halt, but with the help of WhatsApp and smart phones we were able to take our club online with a 30-day anatomy art challenge over what should have been our Easter break. At its peak, the challenge had 25+ daily contributions with students sharing their digital art, textile pieces, sketches and paintings based around the daily theme. as well as kind words and jokes to brighten everyone’s day. The challenge really helped to lift spirits and help us all stay connected through what was a really difficult time for everyone.

Although the future of DAAS is somewhat uncertain, with the help of Microsoft Teams and heap of enthusiastic GEM1s who will be joining us this year, we hope to continue virtually for as long as we’re able to. With the opportunities for socialising being increasingly few and far between we’d love for DAAS to be one of the forces keeping our year group connected and extending those links to the year below through the power of creativity. Watch this space!

Advice and Wellbeing Advice and ideas from other medical students Tips for research publication Have you washed your hands? Meditation Reflections on dealing with people Studying at Home Mind the Gap

Tips for publication Catherine Himsworth, GEM2 I have recently had the good fortune to have a piece of research published in the June edition of the BJGP. This case-control study was completed as part of my MSc in Public Health. As an absolute beginner in terms of research I had no idea what the experience of being published would entail. It seemed to be a mythical pot of gold that many academics, medics, and scientists strive for. Careers are made and destroyed on the back of peer reviewed publications. Notwithstanding this, I have had a very warm response to my work. Many academics have reached out to me with congratulations and supportive chats regarding future career prospects. Although these are early days (no-one has yet disputed my analysis or methodology!), the experience has been very rewarding. It is heartening that even though publications are coveted by the academic community, a novice can submit a piece of research and have it published. Clearly when you are designing a study you will be taking the lead from your supervisor and institution. However if you are then planning to prepare your study for submission to a peer reviewed journal, I have put together some general tips that may be of use.

Passion, motivation and competing priorities The act of preparing a piece of research for publication as the lead author takes a great deal of time. This piece was submitted for a degree in Sep 2016 but was only agreed for publication in October 2019. During this time I was working as an NHS Manager and had childcare responsibilities. Despite this I planned my paid work around the time that I had allocated per week to spend on research. You must take stock of whether you are able to commit time to writing on top of your prior commitments. 33

One of the most challenging periods was aiming to submit a rewrite to BJGP when I had just begun the GEM course. When studying medicine is your day job there is not much space for anything else. My former course lead passed on a great tip, which was that you need to be able to sit down for 4 hours at a time and do work. This is particularly pertinent when you are analysing statistics. You need to give yourself time to really understand what you are doing. This is the challenge of trying to shoehorn additional research into a medical degree/ a busy working life. It is simply too involved to just quickly pick up where you left off. Given that it takes time to really think about your research, you may want to save this work for the weekend rather than at the end of a long day! My ability to work on this piece and remain motivated was due to the fact that I was, and remain, passionate about the subject matter. You may want to consider this when designing a project, as a deep level of personal interest will assist with determination to complete the project in the long run.

Methodology â&#x20AC;&#x201C; focus on your study design and the rest will follow My general advice for designing a methodology would be to work closely with your co-authors (see tip no. 4) and to do your research. My piece of work was inspired by studies that had been completed in the US and Australia. These previous studies started to shape my methodology, but I altered the data-set used and the outcome measured. There is very little in terms of research on homeless health in an NHS context, due to a lack of good data (see tip no.3). Consequently the fact that this was a niche piece of research will have helped with publication. Ask yourself whether your research is looking at something new, building on an important question or investigating an underrepresented population. A further comment when designing a quantitative study is make friends with a statistician â&#x20AC;&#x201C; or several. I had numerous meetings over the years with various statisticians, particularly when altering the methodology. I would also recommend ensuring that you have a good knowledge of statistics by completing a short course. As a final point, ensure that the outcome that you are looking for will be of use. Try to design a study that is of use for clinical practice, or general scientific 34 endeavour. It is unethical to undertake a study of little clinical value.

Good data â&#x20AC;&#x201C; just ask for it, but go about it the right way! I was lucky to gain access to a rich data set, which was a gift for my research. I asked for the hospital admissions data, by finding the right person in informatics in the local NHS trust to email, stating what the data would be used for and organising a data sharing agreement. I had to agree that patient identifiable information would be removed, that it would be stored securely and not used for any other purpose. It was all very professional and straight forward. This tip is aimed to highlight that with the right approach, you may be able to access data that you would not have dreamed possible. Nevertheless, you must ensure that you have the formal backing of your co-authors and institution before making requests for NHS data sets.

Great co-authors and supportive departmental team The strength of your relationship with your co-authors can make or break a piece of research. I was only able to pursue my mission for publication due to the support, guidance, and patience of my co-authors. From the initial stages when they suggested that we prepare it for publication, to the multiple meetings, emails, phone conversations and re-reading of drafts. Without the expertise and fortitude of my co-authors then this piece of work would not exist in any form.

Choosing the journal â&#x20AC;&#x201C; appreciate rewrites may take some time! If you have a specific journal in mind when writing up your research, then this will focus the structure required and save time in the long run. Your co-authors should be able to guide you towards which journal should be a good fit for your work. You can then research the requirements of the journal and how they want work to be submitted. Be willing to spend time re-writing after your initial submission. I was asked to make changes to my paper once it had been peer-reviewed. This was a very useful process as the paper had been reviewed by experts using fresh eyes. Be careful to keep good notes on your working as you re-write the piece. You may have to return to analysis years after you have completed it. It is a requirement to keep your data and working for future use. 35

Talk about your piece of work â&#x20AC;&#x201C; share it and disseminate! Practice talking about your research. Go to conferences and present posters. Find fellow students to discuss your findings with. I was lucky to be interviewed for the BJGP after publication, but I regret that I had not spent more time discussing my research and its application before I had to speak about it formally. Finally, if you believe that your research is publishable, then have a chat to your supervisor. It was actually a very straightforward process, just one that took some focus and motivation.

Have you washed your hands? Natasha Harris, CP2 There’s nothing quite like an OSCE to inspire different emotions in students. You’ll start out being terrified of them (“I’ve never done anything like this before!”), get sick of them (“this OSCE needs to be over yesterday, I have actual exams to study for!”) and suddenly the terror is back (“It’s the finals. I’m almost a doctor, and the OSCE patients can even be healthy.”) But let’s rewind the clock a little. This is your first OSCE. How can you gain the easy marks? Do you really need to practice? This is what I (as a GEM OSCE survivor!) have learnt:.

New station = clean slate. Remember your MMI? Well, the good news is that (almost) everything you learned from your (successful- remind yourself of that) medical school interview can be applied to your OSCE exams. Most of us had the odd, abstract interview question that stumped us. There might have been an awkward silence. A long awkward silence. But, you dear reader, still got accepted into medical school, because a couple of less than stations were balanced out by the ‘better’ ones. So remember, just because you feel you did badly at one particular station (did you even do as badly as you think you did?), doesn’t mean you won’t pass your OSCE overall. Each station will be overseen by a different person and even the actor/patient will be different, so think of each new station as a new opportunity. The examiner in your cardio station won’t know that you forgot to ask about the patient in the history station about recreational drug use, so stop thinking about it! Seriously, stop thinking about it. The couple of minutes between stations are to catch your breath and hype yourself up for the next event, not to start planning your retake. And, if you must think about previous stations, remind yourself of all the things you did right. Did you wash your hands and introduce yourself? Excellent, that’s 2 marks no examiner can take away from you. 37

Practise, practise, practise! You may think your know your lower limb examinations from top to bottom. You’ve watched Geeky Medics videos until they are all that YouTube recommends. You memorised all the common cyst locations. All of them. You confidently stroll into the examination room, introduce yourself, wash your hands and start the examination…but hold on how do you test knee extension again? You tested flexion (they were lying down and you asked ‘can you move your heel as close to your bottom as you can manage’), but what about extension? Dang, it’s been like a minute, stop, move on. Active movements- check. Passive, passive, have test the passive ones now. Do I use one hand, both hands? Where do I hold the patient’s leg? I can’t remember how they did it in the video… That’s the five minute timer. I’m going to fail this station! Take a deep breath. The above scenario can easily be avoided. All you need to do is practice with your friends, family members and honestly, anyone who is willing to give up their time. Do a grand run through of the entire examination. Don’t just say, “I’ll now extend the patient’s knee” actually do it. Did you ever wonder why you can always type your computer password automatically, even if you are tired? Well, you can thank your cerebellum for that. Without it, you wouldn’t be able to walk and talk at the same time; you’d be too busy thinking about how not to fall over. So, if you extend your friend’s knee 20 times, you will remember how to do it, even on your first OSCE. And you’ll thank your ‘muscle memory.’ (Just remember, when it comes to your MEQ, forget the term “muscle memory” Your cerebellum is most certainly not a muscle).

Don’t forget the basics It can be overwhelming to be shown an image or a set of lab results and be expected to diagnose the patient on the spot, especially after a long examination. However, remember that these are simply opportunities to get more simple marks. A correct differential diagnosis will usually only be worth one mark or so, so don’t worry too much if you don’t quite know what’s wrong with the patient. In the preclinical years, getting to grips with the systematic approach is arguably more important than demonstrating your diagnostic genius

Scientific terms and you In the heat of the moment, you may forget the names of specific signs. (Hey, you remembered to wash your hands and your brain can only cope with so much under pressure) Instead of wasting time pausing and trying to remember the exact term, you are probably better off describing the sign and what its presence could indicate. Boutonniere’s and swan neck deformities can simply be referred to as ‘finger deformities that indicate progressive rheumatoid arthritis.’ Instead of looking for Dupuytren contractures, you can be examining the palms for abnormalities potentially caused by excessive alcohol intake. And if you do happen to remember the name as you go along, all the better.

Wash your hands! Hopefully, my not so subtle hints to remember to wash your hands before and every station will pay off, and you’ll not forget to do something so simple and important. But most importantly, good luck in your future OSCEs, I’m sure you’ll do great!

Meditation Rushan Vellani, GEM1 What is it? There are a lot of different ideas around the purpose of meditation and I don’t propose to know the answer. I believe that at its core, meditation is a way to come back to the present. The practice is fundamentally grounded to the here and now. Effectively, you are just being or giving yourself permission to just be.

Why do it? There are many articles explaining the effects of meditation on the body and mind, but I think in this case I’ll ask you to engage in the timehonoured tradition of self-experimentation. You’ll soon find out what happens for yourself and the experience is always unique. That being said, there are general benefits which people can experience. The first of which is a realisation of how busy the mind is, how many thoughts go on without your awareness. An awareness and acceptance of the existence of these thoughts make them less prominent in your mind, leading to a sense of calm. It’s the perfect way to start the day before your lectures and even more importantly, after your studies. It helps reset your mind and to leave the anxieties of work behind, so you can actually relax! It also happens to be the most time efficient way of changing your mental state… in my opinion. As we’re medical students, I know time is not an unlimited resource! 40

How to do it? This is the tricky bit. Many people (myself included) put off making time for meditation. There is something strangely difficult about sitting quietly with no particular goal for 10 - 20 minutes. More specifically, it can be difficult to just start! There are so many distractions available to us which are more instantly gratifying. My advice is to schedule an actual time to do it, regularly if possible. First, find somewhere quiet and comfortable so you won’t be disturbed. Next, have a chair ready and sit in it, have your back comfortably straight. There’s no need to try to do a full lotus position, unless you flexible and up for a challenge! What happens next is up to you, there are a few options:

Guided meditations: A very good way to begin. Pop on a video or use an app and just follow the instructions. No experience required meditation without tears! I recommend the Mindfulness of Breathing Meditation you can find online at the London Buddhist Centre. It basically consists of breathing in different ways, bringing awareness to the breath at different points. If your mind starts to wonder (it will) then just bring it back to the task without judgment. The act of breathing is quite special, it that it is both something you do automatically and something you can consciously control. This grounds you and gets you feeling calm.

Just sitting! No, I mean it! Just sitting is the real name for a type of Zen Meditation practiced all of the world. You sit still, focus your gaze on a point on the floor and just observe your thoughts. When you feel yourself getting caught up in one, let it go and come back. Don’t beat yourself up about it, it’s going to happen anyway so why worry? You’ll need to have a timer on your phone, set it to 10 minutes to start with. It’s sometimes a little more of a challenge because you don’t have the helping hand from a guided meditation, but you also don’t have its distraction and limitations.

Body Scanning: This one involves laying down, eyes closed and taking a few deep breathes. Next you bring attention to your feet and notice the physical sensations there. Acknowledge them and visualise letting any tension go. Try to visualise relaxing the body part with the outbreath. After you’re done, move up to the next body part. Maybe you can practice your anatomy in this mediation? Look for guided versions and articles online. This is really helpful for alleviating stress and trauma that can get “stored” in tensions in the body.

Final Advice: You need to make time for meditation, try to schedule it in, you’ll probably forget otherwise. Furthermore, it’s very much an exercise in acceptance not judgment, try not to get frustrated with yourself or go into meditation with loaded intentions. Give it a go, have fun. You’re just sitting on your own, what’s the worst that could happen?

Reflections on dealing with people. Karen Moran, GEM1 In 1993 I earned an A in ‘single award science’. This is the equivalent to 1/3 of a GCSE in each of physics, chemistry and biology. That was the end of my formal science education. It is 2020 and I am a GEM1. Surrounded by students with dazzling scientific qualifications and meaningful healthcare backgrounds it would be easy to feel completely out of my depth. But I don’t. A quick glance at any playground will tell you how important a person’s peer group is in shaping who they become; what a privilege to be sharing this playground with so many highly educated, committed and interesting people. There is no such thing as being out of one’s depth when there are enough people to make a raft. So if I’m going to mine your brains and experiences for all things science and healthcare related, what can I offer in return? Well, medicine doesn’t exist in a science and healthcare vacuum—there have to be people. People to do science and healthcare to. People to do science and healthcare with. People to do science and healthcare about. And I may not know science and healthcare, but I do know people. In two decades in education I have taught in a small rural secondary school with an abnormally high number of students with special educational needs, a huge city secondary school known for its great exam results and a Pupil Referral Unit (PRU, a school for students who’ve been excluded from mainstream education). I have taught RE, English, maths, PE, geography and music. I have been Head of Department, Head of Faculty and Head of House. I’ve taken kids on trips to Ethiopia, Costa Rica, South Africa, Spain, Germany, France, Romania and Alton Towers. There is not a teenage drama, real or imagined, that I have not dealt with. If you promise to help me out with the science, I’ll share some of what I’ve learned about how to make dealing with people a little less daunting?

Your attitude is contagious. My teaching specialism is RE. When discussing the (literal) ins and outs of every contraceptive method with 13 year olds, or exploring whether IVF should be permitted within Roman Catholicism if the sperm is collected by the wife masturbating the husband rather than him taking matters into his own hands, or considering why people are racist/Islamophobic/homophobic/etc. it is essential to foster open and safe discussion. If you are uncomfortable with a conversation then the other people involved in it will be too. Conversely, if you appear in control and unembarrassed this will help them to open up. Sometimes, this will be a ginormous act—you may be toe-curlingly mortified on the inside—but keep it up, you will be rewarded with insights that others won’t glean. ‘Fake it ‘til you make it’ is key here.

Try to develop selective hearing. Listen to everything someone says to you, but hear the bits which are relevant, useful or positive. Shortly before being forcibly removed from my classroom, one of my PRU students did circuits of the classroom on the tables, pausing only on the windowsill to spit out of the window, before stealing my pen and systematically scrawling obscenities over as many tabletops as she could reach before she could be restrained. As I was supervising her scrubbing off her handiwork at lunchtime she announced to me, “Just because you’ve got good hair, doesn’t mean you’re not a **** teacher and a ****ing ****.” I listened to all of it. I chose to hear (and reply to) the first part, whilst also noticing that she hadn’t got herself tangled in her double negative and had made excellent use of adjectives. (Not such a **** teacher after all, eh?) If you can’t develop selective hearing, at least get good hair.

Nobody knows what they are doing all the time Of course there are experts. But, as I’ve got older, I have realised that most people are simply bumbling along, most of the time. Let this knowledge free you to bumble too.

Most people love to be asked for help. Bumbling is one of imposter syndrome’s favourite fuels. Being asked to help is the perfect counter-balance. If someone asks me to help them, I don’t feel imposed upon and I don’t think that person is weak. Instead I get a useful insight into how I am perceived by others, a massive confidence boost and a real sense of worth. In my 20s, I couldn’t understand the concept of mentoring or support—why would anyone provide help to those who were seeking to reach their level, isn’t that just increasing their own competition?—but I now realise that success is not a zero-sum game and that everyone benefits in a supportive environment.

As I restart my formal science education, I come at it older, wiser and surrounded by most of you lot. We have tons to learn from each other and if I ever understand pH values then you’ll have done your bit.

Studying at home Ananya Bhardwaj, A100 Y3 With the COVID-19 global crisis, in-person and face to face lectures have transitioned to online distance learning. Especially for incoming freshers, it can be quite challenging to remain motivated and productive while adapting to a new environment. It takes stronger willpower to stay focused at home and keep on track with the demanding course. This article aims to tackle some of the obstacles students might face when revising from home and tips on making this adjustment more manageable.

Set aside a dedicated workspace at home With plenty of distractions at home, such as your roommates, family, Netflix, and your comfortable bed (to name a few), it is difficult to concentrate on prerecorded lectures throughout the day. You can often find your mind wandering and end up having to re-watch the same class again and again. One solution to avoid this dilemma is to create a separate study area, free of distractions. Having a dedicated work environment can put you in a productive mindset and help you disconnect from it at the end of the day. This space should be quiet and with adequate lighting (preferably sunlight or a bright desk lamp). Sit in a comfortable chair, whether on a desk or a nook in your bedroom, wherever you feel you can work most effectively. Remove any distractions in your vicinity, switch off your phone, close the extra tabs and avoid cluttering it. Have the essential materials you need, such as textbooks, paper, pens set up in advance to avoid looking for them later on. Keep your study area, and your relaxing place separate so that you can sleep without associating your relaxing time with study and stress. 46

Take regular breaks Cramming information and watching lectures back to back can lead to over exhaustion and is not effective in the long run. Taking regular breaks can lead you to feel re-energized and improve your focus. However, it is essential to note that what you do on your break can also impact your learning. For me, doing a quick 10minute yoga stretch on Youtube relaxes my tense muscles and leaves me feeling refreshed. For others, taking a short walk outdoors or even a shower can improve attention and invigorate the body and mind. Choose an activity that helps you destress and take your mind off work so that you come back feeling ready to plow through the day ahead. Avoid checking your social media since your screen time is already increased with online learning, and you can end up wasting hours on your phone instead of working. If you feel drawn to your phone anyway, downloading apps such as Pomodoro, Forest, and Focus Keeper (below) can limit your time on apps and build a timeframe for taking breaks.

Make a schedule and set deadlines This might seem like an obvious one, but it is the most important tip to surviving virtual learning. Just because you don’t have to wake up for that 9 am lecture doesn’t mean you should sleep in till noon. Having a structured routine can help you avoid burn out and ensure you aren’t falling behind. Have a planner or calendar where you can write out the topics you have to cover and set aside time for revising and making notes. Include time for exercise since it’s often overlooked, but it is imperative to stay healthy while being at home. Wake up and sleep at fixed times to maintain a regular sleep cycle and maybe add in time for meditation or mindfulness to help you relax. Keep track of any significant deadlines coming up where coursework might be due to avoid late submissions. It is also helpful to create your deadlines to have certain tasks completed within a specific timeframe, whether it’s a personal goal such as learning a new language or academic such as writing your CV. 47

Keep in touch with friends and peers Friends and coursemates are excellent to help you stay motivated and keep you accountable. If classes were taking place, as usual, your peers sitting next to in lecture halls could help answer any doubts or provide extra resources you can use. The same can apply in online learning; creating a virtual study group can help you recreate the group setting and test each other’s knowledge. Even outside of studying, catching up with friends is a great way to release stress and have fun! However, be mindful of following the COVID regulations and be safe at all times.

Join Uni Societies University Societies are part of the student experience and contribute significantly to university life. They are a great way to try something new that you’re interested in and meet like-minded people outside of your course. Especially for first-years who are new, it’s perfect for making life-long friends. It is also a great way to build your skills, such as communication, teamwork, and leadership, while doing something you enjoy. It is something to look forward to in the week and help you with the work/life balance essential in the medical career. There are multiple sport and creative societies to join on the Nottingham Student Union Page, so check them out !

Mind the Gap India Capper, A100 Y3 An illustration of a health inequality that is more than skin deep. ‘Mind the Gap’, the handbook written by second year medical student Malone Mukwende along with his two professors fills the longstanding void related to a coherent knowledge of the presentations of disorders in black and brown skin. Mukwende’s pivotal and long-impending booklet not only reflects on the various presentations in black and brown skin but also, critically, the different language used in such descriptors. As with any medical discipline, care should be tailored to the patients themselves, and with the relative absence of knowledge of how black and white skin and hair differ, treatment is often compromised as a result. Equally astonishing is the lack of resources surrounding the topic, evidenced by Mukwende’s findings: “Gathering the information was probably one of the hardest things I’ve ever done. It’s almost as if the information didn’t exist, it was so hard to find. But that reiterated to me how important this work is.” Indeed the lack of information and resources regarding disorders of black and brown skin further emphasises the problem and its urgency.

“The lack of diversity in medical teaching has the potential to have fatal consequences” - Mukwende This speculation is by no means farfetched; the estimated five-year survival rate of black patients with melanoma is 65%, contrasting a 91% survival rate in white patients. Melanoma, a skin cancer with one of the highest fatalities, exemplifies the disparities in outcomes of patients with white and black skin. Those with black or brown skin are almost consistently shown to have a more advanced stage of cancer on diagnosis, lower survival rates

associated with the disease and overall poorer outcomes. Survival rates relate directly to the stage of cancer at diagnosis and the promptness with which the melanoma is diagnosed. Factors affecting these parameters are education, awareness and early intervention. There is a notable lack of awareness of the risks of skin cancer among people of colour. A lower prevalence of skin cancer in black people has resulted in a reduced chance of the patient receiving a full body examination, owed to the physician’s diminished suspicions of such a diagnosis. In addition, the more covert sites in which skin cancers often present in black people (differing to those in white people), such as the soles of the feet, are often not accounted for, further hindering their detection. Informing patients of the risks associated with melanoma, preventative factors and how to carry out a selfexamination, particularly in common sites for such presentations, is crucial in enabling a timely diagnosis and subsequently improving outcomes and reducing mortality and morbidity in patients. As well as an effect on outcomes due to a lack of information, is the impact on a patient’s experience and comfort. An American cross-sectional study assessing black patients’ perceptions of the care they received reported increased patient satisfaction with the care from a dermatology clinic specialising in the treatment of skin of colour (SOCC), contrasting their experience at previous clinics. Amongst the factors determining this outcome was the dermatologists’ knowledge ; patients expressed an appreciation of dermatologists with experience and knowledge of black skin, hair and their disorders. In addition, physicians who educated the patient about their condition resulted in greater patient satisfaction. This is only made possible by a sound clinical understanding of the condition and its presentation in black and brown skin types.

“Not Just Skin Deep” “It’s already widely known that there are disparities in healthcare. The current COVID-19 pandemic has further highlighted why this work is needed” - Mukwende The disproportionate effect of Covid-19 on black and ethnic minorities has highlighted the health inequities that exist between black and white people. The Black Lives Mattermovement has further exposed the role of systemic racism in such disparities. People of black and ethnic minorities havebetween 10% and 50% increased risk of dying from Covid-19 compared to white British people. In an ONS analysis black males were found to be 3.3 times more likely to die from complications of Covid-19 than white males. 50

This data, published by Public Health England, did not include the effect of occupation, a widely acknowledged risk associated with exposure to Covid-19. ‘We know some key occupations have a high proportion of workers from BAME groups’ – PHE. The study also found that BAME people have a greater risk of acquiring Covid-19 due to the increased likelihood of them living in urban areas, overcrowded housing, deprived areas and having jobs that involve greater exposure. The amalgamation of these factors indicates a much wider, systemic problem. The difference in the rates of infection and outcomes with Covid19 among white and BAME people is undoubtedly multifactorial, relating to occupation, comorbidities and socioeconomic status. Nonetheless, the root of several of these factors and the resulting pattern is systemic and embedded in various aspects of society. As a second-year medical student myself at time of writing, I find Mukwende’s ambition and ingenuity even more impressive, and at the same time cannot help but feel an element of astonishment that such literature does not already exist. This has undeniably highlighted a great failing in society and modern medicine, that such a handbook is required to fill the prevailing gap in knowledge of how black and brown skin differ from that of a white person; that clinical teaching itself is insufficient in providing material that is so commonplace involving its white counterpart. Such a disparity in medical teaching surely cannot be without its repercussions. It has taken a global pandemic, an international civil rights movement and the initiative of a second-year medical student to highlights the health, and so many more inequalities that persist between white and black people. I hope to one day see Mukwende’s ‘Mind the Gap’ handbook in every medical school and university library in order to eradicate its necessity altogether.

Stories and Views Personal stories and views from life as a medical student The problem with Evidence Based Medicine I want to do medicine to help others. Being an Interim FY1 during COVID-19 The Perfect Medical Student DA Diary Last Day of CP2 A World Turned Upside Down Can you run a YouTube channel when studying at med school? Controlling COVID-19

The Problem with Evidence Based Medicine Yasmin King, A100 Y3 Throughout medical school, we often hear about Evidence-Based Medicine (EBM) in the context of using research to improve patient care. It is a great concept that, overall, improves treatment efficacy and patient outcomes. However, as with all things in medicine, we should delve a little deeper and see whether EBM is all it is made out to be. Should we take researchers’ claims as gospel truth and how can we use EBM in practice to do the best for our patients?

What is EBM and how did it develop? Since the first randomised controlled trial in 1662, testing the efficacy of bloodletting, the face of clinical medicine has dramatically changed; one of the main changes being how doctors make treatment decisions1. The long timeline leading up to EBM had begun. Following bloodletting was the first published trial report on the treatment of scurvy in 1753 and then the introduction of statistical method critiquing in medicine followed in 1835. Before 1990, when Gordon Guyatt coined the term “Evidence-based medicine”, countless clinical trials had taken place, guiding the way doctors made decisions. However, it was only over the previous few decades when epidemiological studies had bridged the gap between randomised control trails (RCTs) and physicians efficiently making good decisions. Although “evidence-based” was being used as a term since 1987, EBM was brought in under the context of medical education1. The definition of EBM is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.”2 Its primary function is to deliver the best care, whilst reducing costs and geographic variation in healthcare. Although it brings many benefits, EBM has limitations which must be considered to improve the healthcare system that we are part of.

A brief history of EBM: examples of its prosperity and its downfalls Although the term was only recently introduced, its concept has a long history. A lot of EBM’s past is a success story, but it is not all positive. As the most common childhood malignancy, acute lymphoblastic leukaemia carries a promising survival rate of over 85% for children in wealthy countries3.This is only after decades of clinical trials testing different combinations of cytotoxic drugs and comparing the outcomes. This is just one instance of how EBM has changed a diagnosis that once meant a certain and rapid death, into one that has significant chance of cure and survival, due to the actualisation of evidence acquired from RCTs. The idea emerged that knowledge of disease and treatment was power and anything that could be found in trials was worth knowing in the battle against disease. Unfortunately, this hunger for knowledge lead researchers to carry out the Tuskegee Syphilis Experiment. This was a 40-year study titled “Tuskegee Study of Untreated Syphilis in the Negro Male” in which 600 black men, 399 of which had syphilis, were followed until death, without informed consent, having been told they were being treated for “bad blood” – a major cause of death in the AfricanAmerican community4. From 1932 until 1972, the men were misled, not told of their diagnosis, and denied treatment, even after 1947 when penicillin became widely used to treat the potentially fatal disease. The uproar from the study eventually resulted in changes to laws in bioethics and human protection, albeit too late for many. Due to the methods of the study, it did not even provide any valid scientific data that could improve patient care. Although this shows the extreme negative end of medical studies, it highlights the importance of ethics and compassion in the acquisition of medical knowledge. This also explains one current limitation of EBM; due to the unethical nature of knowingly harming or denying treatment to people, some medical knowledge cannot be acquired in the context of an RCT.

Sadly, this was not the end of vulnerable groups being exploited in the name of furthering medical knowledge.More recent was the Baltimore Lead Paint Study, in which healthy families were moved into homes with varying degrees of lead contamination, during the 1990s5. As a result of the study, many poor, AfricanAmerican children sustained permanent nervous damage. Highlighted by this study is the discrimination faced by black and minority ethnic groups in medicine and medical research, something that is not just historical.

EBM today: what needs to improve? As medicine moves towards being patient-centred, EBM becomes more critical to allow the best patient outcomes to be achieved, regardless of location and context of treatment. The main limitation in this aspect of EBM is whether the outcome in the “evidence” is representative and applicable to the patient in front of you. Although often referred to in behavioural sciences, the concept of “WEIRD” participants skewing data may be reflected in medical sciences as well. WEIRD stands for western, educated, industrialised, rich, and democratic6. It refers to the way in which studies are carried out such that minorities are not represented in the participants and so, perhaps the evidence provided is not helpful in improving the clinical care of these minority groups. In a similar way, children and pregnant women often are difficult to prescribe for with as much confidence, due to the smaller bodies of relevant evidence. This may also be true for those with complex co-morbidities and so they respond differently than the simpler profiles of the study participants. Presently, medical research is guided by ethics and a patient-centred approach, at least on the surface. Unfortunately, RCTs require copious funding, time, and resources and so, often sufficient funding for such trials is only received from organisations that can benefit from the data provided by the studies, i.e. they have vested interest. The outcome of this tends to be that the results can be statistically analysed or manipulated in such a way that they promote the product, even if there is no realistic and significant clinical improvement. It also means that areas with less financial potential (e.g. diseases with a small prevalence) must conduct cheaper and less resource-consuming studies, such as retrospective and cohort studies. These provide evidence lower in the hierarchy of quality as they can show association but not necessarily causal links, and thus the improvement to patient care may not be so great.

An area similarly affected by this is weight loss and nutritional research. There is a gargantuan industry for weight loss pharmaceuticals due to the ideals held up by the media and health professionals. However, whether all the potential drugs and regimens for weight loss are effective in the long run, or even improve patient outcome, is unlikely7. Instead, the “war on obesity” may have some unintended negative consequences, such as weight-based stigmatisation8. It is difficult to find studies that follow weight loss for longer than 12-24 months, due to a combination of the cost of the study and also the significant financial incentive of supporting the weight loss narrative, rather than providing evidence to the contrary. In such cases, perhaps it is better to provide treatment with more reliable evidence supporting it than to prescribe something that is only weakly supported by evidence (i.e. prescribing physiotherapy for chronic back pain, rather than simply weight loss)9. This demonstrates the importance for doctors to read further into their teaching in order to have a deeper understanding of which research has greater reliability and, thus, preferred impact on patient outcome. We have come to learn that not all evidence is equal, but there is a vast ocean of research that we must navigate. How do we manage the sheer volume of knowledge, deciding which studies to trust and which to discard? It is common knowledge that doctors, especially in their junior years, are not blessed with plenty of free time. This makes it challenging to keep up with the hasty outflow of research from institutes around the world, whilst also weighing up their quality and relevance to their practice. Systematic reviews and meta-analyses assist with filtering the “current best evidence” out of the extensive number of articles, but details of studies can be ignored in the writing of these summarising papers. Furthermore, studies with great differences in methodology will markedly skew the results. Perhaps this oversight leads to some outcomes being unreasonably weighted more so than others. Furthermore, more recent ideas may not be as widely utilised due to the lack of familiarity. Body mass index (BMI) has been used to determine metabolic health in individuals for nearly 50 years, despite its intended use being only at populationlevel, due to its simplicity10. Perhaps a more recently constructed system should be adopted to keep with the “current best evidence”. The Edmonton Obesity Staging

System (EOSS) is a more useful measure since it considers the impact of the patient’s weight on their health and wellbeing, rather than their size alone. It is used as a predictor for post-operative complications in metabolic surgery but maybe it has the potential to replace, or accompany, the use of BMI in more areas across medicine to ensure only appropriate levels of intervention are occurring11.

How we can use EBM to be better doctors We have explored a few of the limitations of EBM, throughout its history and its use. But this has not been comprehensive; there are more opportunities for improvement. Other restraints of EBM include statistical significant benefits only providing minimal improvement in reality, and mindless rule-following leading to a less patient-centred care12. So, what can we do? Using intuition and expertise, as well as guidance from EBM, rather than simply rule-following, allows more personalised, compassionate, and effective care for patients. Also, research providers should explore and explain the applications of their research, accounting for realistic limitations and constraints. Finally, in a rapidly changing environment, we should adapt and be open-minded: critically analysing data and using the current best evidence to support our practice. 1. Evidence-based medicine - Wikipedia. https://en.wikipedia.org/wiki/Evidence-based_medicine#cite_note-sackett2-1. Accessed July 10, 2020. 2. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. 1996. Clin Orthop Relat Res. 2007;455(7023):3-5. doi:10.1136/bmj.312.7023.71 3. [A Brief History of Treatments for Childhood Acute Lymphoblastic Leukaemia] - PubMed. https://pubmed.ncbi.nlm.nih.gov/20669630/. Accessed July 10, 2020. 4. Tuskegee Study - Timeline - CDC - NCHHSTP. https://www.cdc.gov/tuskegee/timeline.htm. Accessed July 9, 2020. 5. Baltimore Lead Paint Study - Wikipedia. https://en.wikipedia.org/wiki/Baltimore_Lead_Paint_Study. Accessed July 10, 2020. 6. Are your findings “WEIRD”? https://www.apa.org/monitor/2010/05/weird. Accessed July 10, 2020. 7. McEvedy SM, Sullivan-Mort G, McLean SA, Pascoe MC, Paxton SJ. Ineffectiveness of commercial weight-loss programs for achieving modest but meaningful weight loss: Systematic review and meta-analysis. J Health Psychol. 2017;22(12):1614-1627. doi:10.1177/1359105317705983 8. Salas XR. The ineffectiveness and unintended consequences of the public health war on obesity. Can J Public Heal. 2015;106(2):e79-e81. doi:10.17269/CJPH.106.4757 9. Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002;48(4):297-302. doi:10.1016/S0004-9514(14)60169-0 10. Body mass index - Wikipedia. https://en.wikipedia.org/wiki/Body_mass_index#History. Accessed July 18, 2020. 11. Chiappetta S, Stier C, Squillante S, Theodoridou S, Weiner RA. The importance of the Edmonton Obesity Staging System in predicting postoperative outcome and 30-day mortality after metabolic surgery. Surg Obes Relat Dis. 2016;12(10):1847-1855. doi:10.1016/j.soard.2016.02.042 12. Greenhalgh T, Howick J, Maskrey N, et al. Evidence based medicine: A movement in crisis? BMJ. 2014;348. doi:10.1136/bmj.g3725

“I want to do medicine to help others” Ibrahim Mutlib, CP3 (A108 pathway)

This is a reflection of my time at medical school, as a final year student. I’ve been really involved, and I want to talk about why I do it, and why you should too. This is not a humble brag… I promise.

Getting into medical school I’m from Alum Rock, a large deprived community in Birmingham and went to school in Small Heath (yes - the peaky blinders place!). For context, both areas come in the top 10% of the national deprivation index. This meant my education experience was less than ideal. In college an email was sent out that asked all those who wished to apply to medicine to come after lessons. At this talk we were told that If we didn’t have 8A*s we were to walk out of the room there and then. There was a cold, unforgiving atmosphere in that room. We were then asked to write down our names with our GCSE grades, I lied about my grades as I couldn’t let my dream die here. We were lectured about how we were unlikely to get in and we should aim for biomed, this was due to the fact that if we did not get into university the college’s stats would go down. The following year we had mock interviews in which we were grilled one on one – they seemed to be telling us not to apply for medicine. They asked “why would they want you, when they could get someone better?”

Starting medical school. This school experience was something that stuck with me. I started medicine already feeling inadequate. Technically, I have the lowest A - levels in the cohort but I never let that stop me. I always tried my hardest at anatomy and loved seminars. However, I also could feel myself being so radically different from my cohort: I always felt different. I come from a family that does not have access to a lot of funds, having a father with cancer and a mother who is a dinner lady doesn’t provide much. Already being in university - I knew what it felt to feel less than, not enough to be here with those who’ve travelled the world over. It took me time to become proud of where I am from, as a result every year I made the effort to visit the new foundation year students and give advice on time ahead, as I know what its like to be them and the mammoth journey ahead also how they can avoid the mistakes I made. So, this is my first piece of advice, use what makes you vulnerable to your advantage. Be proud of your perceived shortcomings, its just part of your origin story. We move on to the third year, when I helped to encourage the creation of a BME officer role in MedSoc. This was partly because, during a first-year placement, on my last day a GP (who knew me the whole year) started referring to me as Mohammed. I, a lowly first year, didn’t know what to say and went with it. Working towards developing a BME Officer role made me realise the importance of diversity – I then started to really engage with my role as the CP1 rep and started attending uni meetings. I then co-founded the BAME education committee alongside other students and staff. I could now really help address differences in medicine, and even begin to address the issue of diversity within the CP2 dermatology module. The second piece of advice comes from this, use your unique perspective to make change, if you believe it in your message it will work out, but also take up the roles of speaking for students, be the one who can make change happen.

Teaching During my BMedSci I was in a state of almost constant confusion. It took me ages to figure things out and I once spent 3 hours in the library downloading 4000 references 50 at a time, until I realised you could do 1000 at time. After finishing my BMedSci, I knew that in a few months’ time, there would be another student just as lost as I was. I just could not sit with this so I organised a teaching session with the year below where I went though the start to finish of my dissertation. Around fifteen people showed up, from this I knew I loved teaching and I loved knowing that I was really helping my fellow students. My third piece of advice is this, your skills are always teachable. The younger years will always appreciate a fellow student to talk to about their experience. Do not be afraid to organise things on your own, it can be scary at first but just knowing how valuable your advice is itself is very rewarding. You are a role model, believe it or not. Similar to the BMedSci, I also arranged talks to introduce and give tips for CP1 and CP2. The clinical phases can be scary and it’s a real change from preclinical work. I knew that so many students would be so nervous and again I couldn’t rest knowing that I could be of use. Following from this, the clinical phases really challenged my ability to maintain my own well-being. I was also hearing from friends that they were also finding balancing medicine hard. For this I created the relax room, the aim was to create a space in which medical students can really relax and unwind. It ended up being really successful and really helpful. I really felt rewarded watching my friends draw and really let go of medicine for second. This leads on to my next piece of advice, don’t forget your people who are in your position - either now or in the future. Remember you are doing medicine, not the other way round.

I have known what its like to be the little guy, I know what it is like to be in the disadvantaged position in a wide variety of contexts and my message is this: you are amazing, you have overcome whatever personal hardships you’ve faced to be where you are. For all medical students, you have done what some dream of. Everyone reading this has done something remarkable in their lives, and I can assure you that others will benefit of hearing what you have to say. To medical students, never feel invalid. You are there for a reason and you wouldn’t have gotten this far if this wasn’t meant to be. There is wisdom in all of us, its now more than ever that we need to share our different experiences and how we can all grown and learn from them. Take up positions of change like reps and be the voice for the voiceless, we often think about patient’s wellbeing but don’t forget your own and that of your colleagues. We are all in this together. As a wise person once said: “the circumstances of one's birth are irrelevant. It is what you do with the gift of life that determines who you are”.

Being an interim FY1 during COVID-19 Dr Tom Le Tissier, FY1 (2020 Nottingham Graduate)

Tom wrote us this piece in May when he was on the wards at Kingston Hospital, Surrey, working as an Interim FY1 to help hospitals to cope with the increased demand for services due to the COVID-19 pandemic. This is a first hand account of his experiences on the job - how it made him feel, what he saw and what he learnt.

May 2020: There are a lot of words that can fairly describe the current situation, including pretty much every expletive. Disruptive is one – alterations to day-to-day life unprecedented in our lifetimes. Uncertain – people unable to plan their lives as they wait for updates. I know I’ve been (im)patiently waiting to find out if I’m still allowed to get married this summer. Frustrating – long-planned electives cancelled, gorgeous weather watched longingly through windows, tensions increased by long periods of confinement. Upsetting is an important one – most people now know someone who has lost their life to coronavirus. The 30,000 deaths, an appalling statistic, also marks 30,000 circles of family and friends grieving a loved one. For those on the front line, there is a huge emotional toll. The speed and brutality of Covid deterioration can be horrifying to see, and more than one colleague has talked sadly with me about how their ward has shifted from mostly discharges to mostly patient deaths. Frightening, infuriating, unsettling. Any of these easily deserve their own paragraph. Despite that though, I’d like this to focus on silver linings – let’s face it, there’s enough clouds to be getting on with.

The benefits to community spirit have been vast. Within healthcare there is a huge sense of people coming together. Many old barriers are if not broken then at least lowered, and everyone has been trying to do their part. The workload of Covid has been a great equaliser as all hands are brought onto help – working as a new interim F1 I’ve been prepping one set of notes on a ward round while a dermatology consultant preps the next patient. At the same time, everyone is happy to provide help and support as needed, and an expert is always on hand. The nature of covid patients also brings staff together – the decline of patients is upsetting whatever your role is, and colleagues are forming that support network for each other. Community outside of healthcare is also a silver lining – it’s been lovely to see people advertising about delivering food and groceries to those that can’t get out. When I had to self-isolate there was almost a queue of friends who would shop for me, and when it was their turn it was great to return the favour. The supportive messages in windows – even if they are often just a way to keep the kids busy! – have been hugely sweet. The weekly clapping for the NHS is community at a grand scale and while there some are cynical about it, it is good for morale. Not just for NHS workers, although it is that, but also for everyone else. People are stuck indoors, feeling frightened and often useless. The opportunity to do something is invaluable. This community feeling is going to be carried forward – within the NHS if not within greater society. There’s a sympathetic wince every time I tell someone my elective was cancelled, and I’m sure that same sympathy will be given to students coming up in years below. At the same time, people like the new, closeknit culture, and in preserving it they’ll also benefit upcoming years of F1. I know many students have been involved in volunteering or other work during the current pandemic and this will have a range of positives for the future. Firstly, it’s a bonding point for people who will feel they were there too. Secondly, it’s a different perspective into life on the wards and that can only improve our practice. Becoming an F1 (or interim F1) can be nerve-wracking, but having that bit of common ground with those around you makes a huge difference. Finally, I’d be re-miss if I didn’t mention the food. Every shift there’s a new range of delicacies provided for us by colleagues, family or even nearby restaurants. I’ve been told not to get too used to it, but for now I’m living in hope.

The Perfect Medical Student Arthur Joustra, CP2 The perfect medical student does not exist. To be completely honest, I am pretty confident that not a single medical student really has much of a clue what’s going on, and I would bet my student loan on the fact nobody has fully completed a‘suggested reading list’ since at least the 70’s. Throughout Medical School it’s very easy to see the side of people that they want you to see; and very rarely see what’s really behind the snapchat of the vente soy vanilla chai frappuccino latte, carefully placed next to an open anatomy textbook in Hallward library captioned ‘Gonna be a long night *gloating emoji* (you know the one)’. It has taken me until my fourth year to begin to realise that the people who seem to have medicine all figured out, are really only slightly less clueless than me, noone really knows what they’re doing, and that every time I’ve chosen to focus on my hobbies and non-medical life instead of perusing the absolutely impossible phenomena of being ‘the perfect medical student’ has been a fantastic decision. I’ve spent many summer weekends as a spray paint artist on the streets of Nottingham, creating art live for the public as a busker. There were many weekends in first, second and third year where I put my books away, got out my spray paints and just spend the weekend in town painting. At the time, I always had a twinge of guilt that I should have been studying, however four years on I have no regrets about perusing my passions alongside medicine. I never told people in town I was a medical student, if anyone asked I was an artist. It was so nice to be able to have a few hours each weekend where I wasn’t a medical student that had deadlines, exams and Echo lectures to catch up on, and just be something and someone I had total control over, and a few hours a week where I knew exactly what I was doing. I think without this release my studies would have suffered, and this vital time off, is what made the time I did study and work far more productive.

Of course, I’m not suggesting everyone takes up spray paint art- in fact quite the opposite as it would put my side-hustle in serious jeopardy! I’m also not saying don’t do any work, medicine is a hard degree and does require a good work ethic. What I’m trying to say is that Medical school is hard enough without the completely pointless competition to try and be better than other medics. Med School will fly by and you’ll be a doctor before you know it, the only thing that should matter is that you had the time of your life getting there. No one will remember who beat who in first or second year exams, it’s not the end of the world if you fail a formative, the only person that matters is you. Medicine is what you make it, but don’t make it everything.

DA Diary James Bluck, CP3 James wrote two pieces comparing his time working as a Doctors’ Assistant at Royal Derby Hospital during the very height of the COVID-19 crisis. He describes his skill development, thoughts and lessons learnt during this “unprecedented” period in his studies.

First Week: After a week of introduction lectures in which the word “unprecedented” has been uttered more times than some have years, we have finally been set loose on the wards as the novel Doctors Assistants (DA). There have been a few changes to care that have come to place since COVID-19. The first one we were taught was how to provide emergency care for a COVID positive patients. Essentially the first responder is to shout for help and use the AED to shock them 3 times until an adequately PPE’d person can come to take over. However, as DAs we do not have the code to override the 2-shock limit so we should just place the sticker on and wait until a responsible adult arrives to take over. Arriving on the ward I was expecting chaos, however, due to cancellation of clinics and elective operations there has never been so many consultants on the wards. There are also less jobs than usual due to all the patients avoiding hospitals as if it were a 9am Public Health lecture (perhaps with hindsight I should have gone to more of these…) The day started by prepping hand over sheets and writing in the notes during the ward round. After all this was done its time to divide up the jobs. As we are a new position, we do not know exactly what we can do but we are certain on what we cannot; prescribe, diagnose and we definitely can’t make decisions. Hours spent labouring over my first TTO and it was finally ready to be reviewed. Staring at my page long essay on Mrs X’s admission, the F1 proceeded to remove paragraph after paragraph of waffle until only 6 lines remained (who knew that connectives such as ‘suddenly’ and ‘unbeknown to everyone else’ don’t belong in a TTO). Finally after my project had been sufficiently flayed she turned to me and said the words that every student longs to hear; “thank you we’ll save this as a draft”, the doctoral equivalent of your mum saying she’ll put your finger print

art on the fridge door. So, after 3 days of failed bloods, TTOs and the occasional ECG, I have found myself doing what I do best, making tea for the 5 doctors in the staff room, “milk and two sugars, gotcha…”.

Last Week: Today marks the start of my last week as a DA, and I have received a few positive comments from the Doctors on our ward. It conspires that by turning up at 8am every morning to prep the notes saves a junior doctor another hour of beauty sleep, allowing them to arrive fresh faced to the morning ward round. Every cloud. As well as paying off a large proportion of my overdraft I have found this attachment somewhat useful in honing skills I would need when/if I graduate. To say I am going to be great junior doctor because of it would be an exaggeration, however I suppose I would be a less incompetent one. My TTO drafting, which has been the bread and butter of this job, has improved considerably. The discharge summaries produced are shorter, more concise, and only require the occasional revaluation. As well as admin work, I have been gifted to try out practical skills such a venepuncture on the unsuspecting DME patients on my ward. These patients have kindly volunteered to act as human pincushions as I tried time and time again to take their blood. And after 2 months of stabbing patients my technique has improved to the level that for only 1 in every 3 patients, I must call for an adult to assist me. I would call that a win. Looking back I have enjoyed this placement, its provided more insight to what it would be like working on the wards as a Junior as well as reminding me that there is more to medicine than remembering the risk factors of peripheral vascular disease or the histology of the pancreas. Finally, I thought I would leave you with the main lesson I have learnt: When doing venepuncture with a butterfly needle make sure the vacutainer is not resting on the patient’s lap, otherwise, they may get an unwanted surprise when you go to thumb the blood bottle in.

Last Day of CP2 Placement Alison Hird, CP3 The last day of my CP2 placement was Monday March 16th 2020. I got up early to try to scrub for a C section, one of the mandatory sign offs in CP2, getting in for 7:50 am. Usually, I try to avoid early starts especially if I’ve not been scheduled for something, but this day felt different. It was the Monday after a weekend of worry about the changes necessary to keep people safe from COVID 19. Our future was uncertain. Only that Friday had I received word from the medical school that CP2 rotations were deemed ‘low risk’ and I could proceed for the time being with my Obstetrics and Gynaecology rotation. Social distancing was still a relatively new term and we were all naïve to the stark reality ahead of us. I arrived on the ward, changed into scrubs and went to the nurses’ station to present myself. I spent the next thirty minutes being passed around from one team to another until I landed on a patient with a complex medical history due to a rare kidney disease, focal segmental glomerulosclerosis (FSGS), who was scheduled for an elective C section. While I waited for her section, I followed a midwife around and got to assist with a CTG, where the heartbeat of the baby and contractions of the mother are monitored, on a lady I had seen in clinic just a few weeks ago. Her baby had IUGR where the baby is not growing at a normal rate; this was most likely due to her smoking during pregnancy . She had just been listed for an emergency C section due to reduced foetal movements. Although it was unfortunate that she was going for an emergency C section, I was happy to have been in a small way a part of this patient’s continuity of care.

https://news.sky.com/story/babys-death-in-nhs-maternity-unit-was-almost-certainly-preventable-11201983

Finally, it was time for the elective C section where I got to scrub and see the delivery of a baby for the first time. The lady I was following with FSGS had long standing kidney disease and therefore had several previous fistula sites from haemodialysis. Due to the fistulas, the anaesthetist had trouble finding a suitable vein to place the two large bore cannulas and ended up having to put a cannula in her foot. Next, he administered her spinal anaesthesia by sitting her up, preparing a sterile field and inserting the needle around L4/5. The drugs worked quickly. She said she had to pee to which the midwife replied that would not be a problem as she handed the registrar the catheter to insert. Once everything was prepared, the actual C section was incredibly quick. I witnessed the registrar make an incision in her lower abdomen and cut through the layers of fascia before feeling for the uterus. She made a small lower segment incision on the lady’s uterus before the consultant and registrar used their hands to attempt to rip the woman’s uterus apart organically. I had heard about this, it is done in order to help the muscle fibres heal more effectively, but to me it looked like the consultant and registrar were playing a tug of war with her womb. Finally, the baby was lifted out and cried using his tiny lungs for the first time. The baby was healthy, however during the surgery the mum’s bladder was nicked complicated by her 3 previous kidney transplants. The reg showed me the catheter balloon visible in her pelvis. The consultant went to call the urogenital surgical team while I helped the registrar complete the lady’s uterine closure. She used big stitches bringing them together like so many draw string purses. I wasn’t a massive help but there have been plenty of surgeries where I’ve just stood for hours in the background.

While we completed the uterine closure and the consultant organised the urogenital surgical team’s arrival the mum nursed her newborn baby for the first time. Despite the chaos it was a beautiful moment. When mum was told she would be put under general anaesthesia for her bladder repair she was more worried about her baby’s feeds than her own wellbeing. It astounded me, but I’ve never been a parent. After the urogenital team was set up, I went back to the labour ward to wait to scrub for another C section. I was put to work barrier nursing a small baby under a heat lamp whose mum had tested positive for influenza B - it wasn’t COVID 19, although it was on everyone’s mind. Every 5 minutes I measured the baby’s temperature. I was proud when it returned to normal, despite it being the heat lamp’s effort, not mine. At 5 pm the midwife came to relieve me and told me the patient with IUGR due for an emergency C section had been taken to surgery if I wanted to go. I washed my hands and checked my phone: at 16:44 I got an email from the medical school cancelling all medical student placements. I left the ward on a high. Most days as a medical student you end up feeling like more of an observer than a part of medicine, but this was a particularly good day. I can’t wait for the chance to get up early for the next one.

A World Turned Upside Down Simon Matthews, CP3 How strange and harsh these times have become. Within the space of a few short months, our sense of normality has been upended in a way most of us have never experienced. I am going to take you away from the world of medicine for a moment or two, on a strange and surprising journey from the recording studios of Los Angeles, via the hills of Kentucky to the English Midlands, with a final diversion to pagan Europe. Bear with me - a brief dive into the dark and beautiful lyrical traditions of American folk music will, I hope, give you a sense of connection to the people who lived your regioncenturies ago, in their own time of disaster. If you do have access to YouTube, it may be useful to listen along to the songs I discuss.

There are two great parent traditions in the American musical landscape. The first and most prominent is the Afro-American folk tradition which was dug in the towns and plantations of the Deep South; a reservoir in which the religious, linguistic and musical traditions of the old African and the new American continents mixed. This provided for the roots of modern gospel, blues, jazz and Râ&#x20AC;&#x2122;nâ&#x20AC;&#x2122;B, led to rock, funk, Hip-Hop - ultimately to a very large proportion of the pantheon of late 20th and early 21st century Western popular musical styles we enjoy today. The second is the white peasant/working-class folk tradition which finds its spiritual home in the coalfields of Kentucky and the plains of Oklahoma. It is broadly responsible for the bluegrass, hillbilly and country & western strands of American folk music. The divisions between the two parent traditions are fluid and there is much exchange, but the concept just about holds. The common thread is that both folk traditions encompass the music of the poor. Folk music is the music of the illiterate. Through it, slaves and the peasant/working-classes handed down their values, beliefs and lifeexperiences through generations, without the convenience and refinement afforded by academic historical record and scholarly analysis. The painful legacy of centuries of economic struggle, migration, war and disaster is

still there in the words of the standards of these folk traditions, giving us a direct and visceral link to our deep, collective histories.Sometimes, these legacies can also be found within the lyrical structures of the standards – a less direct link but none the less powerful for it. The second, white peasant/working-class American folk tradition has been enjoying something of a resurgence overthe last two decades. Taking the form of ‘indie’ folk music and its associated sub-genres, the tendency towards nostalgia and revival embodied by artists such as Joanna Newsom has revealed once again some of these ancient fragments of pain and struggle. Pay attention to both the words and the style of some of these old songs, and you can hear them too. I’ll use a modern track as an example of an important lyrical style it would be easy to pass over. Joanna Newsom came to prominence in the early 2000’s andhas built a reputation as one of the foremost folk lyricists of her generation. On her 2015 album ‘Divers’, an old folk standard called ‘Same Old Man’ makes an appearance. There have been a few different arrangements of ‘Same Old Man’; this is a cover of Karen Dalton’s seminal 1971 arrangement. If you listen to it, you may notice something strange: “It’s the same old lady puttin’ out the wash // standin’ in the rain in a Mackintosh”

https://commons.wikimedia.org/wiki/Fi le:Joanna_newsom_(1521403660).jpg

“It’s the same old man, sittin’ at the mill // Mill wheel turnin’of its own free-will” It is impossible to replicate here, but these lyrics support a wonderfully magnetic, dark atmosphere which is very hard to pin down. Partly, this evocation is the result of the work of these rhyming couplets. Though one part fits the next beautifully in terms of form the meaning of the content clashes. It does not make sense. It is absurd. Why is she putting her clothes out in the rain? How can a mill wheel turn of its own free-will? This tension between form and content is not an invention of Joanna Newsom. It appears elsewhere in American folk music and is one link that we can follow all the way back to the war-ravaged English Midlands of several centuries ago.

From modern indie-folk, one does not have to trace the lines of influence far to find oneself at the feet of Jean Ritchie. A folk singer-songwriter and dulcimer player, she rose to prominence in the mid-20th century and is known as a great custodian of the oral folk tradition of the SouthernAppalachian Mountains. On her 2004 compilation album "Mountain Hearth & Home”, there appears an ancient song called ‘Nottamun Town’, which Jean believed had been passed down through many generations of her own family. Five short, haunting, tremulous verses employ the same tool as ‘Same Old Man’: “I bought me a quart to drive gladness away, And to stifle the dust, for it rained the whole day, Sat down on a hard, hot cold frozen stone, Ten thousand stood round me, and yet I's alone”.

https://www.flickr.com/photos/ internetarchivebookimages/200 61999694

What on Earth is a dark, surrealist fable about ‘Kings and Queens’ and ‘Nottamun Town’ doing on this album, by an apparently genteel mid-20th century folk-song writer from Kentucky? The answer, unremarkably, lies in the migration patterns of the folk settling the area. This echoes the process we find within the Afro-American folk tradition, though the causes of the population movement were different, happening over a longer period and in less brutal and traumatic circumstances. Successive waves of emigration to America from all over Britain escalated from the early 17th century onwards for a combination of economic and religious reasons. A detailed history of historical migration patterns is often difficult to ascertain, especially those patterns which concern the lower classes. Luckily for us, Jean Ritchie herself took on the task of researching the interchange between English and American folk music, in the context of her own family, as a Fulbright Scholar, resulting in her book ‘The Singing Family of the Cumberlands’. Ritchie determined that the first member of her family to emigrate to America, James Ritchie, did so in1768. His son Crockett was credited with keeping a huge range of folk songs alive amongst the Ritchie family and their friends and acquaintances at his ‘play-parties’, where songs would be swapped amongst the families. There were hundreds of these songs. She recalls a conversation with her Uncle Jason after he treats her to a rendition of Nottamun Town: “I learnt that one from Will at a play-party, that was the best place to learn more

songs. When I was growing up that’s where songs got swapped about the most. For when young folks’d get tired, they’d just sit around the fireside and sing for hours on end, or sometimes just until they got their wind back for the games. There wasn’t much singing all together, everybody just sang what he knew.” Jean was ultimately unable to trace a specific origin story for Nottamun Town. In her 1965 book ‘Folk Songs of the Southern Appalachians’, she records that it was ‘not ever sung lightly about the house, not even by us https://www.flickr.com/photos/ girls over the dishpan, but was saved for summer floridamemory/18470472681 evenings on our long front porch after supper. We knew from the words that it was supposed to be a funny song, but somehow the tune of it was so sadly beautiful, so sort of eerie, that we never felt like laughing whenever we sang it’.

One theory of the origin of Nottamun Town relates to the period of the English civil war. Fought between 1642 and 1651, this devastating conflict killed hundreds of thousands through disease, violence and famine in a country of five million. The aftermath undoubtedly provided additional drivers for emigration to the New World, carrying with it the themes and tropes of the old. It was in Nottingham that Charles I raised his royal standard in 1642, transforming what had been a morass of smaller conflicts into a full-blown war. Pamphlets, woodcuts and songs all made use of the kind of ‘topsy-turvy’, absurdist imagery we find in ‘Nottamun Town’ to interpret and satirise the traumas that they had witnessed. In fact, people often referred to the Civil War itself as ‘the World Turned Upside Down’. Revolutionary England was a fervent and fertile arena for the spread of cultural ideas – the printing press was becoming more widely available and the political and economic earthquakes of these times had shaken apart traditional modes of civil practice. In his book ‘The World Turned Upside Down: Radical Ideas During the English Revolution’, Christopher Hill explains that “the Revolutionary decades produced a fantastic outburst of energy, both physical and intellectual... [namely,] the continuous flow of pamphlets on every subject under the sun... For a short time, ordinary people were freer from the authority of church and social superiors than ever before, or were for a long time to be again...” Just so with our song: “Met the King and the Queen, and a company more, Come a-walking behind and a-riding before”.

A famous example of one of these radical political pamphlets gives us reason to think that the proper origins of Nottamun Town and its topsyturvy imagery may be truly ancient.

https://en.wikipedia.org/wiki/The_ World_Turned_Upside_Down

An English ballad called “The World Turned Upside Down”first appeared within political pamphlets the mid-1640’s. It lamented that the recent, decisive Parliamentarian victory at the Battle of Naseby had put paid to traditional English Christmas traditions. The newfound religious puritanism which had settled across the land, it was sung, had ended ancient modes of Christmas celebration which had brought rich and poor together since pagan times.

“Our Lords and Knights, and Gentry too, doe mean old fashions to forgoe: They set a porter at the gate, that none must enter in thereat. They count it a sin, when poor people come in. Hospitality it selfe is drown'd. Yet let's be content, and the times lament, you see the world turn'd upside down”. Despite the upheavals of the time, the song was popular and enduring enough to have been sung by the defeated army at the British surrender at Yorktown to American Revolutionaries a century-and-a-half later, an event recently commemorated by Lin-Manuel Miranda in his smash-hit play ‘Hamilton: An American Musical’. In the play, as the British surrender, Alexander Hamilton describes the retreat of the British as he hears “that drinking song they’re singing”. Duly, the cast burst into chorus: “A world turned upside down!”. It is a brilliant moment to watch. “Yet let’s be content, and the times lament”. This was the same form/meaning tension we heard in ‘Same Old Man’,recorded in Los Angeles in 2015. We heard it again in ‘Nottamun Town’ handed down through generations of a sprawling Appalachian family from the 1780’s until It was committed to record in the 1950’s. It pops up again in a 384-year-old English political pamphlet written to decry the loss of still older traditions of absurdist dramatic invention. So how far back does the topsy-turvy, absurdist trope really go? The verse I selected from ‘The World Turned Upside Down’ seems to refer to a tradition known as the ‘mummer’s play’. Mummer’s plays were typically formed by amateur troupes who would go from pub to pub or manor to manor, acting out

skits and sketches in return for cash, particularly at Christmas time. Seasonal plays which commemorated important events of the agricultural calendar probably go back in one form or another to the origin of civilization. According to Tom Leonardi who addressed the subject in a blogpost in 2014, the English tradition of mummer’s plays and their Western European analogues evolved from the Roman Festival of Saturnalia, held to commemorate the onset of the Mediterranean sowing season in December. Saturnalia featured activities and behaviours that were the opposite of those normally accepted.Drunkenness, sexual promiscuity and the singing of nonsensical songs were encouraged. Importantly, this was also one origin of so-called ‘rites of reversal’, wherein rich folk and paupers would ‘swap places' for the period of the festival. This exchange of wealth and authority was supposed by anthropologists to have released tensions that had built up across the year. A winter celebration of sowing was not much use in the dead of British winter, but the rites of reversal and cultural flipping were kept. “Every December, British peasants continued to dress up or down… they made the rounds of the manor houses where they’d sing, perform foolish skits, and beg for rewards. The performers were called mummers”. Skits and songs often dealt with the big topics of the day - plagues, wars, and religious persecution. Half a continent away and a couple of thousand years after early versions of these rituals were first performed, it is this mummering tradition that our satirical pamphleteer complained of losing as he lampooned the meanness of the newly solemn and puritanical British nobilityin the mid-17th century. Nonsensical flipping of normal social relationships, clashing meanings, absurd imagery – these modes of expression are mechanisms of social coping as old as society itself. If after reading this, your ears are pricked by an apparently strange or nonsensical lyric, remember the Roman peasants and slaves. Remember the English mummers satirising and celebrating their world. Remember the Kentucky mountain-folk and their hard scrabble life. Remember the Afro-American musical tradition and how it was used in the same way to remember ancestors, interpret social relationships and cope with brutality and trauma. We join their descendants in lamenting, celebrating and commemorating these histories every day, whether we realise it or not. Think about the famous black humour of the medical profession and for how many millennia this coping mechanism could stretch back into the past. If you want to hear a real-life example of the kind of local oral tradition I have

been discussing in action, head in Decemberto one of the various pubs around the Peak District which maintain their own tradition of Christmas Carolling – some of whose songs very much fit the description in terms of irreverence and absurdity. The tradition has in the past fallen foul of the churches and the scholars due to so-called ‘poor taste’. Each village has its own canon, kept alive by the old methods. You can also catch up with the various troupes of mummers/’Guisers’ still roaming the pubs of the Peak District at Christmas time. If at first glance, it seems a rather quaint tradition – remember that it is a direct descendant of the pagan Saturnalia and they got up to all sorts, so it is probably for the best.

https://en.wikipedia.org/wiki/Winster_Guisers#/media/File:Winster_Hobby_horses_&_mummers_(small).jpg

Can you run a YouTube channel whilst studying at med school? Krish Shah, CP2 Short answer: Yes. Hi, my name is Krish and I am a 4th year medical student at Nottingham. I currently run a YouTube channel (search “Krish Shah” on YouTube). In this article, you’ll find out why and how I started, as well as how I make my videos.

Why? The medical school application can be a very daunting process, with many stages such as the UCAT (formerly UKCAT) exam, the BMAT exam, personal statement and the interviews (and obviously A levels…) Some people, including myself, are lucky enough to have gone to a school which coaches you and provides enough resources to help you through the entire application process. I naively assumed that all schools would also provide help, however it was only after meeting other medical students that I began to understand the struggles that some have gone through. Many students don’t have any support from their 6th form and turn to external tutoring such as through “The Medic Portal” or “Kaplan” for help with the medical school application, and only upon researching did I find out just how ridiculously expensive these courses can get.

Let’s take a look at the UCAT exam, since this is where most students rely on tutoring. The Medic Portal offer a UCAT online webinar for a total of £157.50… and that’s including a discount (normally its £175.00). This is a huge amount to stomach for a single day’s worth of preparation for only one facet of the medical school application. Many prospective medical students were asking me questions about the UCAT exam and about medical school, so I decided to put all this knowledge on the internet as a free resource. I decided that YouTube would be the best medium for me to share this on.

“If you’re in the luckiest one per cent of humanity, you owe it to the rest of humanity to think about the other 99 per cent”. – Warren Buffett How? YouTube is an extremely competitive environment, and so it’s important to make your videos and thumbnails as polished as possible. I personally don’t have any specialist audio or video equipment, so initially all my videos were filmed entirely on my iPhone and edited on my ageing 6-year-old MacBook. You definitely don’t need the flashiest and most expensive hardware to make videos. It is definitely worth watching tutorials and courses on how to make videos tailored to the editing software of your choice – in my case, these would be Adobe Photoshop & Apple’s Final Cut Pro X (although iMovie is free on mac and also fantastic). My advice is to just start making videos and learn while you’re going. If you want people to watch your video, it’s initially important to promote it within your friend circles. An easy way to do this is by utilising your existing social medias like Instagram, Snapchat and Facebook. Just make sure you’re not over-promoting and annoying all your followers.

The Process: Making a YouTube video is a lot more complicated than it looks. There are many stages to the process and I’ll give a quick explanation of each step. 1. Video idea • Think about videos which you would have wanted / needed to watch • Think about topics which would be entertaining • Think about topics which would be educational

2. Script (rough) • Once you have a video idea, start writing a rough script. • Use bullet points & don’t write it word for word, because then you will tend to read off the script and not look at the camera. Bullet points make your videos sound more natural & flowing. 3. Filming • If you have any good smartphone from the last few years, it probably has a good enough video camera to film basic YouTube videos. • A tripod is a great investment (amazon basics one is more than good enough) and gives you a nice steady camera shot. • Don’t worry if you make mistakes while filming, just say the phrase again and you can easily cut out the mistakes while editing. 4. Editing • For basic editing, cut out any mistakes. • Think about putting in some background music (this is a personal preference, for me it depends on the video) • Make sure background music is quiet enough that your video topic is still the main thing being heard 5. Thumbnail photo & edit • You can either use a screenshot of the video as a thumbnail or take a new picture. • Make it a clean thumbnail and put your video title in the photo. • Make sure everything is clear and can be easily read and seen. 6. Upload & video settings online • Upload the video onto YouTube Creator Studio • Create a catchy description with relevant information inside it. I use a template, so feel free to take a look at my descriptions. • Make sure to use tags to give your video a larger reach So, I’ll end this article in the same way I end my YouTube videos. Thank you so much for reading and I hope this was enjoyable or educational. If you did enjoy it, then feel free to go over to my channel and like, subscribe and leave a comment.

Controlling COVID-19 Ahsab Chowdhury, A100 Y1 The world has been brought to a halt by COVID-19 and scientists are scrambling to understand both how to cure the disease and how to prevent its spread. In many ways the work of John Snow and modern-day epidemiologists is fundamentally the same – work to find the cause of their respective diseases and put a stop to it. However, the size of the global population, its interconnectedness as well as improvements in research and understanding make the coronavirus pandemic drastically different from 1854. The cholera outbreak in Soho, London in the autumn of 1854 was, as Snow wrote, “the most terrible outbreak of cholera which ever occurred in the kingdom”. One hundred and twenty-seven people living in or around Broad Street died. Within a week over three-quarters of the residents had fled their homes. By the 10th of September the death rate of the St Anne’s, Berwick Street and Golden Square areas had risen to 12.8% - more than double that of the rest of London. Though Snow did not understand how cholera was transmitted, he was quick to understand the correlation and spread of the disease. He used personal accounts, a dot map and statistics to point out that the water pump on the corner of Broad Street and Cambridge Street was at the centre of the Soho outbreak. He recognised that treating disease required looking at the whole population and its environment rather than individual, isolated cases. There was a large amount of resistance to Snow’s ideas and both the council and water companies dismissed him. In today’s world such research would not be ignored. In fact, Snow’s work was published in a local architecture magazine called ‘The Builder’, a far cry from today’s the peer reviewed journals, and this certainly did not help stop the spread of cholera in London. Despite this, Snow’s methods are a good way of framing our understanding of disease and certainly gives doctors a way to approach the global pandemic. The attempt to control the COVID-19 pandemic has benefitted from our understanding of virology and communicable disease. Sequencing the genome of the virus allows us to identify it origin, mutation rate and what kind of virus it is (double stranded or single stranded, for example). Moreover, detailed research has revealed the best methods of preventing the spread of the disease. Epidemiological records in China reveal that up to 85% of transmission has

occurred between family members and healthcare workers. This suggests that a close, unprotected environment is ideal for direct contact or via fomites left on surfaces. As a result, health care workers across the globe have been provided with personal protective equipment (PPE) to stop the spread of disease between colleagues and family. Moreover, complex mathematical models only further our understanding of the spread of disease. Stochastic modelling by Hellewell showed that as the R0 value of COVID-19 increased the amount of contact tracing needed to control spread also increased (up to 90% for a value of 3.5). These models only benefit modern-day epidemiologists and provide incentive for government and healthcare workers to properly document and isolate infected patients. Indeed, Hellewellâ&#x20AC;&#x2122;s model showed that effective contact tracing and case isolation was enough to control a new outbreak within 3 months. A large arm in the fight against the novel coronavirus is also testing and public health policy. Not only did Snow lack both, as mentioned there was even pushback. Researchers have large amounts of trust from the public and from governments. Many countries review evidence with researchers and are now using a combination of containment and mitigation activities to reduce or delay the chances of large outbreaks, learning from the Wuhan outbreak. They vary their activities/policies, such as selfisolation and banning group activities, based on national risk assessments that consider population, hospital resources and ventilators. Indeed, Snowâ&#x20AC;&#x2122;s closing of the water pump was not replicated and there were still over 3,000 cases in the rest of London. The Soho council also did not improve living conditions in the area a year after Snow visited, again showing how the coronavirus outbreak differs from the Cholera outbreak. An important distinction to make between the cholera outbreak and the COVID19 pandemic is the nature of the disease. Whereas cholera is caused by contaminated water, the coronavirus is a respiratory disease that can survive in the air and as fomites. In cramped metropolitan areas diseases like this can easily spread from one person to another. In Snowâ&#x20AC;&#x2122;s case, however, simply closing the source of infected water is enough to prevent the spread of cholera. Moreover, viral diseases are more difficult to develop drugs for as they are difficult to target with their complex life cycles and can easily mutate, whereas antibiotics can be used against cholera. In this way modern epidemiologists struggle to control COVID-19.

Epidemiologists today assess the severity and spread of infectious diseases in context of human activity and the environment. Our understanding of large-scale outbreaks, like Ebola or SARS, by contact tracing, monitoring the threat of a global pandemic, and educating the public with the help of media and the government. We view the people and cases of disease passing through a region within the context of their community and, more broadly, the environment surrounding that community, much like Snow did in Londonâ&#x20AC;&#x2122;s West End. However, unlike Snow with more research and research, we might have seen and will continue to see advances in contact tracing. In the fight against COVID-19, control measures such as isolation, testing and contact tracing are important to prevent the spread of disease.

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