Advance your career. Enhance your quality of life. Explore your job opportunities in British Columbia, Canada. Meet Health Match BC’s recruitment consultants at: BMJ Careers Fair Stand D, Business Design Centre London, UK October 1-2, 2010 Or join us for an information session: Newcastle upon Tyne, UK June 26th at 14:00 Newcastle Marriott Metrocentre European 3 Suite
York, UK June 28th at 19:00 Royal York Hotel and Events Centre Station Road, North Yorkshire
Connect with us online: Please note: Specialists with postgraduate training from the UK or Ireland must hold the CCT /CCST or equivalent from the UK Higher Specialist Training Authority (Medicine or Surgery). Family Physicians/General Practitioners must have a minimum of two years approved and accredited postgraduate training.
Toll-Free: 1.800.262.70000 welcome@healthmatchbc.org www.healthmatchbc.org
Health Match BC is a free health professional recruitment service funded by the Government of British Columbia, Canada.
THE MAGAZINE FOR JUNIOR DOCTORS
Presenting History JuniorDr is a free lifestyle magazine aimed at trainee doctors from their first day at medical school, through their sleepless foundation years and tough specialist training until they become a consultant. It’s proudly produced entirely by junior doctors – right down to every last spelling mistake. Find us quarterly in hospitals throughout the UK and updated daily at JuniorDr.com. Team Leader Matt Peterson, team@juniordr.com Editorial Team Ben Chandler, Yvette Martyn, Ivor Vanhegan, Anna Mead-Robson, Michelle Connolly, Muhunthan Thillai JuniorDr PO Box 36434, London, EC1M 6WA Tel - +44 (0) 20 7 193 6750 Fax - +44 (0) 87 0 130 6985 team@juniordr.com Health warning JuniorDr is not a publication of the NHS, David Cameron, his wife, the medical unions or any other official (or unofficial) body. The views expressed are not necessarily the views of JuniorDr or its editors, and if they are they are likely to be wrong. It is the policy of JuniorDr not to engage in discrimination or harassment against any person on the basis of race, colour, religion, intelligence, sex, lack thereof, national origin, ancestry, incestry, age, marital status, disability, sexual orientation, or unfavourable discharges. JuniorDr does not necessarily endorse or recommend the products and services mentioned in this magazine, especially if they bring you out in a rash. © JuniorDr 2010. All rights reserved. Get involved We’re always looking for keen junior doctors to join the team. Benefits include getting your name in print (handy if you ever forget how to spell it) and free sweets (extra special fizzy ones). Check out JuniorDr.com.
INNOVATING FROM THE FRONTLINE Y oung doctors are bright, often highly creative, highly energised people. It is hardly surprising that some of them have very highly developed entrepreneurial skills. What is more surprising is that the establishment does not harness young bright brains and use them to their full potential as any other industry would do. The NHS tends to somewhat distain new ideas from anywhere other than the traditional academic world of scientific breakthrough, double blind trails and learned papers. Instead of encouraging innovative thinking in junior doctors, the tradition has been - apart from in a small number of forward-thinking organisations - to ignore it. What if a pair of fresh bright eyes, close to patients and the clinical frontline happens to spot a new way of doing things that improves the process; the way patients feel; or maybe a radical way of communicating key information to clinicians who work at strange times of the day and night? What if those fresh eyes see ways through problems that others, with their eyes tired from being so close and their minds, brainwashed and stuck in a groove of ‘this is how it is and always will be’ have tried for years to solve? Huge, complex, publically-funded organisations like the NHS are not on the whole given to welcoming entrepreneurial thinking. Indeed, an indicator of how well the would-be entrepreneur is doing can be measured in terms of the number of times per day they are told to ‘not rock the boat, doctor’. Yet, the complexity of running healthcare, free for all at the point of delivery is unlikely to become miraculously easy over the next few years of financial constraint. And it may just be that the NHS can no longer afford to ignore the innovative ideas of its junior doctors. This issue we look at ‘Medrepreneurs’ – medical professionals who turn entrepreneurs. Read how junior doctors are taking the lead in improving our healthcare system then join the movement online at JuniorDr.com and on Twitter @ juniordr.
Professor Jenny Simpson Chief Executive British Association of Medical Managers (BAMM)
“The NHS can no longer afford to ignore the innovative ideas of its junior doctors.”
What’s inside 04 09 19 20 24
LATEST NEWS Medrepreneurs Pre-hospital Medicine
26 30
Snow white gets a check-up Medical Courses and Conferences
Careers Ophthalmology Secret Diary of a Cardiology SpR
TRIAGE
3
Tell us your news. Email team@juniordr.com or call 020 7684 2343.
NHS
Coalition government outlines plans for the NHS ✓Less ‘political micromanagement’ ✓More decision making by doctors
T
he new coalition government has outlined their health programme in a document which puts an independent commission at the forefront of the future NHS. It also guarantees that health spending will increase in real terms for at least the term of the current parliament. Key objectives to free the NHS from ‘political micromanagement’ and to increase democratic participation were also introduced. Speaking at the launch of the proposals Health Secretary Andrew Lansley said: “This document sets out a clear message to the NHS. That our united vision is for a healthcare system which achieves outcomes that are amongst the best in the world, and free from day-to-day political interference” “We will cut back bureaucracy and hand back power to clinicians and patients to ensure they are at the forefront of decision making about NHS services. The proposals will drive up standards of care, eliminate waste and lead to better outcomes that improve the health of the nation.” On NHS structure: • We will establish an independent NHS board to allocate resources • We will significantly cut the number of health quangos • We will cut the cost of NHS administration by a third and transfer resources to support doctors and nurses on the front line • We will reform NICE and move to a system of value-based pricing • We will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers
4
NEWS PULSE
On NHS institutions: • We will strengthen the power of GPs as patient’s expert guides through the health system by enabling them to commission care on their behalf • We will publish detailed data about the performance of healthcare providers online • We will ensure there is a stronger voice for patients locally through directly elected individuals on the boards of their local PCTs On doctors: • We will seek to stop foreign healthcare professionals working in the NHS unless they have passed robust language and competence tests • We will enable patients to rate doctors according to the quality of care they received • We will renegotiate the GP contract The coalition document was published in advance of a government white paper planned for July which will provide a detailed plan of the Department of Health plans for the coming parliamentary term.
Andrew Lansley Health Secretary
“We will cut back bureaucracy and hand back power to clinicians and patients to ensure they are at the forefront of decision making about NHS services.”
programmeforgovernment.hmg.gov.uk/nhs
Frontline services already feeling the pressure
R
edundancies, recruitment freezes and service cutbacks are already being felt across the NHS, according to a BMA survey of local negotiating committee (LNC) chairs. Around one in four respondents (24%) reported that redundancies were planned in their organisation. Nearly three quarters (72%) indicated that clinical service or infrastructure developments were being postponed for financial reason, and two out of
five LNC chairs reported that access to treatments or therapies was being limited. “Despite the government’s best assurances that front-line services will be protected, our data show that cuts are already being planned or becoming reality and that these will have an impact on doctors’ ability to care for their patients,” said Dr Hamish Meldrum, Chairman of Council at the BMA. www.bma.org.uk
NEW MICROBIOLOGY TEXTBOOK
Regulation
GMC: Improper relationships with patients most common reason for being stuck off
T
he GMC has published the annual report on the number of complaints received about doctors and how those complaints were dealt with. 85 doctors were erased from the Medical Register at a Fitness to Practise panel hearing in 2009 compared to 42 in 2008. The most common allegation resulting in erasure from the register was improper relationships with patients – 15 cases in total. The report shows that 270 Fitness to Practise Panel hearings took place in 2009 compared with 204 in 2008. The most common hearing outcome was suspension – 77 doctors were suspended in 2009. Paul Philip, Director of Standards and Fitness to Practise, said: “We are seeing an increasing number of referrals to our fitness to
practise procedures from employers and other public authorities like the police but the reasons for this are not entirely clear,” said Paul Philip, Director of Standards and Fitness to Practise. “What is clear is that although there has been an increase in the number of cases the overall numbers represent a very small proportion of the 230,000 registered doctors in the UK.” www.gmc-uk.org/about/council/7036.asp
CONTENTS PART I Foundations PART II Disease Mechanisms PART III Characteristics of
Working conditions
EWTD causes higher rates of sick leave in junior doctors
T
he European Working Time Directive (EWTD) may be failing in its primary objective to improve the welfare of employees, according to a study published in Clinical Medicine, the journal of the Royal College of Physicians. A group of doctors have found a link between the introduction of rotas compliant with a 48-hour working week and increased prevalence and longer periods of sick leave in junior doctors. The study at a district general hospital in East Sussex reviewed sick leave data for all junior doctors in the year prior to, and following, the reduced hours working week. Although mortality rates and length of stays did not alter significantly during the study period, episodes of sick leave among junior doctors more than doubled with just over 1 in 3 taking leave in the year before implementation to nearly 3 in 4 the following year. “Research carried out by the RCP supports these findings such as high sickness and vacancies levels across England and Wales. We are concerned
Microbiology: A Clinical Approach is a new and unique microbiology textbook for health science students studying microbiology. It is clinically relevant and uses the theme of ŝŶĨĞĐƟ ŽŶ ĂƐ ŝƚƐ ĨŽƵŶĚĂƟ ŽŶ͘ dŚĞ Ŭ ŝŶĐůƵĚĞƐ ŝŶŶŽǀĂƟ ǀĞ ĐŚĂƉƚĞƌƐ ŽŶ ĞŵĞƌŐŝŶŐ ŝŶĨĞĐƟ ŽƵƐ ĚŝƐĞĂƐĞƐ͕ ĂŶƟ ďŝŽƟ Đ ƌĞƐŝƐƚĂŶĐĞ͕ and bioterrorism not seen in other textbooks.
that this has significant implications for patient safety and the quality of medical training in the UK,” said Dr Andrew Goddard, Director of the RCP’s Medical Workforce Unit. Doctors’ leaders have argued that increased shift work and reduced working and training hours, in part in response to the new working time regulations, have led to a breakdown of the traditional medical team, which offered much support to trainees.
Disease-Causing Microorganisms PART IV Host Defence PART V ŽŶƚƌŽů ĂŶĚ dƌĞĂƚŵĞŶƚ PART VI Microbial Infections PART VII dŚĞ ĞƐƚ ĂŶĚ ƚŚĞ Worst; Important Issues in Microbiology
STUDENT RESOURCE WEBSITE z z z z z
ͲdƵƚŽƌ MicroMovies ƵŐ WĂƌĂĚĞ Interactive Flashcards and Searchable Glossary Student Lecture Notes
(www.garlandscience.com/micro)
INSTRUCTOR RESOURCES z
dŚĞ ƌƚ ŽĨ DŝĐƌŽďŝŽůŽŐLJ͗ ůŝŶŝĐĂů ƉƉƌŽĂĐŚ z Instructor’s Manual z Instructor’s Lecture Outlines z MicroMovies z Instructor’s Media Guide z YƵĞƐƚŝŽŶ ĂŶŬ z Diploma® Computerized YƵĞƐƚŝŽŶ ĂŶŬ z Classwire™
www.classwire.com/garlandscience (Classwire™ is a trademark of Chalkfree, Inc.).
January 2010 ϳϯϯ ƉĂŐĞƐ͗ ϲϯϬ ĨƵůů ĐŽůŽƌ ŝůůƵƐƚƌĂƟ ŽŶƐ WĂƉĞƌďĂĐŬ͗ ϵϳϴͲϬͲϴϭϱϯͲϲϱϭϰͲϯ͗ £45.00
www.rcplondon.ac.uk www.garlandscience.com
Senior manager bills NHS for horse semen
Medical students
Parents face hidden £15,000 bill to send their children to medical school
M
any families are being forced to find an average of £3,123 a year – or an estimated £15,000 over a five year medical course – to get their children through medical school due to spiralling levels of debt and the impact of tuition fees, says a new BMA report. The report which surveyed 1,987 students across the UK found that two-thirds of students are now relying on parental support while they study, with the average amount being given in a year standing at £3,123. It also found that junior doctors who graduated in 2009 left medical school with an average debt of £22, 851 – up by a fifth since 2008. “The UK is facing a growing crisis in medical student finance that many policy makers appear unwilling to address,” said
Louise McMenemy, the BMA’s student finance lead. “Levels of medical graduate debt have grown by a fifth to more than £22,000 in just one year owing in part to the increasing burden of tuition fees, as well as rising accommodation and other costs.” “All students are facing rising debt levels, but those studying medicine are being hit particularly hard, partly as they are often not able to take part time work as their degree is more intensive and lengthy than other undergraduate programmes.” The study also found that the number of students entering medicine from low incomes remains poor, with just one in twenty medical students coming from the lowest two income groups. www.bma.org.uk
A senior NHS manager who bought horse semen, thoroughbred horses and numerous other goods and services for her private stud business with NHS funds has been jailed for two years and nine months for defrauding the NHS of over £200,000. Louise Tomkins, interim Director of Operations for Ealing Hospital NHS Trust, paid the high costs of her private horse and stud farm business by fabricating and manipulated invoices which she took into work and then authorised for payment by the NHS. www.nhscounterfraud.nhs.uk
Knighted in Queen’s Birthday Honours
Professor Ian Gilmore, president of the Royal College of Physicians (RCP), and Peter Rubin, Chair of the General Medical Council have both been awarded a Knighthood for services to medicine in the Queen’s Birthday Honours list. Professor Sir Ian Gilmore became president of the RCP in 2006 and previously served the RCP as registrar. Sir Peter Rubin was head of PMETB from 2005 – 2008. www.gmc-uk.org www.rcplondon.ac.uk
Training
GMC offers reassurance on exams outside training programmes
T
he GMC has sought to reassure doctors about examinations taken outside approved postgraduate training. It will now permit all trainees already in approved CCT training programmes, subject to successful completion of them, to obtain a CCT even if they passed one or more of their examinations before entering the programme. This includes doctors already selected to enter CCT training programmes in August 2010. “This issue has caused a great deal of concern among trainees and we are determined to sort it out as quickly as possible,” said Niall Dickson, Chief Executive of the GMC. “It is now apparent that we can be more flexible while still maintaining the coherence and quality of postgraduate education in the UK. I hope we have given the immediate assurance that is needed and I am sure that working together with all those affected we can agree a long term solution.” The GMC took over the regulation of postgraduate training in April this year and
6
NEWS PULSE
sought legal advice in relation to examinations taken by doctors who are not at that point part of an approved training programme. The GMC is now planning to draw up proposals for discussion on the timing of examinations for future trainees. It believes there is scope for doctors not currently in or about to enter approved training to benefit. A further meeting will be held in late summer or early autumn to discuss the proposals. www.gmc-uk.org
Niall Dickson Chief Executive, GMC
“I hope we have given the immediate assurance that is needed and I am sure that working together with all those affected we can agree a long term solution.”
New interim Chief Medical Officer Professor Dame Sally Davies will take up the role of Chief Medical Officer following the departure of Sir Liam Donaldson at the end of May. Sally Davies has been actively involved in NHS research and led the development of the National Institute for Health Research (NIHR). Liam Donaldson has been appointed as the new Chairman of the National Patient Safety Agency (NPSA). www.dh.gov.uk
Psychiatry recruitment crisis Short placements in psychiatry for medical students could be enough to halt the specialty’s recruitment crisis. A study in Scotland found that the appeal of a career in psychiatry among medical students who completed a four-week placement jumped from 25% to 70%. The research follows a previous study which found that among non-psychiatrists psychiatry was the least respected (28%) of all specialties, whilst medicine was the most respected (54%). www.rcpsych.ac.uk
GetThrough_advert_2:Layout 1
Working conditions
Interrupted docs give shorter and poorer care to patients
H
ospital doctors who are frequently interrupted whilst working spend less time on tasks and fail to return to almost a fifth of their jobs, according to new research published in the journal Quality and Safety in Health Care. They found that, on average, doctors were interrupted 6.6 times per hour and during 11% of all tasks. Interruptions happened most often during documentation (around 43%) and direct or indirect care (17% and 19% respectively). “Our results support the hypothesis that the highly interruptive nature of busy clinical environments may have a negative effect on patient safety,” say the authors. “Task shortening may occur because interrupted tasks are truncated to ‘catch-up’ for lost time, which may have significant implications for patient safety.” The study of 40 doctors in Australia also found that in a fifth of cases (18.5%) doctors failed to return to the task they have been working on before being interrupted.
“Junior doctors multi-task for 13% of their time.”
Of the 210 hours monitored during the time and motion study junior doctors multi-tasked for 12.8% of the time and the average time spent on a task was 1.26 minutes. qshc.bmj.com
Regulation
Difficulties at medical school increase the likelihood of professional misconduct
D
octors who are male, from lower income groups and have experienced academic difficulties at medical school are more likely to find themselves in front of the GMC for professional misconduct, according to the BMJ. The study of 59 misconduct cases was compared against 236 individuals who had not been referred to the GMC. It found that those called before misconduct hearings were more likely to be male, from lower social class groups and to have failed exams or repeated parts of their medical training than their peers. It also found they were less likely to have achieved Consultant status or to be on the GP Register. “This small preliminary study provides the first evidence in the UK that male students and those who perform poorly in the early years of the course might be at slightly increased risk of subsequent professional misconduct,” say the authors. “Lower social class background (as estimated from the father’s occupation at course entry) was
Save 20%
on our selection of detailed, uncomplicated revision guides for junior doctors
also an independent risk factor in this retrospective study.” The authors from the University of Nottingham Medical School emphasise that this is a small study and that “the findings are preliminary and should be interpreted with caution”. They maintain that the data must be viewed in context stating that 86% of the doctors graduated at least 20 years ago when life at medical school and in the profession may have been different. www.gmc-uk.org www.bmj.com
rsmpress.co.uk Please quote JuniorDr when ordering
1
SkinBag jacket by Olivier Goulet
T
his summer the ‘Skin’ exhibition at the Wellcome Collection invites you to re-evaluate the largest and probably most overlooked human organ. It considers the changing importance of skin, from anatomical thought in the 16th century through to contemporary artistic exploration. Among the items on display is the SkinBag jacket (pictured), a material created by Olivier Goulet, a french transmedia artist. ‘Skin’ runs at the Wellcome Collection from 10 June - 26 September 2010.
www.wellcomecollection.org Used with permission. Wellcome Collection / www.skinbag.net
Medr epr eneu rs
When medicine and entrepreneurs meet Doctors have always been entrepreneurs. From developing the stethoscope to patenting the kidney dialysis machine, they have been involved in some of the world’s most successful and profitable products.
W
ith our imagination and experience of the NHS frontline, junior doctors have an advantage. We’ve all had that ‘eureka’ moment or fantastic business idea but developing a successful business plan is often the stumbling block.
In this medrepreneurs section you’ll find a showcase of junior doctors who have ventured into business to improve health and make a profit. Each of these success stories demonstrate how medicine and business can meet.
Read it, then think of your big idea. Want to be a medrepreneur? Get advice, collaborate and join the discussion in the medrepreneur group on JuniorDr.com.
Section editors: Ivor Vanhegan / Emma Stanton / Claire Lemer
Medrepreneurs
From idea to reality
Tournistrip Taking a great medical idea to reality is a huge step – never mind doing it whilst revising for medical school finals. Two Imperial College medical students, Christian Fellowes and Ryan Kerstein, did just that developing the award winning Tournistrip – a disposable single-use device aimed at reducing disease transmission during venesection. JuniorDr’s Ivor Vanhegan asked them about their journey to a finished product. How did you come up with the idea for the Tournistrip?
We had been friends throughout medical school and found that we worked well together, regularly feeding ideas off one another and coming up with new projects. We struck upon the idea of a disposable tourniquet during our clinical attachments in the fourth year when we realised its potential as a means of reducing infection. We then set about trying to work out what worked best and if people would be really interested in it.
the entire process the most crucial step was obtaining this patent. There are quite a few aspects to consider with the patent but one key factor is being able to justify the originality of your product. As I remember, Tournistrip has numerous separate claims of originality. Completing the paperwork can take some time so it also pays to be patient. With the prototype in hand and with enough scientific literature to back up our challenge we approached Lord Darzi who pointed us in the direction of Imperial Innovations for help developing the idea.
What did you learn from your initial research?
The potential risk of infection with reusable tourniquets is self-evident. It is estimated that 40 million procedures requiring tourniquets are carried out each year in the NHS. During the early days of our investigation we were helped enormously by Dr Berge Azadian, a Consultant Microbiologist at Chelsea and Westminster Hospital. It was with his help that we designed our own work to investigate the need for single use tourniquets.
“In all this, certainly the most crucial step was obtaining the patent.”
How did you patent the idea?
As soon as we knew the idea was valid we then approached a specialist patent solicitor. It is so important to get this process right first time as once it has been submitted you cannot change the initial patent. In 10
Medrepreneurs
“It is very important to be wary of the great offers that are made to you in the beginning.” Once our product was protected we then went to meet potential manufacturers and one particular company took sympathy on our plight as students with a novel product. With their help we were able to source the appropriate materials and then it was a long process of trial and error to get the right design and develop the prototype. In all this, certainly the most crucial step was obtaining the patent. What support did you get along the way?
We opted to go with Imperial Innovations as they have the expertise and experience necessary in the field of intellectual property and product development. They sat us down at the beginning to find out
what our ambition and idea for the product was. They gave us the option of handing over all responsibility for manufacture and development to them and for us to take a back seat, or to remain involved in its development. Our aim has always been to see our idea turned into reality and it’s that which motivates us so we remain involved in all aspects of the project to this day. There are many other similar organisations out there that are willing to assist with your invention and it’s well worth shopping around to find who is best for your needs. I’m aware that NHS innovations provide a similar service and its my understanding that if your idea comes from working in the NHS then you have to use their support as they own the IP. As a student it’s also worth considering that many universities have enterprises designed around helping to develop your inventions. It is very important to be wary of the great offers that are made to you in the beginning. Always check the terms carefully and be realistic - just because you have an idea does not mean that you are entitled to all the potential benefits. What stage is the Tournistrip at now?
Things have moved on enormously in the last month or so. We were excited to hear that the product has made its way into the NHS Supplies Catalogue. This means that if a Trust is interested in buying a supply of Tournistrips it is now readily available for order and will hopefully be seen nationwide shortly. We are also about to start a huge Showcase Hospitals Trial organised by the Department of Health. Furthermore, the design
Box of Tournistrips
Top tips to getting your idea to market We asked Christian and Ryan for their top tips on taking a bright idea forward. (i) Get the patent right
Tournistrip SingleUse Tourniquet
It is so important that this first step is done properly or else all is doomed to fail. It is important for the patent side to be robust. Once made it cannot be altered and you must be ready to face multiple challenges to your design and be able to justify the originality and novelty. (ii) Be patient
has been approved internationally and we will soon be distributing to New Zealand, Australia and Holland.
There’s an old adage that invention is 1% inspiration and 99% perspiration! That’s certainly true - we came up with the idea as fourth year medical students and now it is some five years later. We were warned that things move at this glacial pace and it certainly pays to be tolerant and patient. Our product was for use in the health sector so required MHRA and CE-Marking approval - both of which we found to be lengthy processes.
What have you gained from the invention?
(iii) Be wary
Coming up with a medical invention has been hugely rewarding. The product itself is highly acclaimed having won the Imperial College Innovations Awards, as well as being a finalist in the National Engineer Innovations awards and the Imperial College New Business Competition. We also find that it has been of on-going help when it comes to job applications. There is often a space for explanation of management and innovation skills, as well as opportunity to discuss it at interviews. Throughout the whole process we have learnt valuable skills which have helped with our respective career progressions.
It might sound a cliché but be very wary of those that offer you fantastic sounding proposals. Read the small print and find out what they want in return or you may discover that you’ve handed over the entire asset to them. Also, when you meet new people make sure you have a Non-Disclosure Agreement and protect your asset at all times. (iv) Have a business plan
We didn’t have one at first and it was only when we entered a competition that required one that we actually got round to writing it. It was a really worthwhile experience actually committing to paper your thoughts of whom you’re targeting, when you will be able to deliver, and how much time and cost you expect to incur. If you want to be taken seriously by an investor they will insist on seeing your plan. There is so much help out there to get you started - most banks have software available as well do many websites.
Have either of you got any other ideas in the pipeline?
We always had some idea or other brewing when we were at medical school, and we both have a few very promising ideas that we are working on at the moment. In fact, we have learnt so much from our experiences with Tournistrip and feel this has been invaluable in knowing how to take these new ideas on. As to what they are exactly? You’ll just have to wait and see!
Got more questions? Ask Ryan and Christian online at JuniorDr.com (search: tournistrip) For more information and a free sample visit: www.asephealthcare.com
medrepreneurs
11
Medrepreneurs
ConQuest MedSchools Facilitating entry to medical school
C
onquest MedSchools is the brainchild of Dr Fiona Pathiraja and Dr Marie-Claire Wilson and was set up to help prospective medical students secure a place at a top ranking university. Fiona and Marie-Claire were medical students at UCL and Cambridge respectively and have since worked across a wide range of sectors gaining clinical, corporate and Civil Service experience. Conquest MedSchools provides information and services to help prospective medical students navigate elements of the
medical admissions process including personal statements and interviews. Their widening access arm also offers bursaries to those students who would otherwise not be able to afford the services. Fiona and Marie-Claire’s interest in widening access to medicine developed from their involvement in the Dick Whittington Summer School, a UCL initiative that inspires talented young people from inner-city state schools to apply to medical school. Conquest MedSchools is founded on the fundamental belief that entry to a top medical
school should not be reserved for the privileged few. Fiona and Marie-Claire have since extended their experiences by sitting on medical school interview panels and continue to help high-flying students of all backgrounds to get into the best medical schools.
Diagnosis
A social enterprise healthcare consultancy According to the Sunday Times1 this year is set to be the decade for “lipstick entrepreneurs” independent businesswomen. Junior doctors and newly qualified Executive MBA graduates, Claire Lemer and Emma Stanton, are living up to this trend.
C
laire and Emma are both actively involved in enthusing fellow doctors to be more involved in healthcare management and policy. Emma is on the National Leadership Council of the NHS and, until recently, chaired a younger branch of the British Association of Medical Managers, Bammbino. Two years ago, Claire created and ran an apprentice style leadership development programme for junior doctors, the Chief Medical Officer’s Clinical Advisory scheme. Despite growing interest amongst junior doctors, Claire and Emma have found that many junior doctors lacked the opportunity to put their passion for improving patient care back into the healthcare system. As individuals, these doctors felt they lacked the power to make change happen. When these agents for change tried to improve things, too often there was little recognition, encouragement or support from the system. To fill this void Claire and Emma set up a social enterprise called Diagnosis. A social enterprise is a business with primarily social objectives whose surpluses are principally reinvested for that purpose in the business or in the community, rather than being
12
Medrepreneurs
driven by the need to maximise profit for shareholders and owners2. There is much that healthcare can learn from other industries about dimensions such as quality improvement, overall strategy and employee engagement. In the future, Diagnosis will sponsor individuals from outside healthcare who wish to go to medical school. Too often, employees within the NHS have little exposure to the ‘real’ working world beyond the hospital walls. Undoubtedly, there is enormous value in attracting and training future clinicians with experience from other sectors into the NHS and Diagnosis aspires to play a role in doing so. Diagnosis positions itself as a healthcare consultancy for organisations such as the NHS, Department of Health and arms length bodies such as the Health Foundation. Rather than employ staff Diagnosis invites high potential junior doctors, medical students and allied health professionals into a virtual talent pool. Individuals are paid a daily rate to contribute towards a portfolio of projects that can be carried out alongside clinical and other professional commitments. www.diagnosisltd.eu
Emma Stanton and Claire Lemer
1. Britten, F. Warrington, R. Meet the lipstick entrepreneurs (January 3, 2010) The Sunday Times 2. DTI, 2002
DHI DM;DG9 HE:8>6AIN IG6>C>C<
8dbegZ]Zch^kZ iZmiWdd`h [dg ZVgan nZVgh¼ heZX^Vain igV^c^c\
IV^adgZY gZk^h^dc \j^YZh [dg bZbWZgh]^e ZmVb hjXXZhh
>cigdYjX^c\ V bV_dg cZl hZg^Zh [dg heZX^Vain igV^cZZh ^c hjg\Zgn! eVZY^Vig^Xh! bZY^X^cZ! ehnX]^Vign! de]i]Vabdad\n! VcVZhi]Zi^Xh! VcY dWhiZig^Xh VcY \ncVZXdad\n#
7gdlhZ ndjg cZVgZhi Wdd`h]de dg k^h^i lll#dje#Xdb$j`$bZY^X^cZ$dhi [dg bdgZ ^c[dgbVi^dc
Medrepreneurs
Yoracle
Notes sharing website
I
n 2005, during their final year at Leicester medical school, Craig Sheridan and Alex Gordon-Weeks founded a website to encourage students to share their revision notes whilst learning from those submitted by peers. The name ‘Yoracle’ is an acronym for ‘Your Online Revision and Clinical Learning Environment’. During the first year over 1500 medical students became members with a significant number contributing to the continually expanding bank of notes. This included providing information about preparing for medical electives and in
keeping with the ethos of the website sharing elective reports from returning students. We secured regular sponsorship from the Medical Protection Society and subsequently wrote their ‘Elective Handbook’ which is available to all UK medical students. Yoracle recently merged with ‘Meducation’ - a bespoke online medical education company - which offers not only revision notes but Powerpoint presentations, free exam questions, access to medical school communities and much more. www.yoracle.com
DocCom
Intelligent Communication Solutions
D
ocCom is a spin out company from University Hospitals Bristol NHS Foundation Trust and was formed to solve the problems healthcare organisations have in communicating critical information to their healthcare professionals. Jonathan Bloor and Jonathon Shaw, who witnessed the dire consequences of communication failure as junior doctors, founded it. The company has developed an Intelligent Communication Management system that uses web, email, mobile and networking technology to enable healthcare organisations to target the right information, to the right individuals, at the right time, using the right communication channel and then measure the effectiveness of this process. This means individual healthcare professionals are only targeted with information that is directly relevant to their job and training. DocCom are currently working with a variety of Healthcare Organisations, including Deaneries, Acute Trusts and the National Patient Safety Agency. The idea and initial development of the system was well supported locally by University Hospitals Bristol and the Severn Deanery. Over time it became more and more apparent that we were tackling a national problem and there was the appetite and potential for a large-scale solution working from the
14
Medrepreneurs
ground up. At this point we had help from NHS Innovation South West however there weren’t the funding or mechanisms to disseminate the innovation and make DocCom happen as a purely NHS venture. Jonathan and Jonathon undertook significant personal risk and formed a company in which University Hospitals Bristol is a shareholder. DocCom is funded through private investment and sales and is currently part of a high tech business acceleration centre called SetSquared (www.setsquared. co.uk) linked to the University of Bristol. Throughout DocCom’s existence Jonathan and Jonathon have collaborated closely with the NHS. The model they have created allows them to develop, implement and
diffuse innovative solutions that meet the requirements of NHS organisations to their front line staff. Progress has been slower than Jonathan and Jonathon would have liked. A major hurdle being the risk averse nature of the NHS. Key to DocCom’s success to date has been the fact that they have a good idea and a solution that works, and have worked long hours with determination and resilience. Jonathan and Jonathon aspire, through DocCom, to have a major impact on the quality, safety and efficiency of healthcare in the UK and beyond. www.doccom.info
Medrepreneurs
Podmedics
Revision Notes for Medical Students
J
unior doctor Ed Wallitt set up Podmedics as a final year medical student in 2007. After recording audio notes in preparation for his final exams, friends became interested and found them useful. Podmedics has continued to grow since then. It delivers high quality audio and video lectures (or podcasts) to medical undergraduates. These podcasts are produced weekly and the current archive contains in excess of 140 episodes covering topics
throughout medicine, surgery and the clinical specialties. All podcasts are available for free online. In the two years that Podmedics has been in existence it has become one of the most popular and highly subscribed medical podcasts. They have also recently developed a collaborative relationship with Elsevier and Oxford University Press. Podmedics tutorials are deliberately and unashamedly simple, presenting conceptual ideas rather than comprehensive reviews. It is designed to give an easily understandable taster to be used as a framework for a students own lecture and hospital experiences.
www.podmedics.com
The Online Journal of Clinical Audits Sharing audit information to drive better collaboration
Clinical audit is firmly embedded within the governance of high quality UK healthcare delivery. The NHS white paper on restructuring the training of doctors in the UK in 1997 stressed the importance of clinical audit as a quality improvement tool.
T
housands of audits are completed each year: some are presented, some are acted on and all are filed away. To date, there has been no platform for sharing audit methodology and results. The Online Journal of Clinical Audits (OJCA) was created by Dinkar Bakshi and Nick Prince - both trainees who were frustrated by the lack of change effected by quality clinical audits. Dinkar and Nick recognised the value of sharing audit information to drive better collaboration, increase re-audit rates, stimulate higher quality clinical audit and ultimately improve clinical care and patient safety. Dinkar and Nick found their greatest challenge was to settle on a suitable format to deliver a professional, cost-effective solution online. They settled on a journal format which doctors are familiar with and
adopted the required professional style of peer-reviewed submissions. The Online Journal of Clinical Audits (OJCA) is freely accessible online journal. Importantly, authors are not charged when their work is published. OJCA aims to stimulate clinicians to write up and present their audits as a professional paper in a timely fashion. The journal hopes to grow to become an online searchable database for quality clinical audits. This serves a multitude of purposes. Publication rewards the authors for completing a quality audit and provides a goal for those with an audit in progress. Clinicians can review audit methodology and results from another unit and use this to develop their own local audits. Re-audits are often not undertaken because they are lost when junior teams rotate to new hospitals. Publication within the journal provides
a lasting record, which juniors can use to direct re-audit. The Online Journal of Clinical Audits was launched in November 2009 with an extremely positive response from colleagues and a large number of submissions received following a limited pilot promotional launch. Dinkar and Nick are trying to develop lasting partnerships between OJCA and national healthcare organisations. This will harness the potential for clinical audit to improve healthcare delivery and patient safety. www.clinicalaudits.com
medrepreneurs
15
Medrepreneurs
When scientists get bored Sitting in a lab all day can be a pretty dull job. If you’re one of the world’s smartest brains that idle time can be a dangerous thing. You begin to start thinking about those things that the rest of us never worry about, like the pressures produced when penguins poo, or the forces required to drag sheep over different surfaces. Luckily, there are awards to be won for all that weird thinking. Michelle Connolly gives us the lowdown on the Ig Nobel Awards - prizes intended to celebrate the unusual, honour the imaginative and spur people’s interest in science, medicine, and technology.
I
f you want to read about weird and wacky research then the Annals of Improbable Research is the place to start. The journal’s popularity is soaring as more of the world’s most respected scientists vie to fill its pages. It’s not just the accolade of having your paper on the homosexual habits of necrophilic ducks published - the best research is recognised at the annual Ig Nobel Awards too. Held at Harvard University the awards ceremony isn’t your average ‘A’ list champagne-quaffing, canapé-gobbling affair either. A succinct “welcome, welcome” suffices for an introduction speech and an eight-year-old ‘Miss Sweetie Poo’ keeps proceedings moving at a rapid pace by greeting any acceptance speeches deemed to be too long with shouts of “I’m bored, I’m bored!”. Both the magazine and the awards are the brainchild of Marc Abrahams, a Harvard math graduate who, in 1991, decided achievements ‘that cannot or should not be reproduced’ must be acknowledged. As Abrahams acknowledges there’s often a little confusion between the Ig Nobels and a real Stockholm approved Nobel Prize. He is certain the Swedish capital would see the funny side, even when it comes to using the word ‘Nobel’. “We tried to be careful that no-one would ever confuse it, but this is a world full of confused people so I’m sure some people still don’t get it.” “By merely existing, the Igs make the Nobels shine all the more brightly, and real Nobel laureates have even been involved.” Actual Nobel Prize winners often present the handcrafted Ig Nobels to the plucky winners. The awards, now in their 20th year, weren’t too difficult to start either. “It was surprisingly easy,” says Abrahams. “MIT [Massachusetts Institute of Technology] gave us a beautiful place to hold the ceremony. We announced the Ig Nobels would be held one Thursday in October and that tickets would be free; all 350 were snapped up instantly. Word got about and some quite eminent scientists came forward to hand out the prizes at the ceremony, wearing the strangest hats.”
16
Medrepreneurs
With such bizarre and far-fetched research it’s often surprising how scientists obtain funding for their projects. Much of the research is done out of the scientists’ own pockets when they really do get bored of pipetting, says Abrahams, but “a surprising number of projects are indeed funded by industry”. A paper on ‘The effect of Star Wars on locust brain activity’ was actually funded by Volvo, and a paper on the flatulence of herrings was funded by the Navy, who in fact requested the research. Surprisingly it’s not the Americans that dominate the Ig Nobel laureates. “Actually, the largest number are from the United Kingdom,” states Abrahams - a fact that has annoyed some big cheeses in the British scientific world. Former chief scientific advisor to the Government, Robert May, even wrote to Abrahams demanding he stop awarding British scientists Ig Nobels, even if they wanted to receive them. “Perhaps he was just having a bad day,” quipped Abrahams. After twenty years of awards Abrahams has seen many examples of bizarre science.
A study published in The Lancet, entitled ‘A man who pricked his finger and smelt Marc Abrahams, putrid for five years’ Ig Nobels Founder was a strong contender for his favourite but that goes to a paper about ducks. A Dutch museum curator was the proud recipient of the 2003 biology prize for his paper on ‘Homosexual Necrophilia in the Mallard Duck’. Kees Moeliker witnessed the death of a male mallard after it crashed into the window of Rotterdam’s Natuurmuseum. A second male duck, thought by Mr Moeliker to have pursued the deceased duck, mated with it for 75 minutes, constituting the first observation of homosexual necrophilia in the male duck. The 2010 Ig Nobel Prizes will be announced and awarded on September 30 at the 20th First Annual Ig Nobel Prize Ceremony at Harvard University. For more examples of weird and wacky science, go to www.improbable.com.
Some of 2009’s winners: PUBLIC HEALTH PRIZE: Elena N. Bodnar, Raphael C. Lee, and Sandra Marijan of Chicago, Illinois, USA, for inventing a brassiere that, in an emergency, can be quickly converted into a pair of protective face masks, one for the brassiere wearer and one to be given to some needy bystander. REFERENCE: U.S. patent # 7255627, granted August 14, 2007 for a “Garment Device Convertible to One or More Facemasks.”
MEDICINE PRIZE: Donald L. Unger, of Thousand Oaks, California, USA, for investigating a possible cause of arthritis of the fingers, by diligently cracking the knuckles of his left hand - but never cracking the knuckles of his right hand - every day for more than sixty (60) years. REFERENCE: “Does Knuckle Cracking Lead to Arthritis of the Fingers?”, Donald L. Unger, Arthritis and Rheumatism, vol. 41, no. 5, 1998, pp. 949-50.
VETERINARY MEDICINE PRIZE: Catherine Douglas and Peter Rowlinson of Newcastle University, Newcastle-Upon-Tyne, UK, for showing that cows who have names give more milk than cows that are nameless. REFERENCE: “Exploring Stock Managers’ Perceptions of the Human-Animal Relationship on Dairy Farms and an Association with Milk Production,”Catherine Bertenshaw [Douglas] and Peter Rowlinson, Anthrozoos, vol. 22, no. 1, March 2009, pp. 59-69. DOI: 10.2752/175303708X390473.
Medrepreneurs
Top five eccentric medical inventors Some of the greatest advances in medicine were spearheaded by some of the most eccentric characters. Ben Chandler reviews his top five eccentric medrepreneurs. Horace Wells (1815-1848) Wells was an American dentist with a dislike for inflicting pain on his patients. His flash of genius occurred at a travelling show where he observed an audience member injure their leg while under the influence of laughing gas (nitrous oxide). Wells noted that the person experienced no pain and realised that this gas might also bring to an end the pain of dental surgery. In his first experiment he took the gas himself for his own tooth extraction and subsequently used it on a number of patients. A month later he staged his first public demonstration but unfortunately the patient was not sufficiently anaesthetised and cried out in pain when the tooth was extracted. The audience were not impressed and booed Wells from the stage. After some time promoting his work in France Wells returned to the USA and continued researching anaesthetics. Unfortunately on one occasion whilst taking chloroform he became deranged and threw acid over two prostitutes, later committing suicide once he realised what he had done.
★★★★✩ ★★★★★
Innovation: Eccentricity:
Alexis Carrel (1873-1944) Alexis Carrel was a gifted surgeon, who was awarded the Nobel Prize for devising methods of suturing blood vessels, as well as developing an aseptic technique that was used extensively throughout the First World War. However, he was a controversial character, firstly drawing criticism amongst some medics for publishing a book about miracle cures at Lourdes, and later for his political views and eugenics work. He died in 1944 having been accused but never tried for collaborating with the Nazi party in occupied France.
★★★★★ ★★★✩✩
Innovation: Eccentricity:
James Barry (1792-1865) Barry was a surgeon with the British Army and an early pioneer of the caesarean section. History suggests that Barry was actually a woman, born Margaret Ann Bulkley. Barry is likely to have been the first British female doctor. She is alleged to have hidden her sex to allow her to follow her chosen career in medicine. It was only following her death that her true identity was discovered when underneath her gentlemen’s garments was the body of a women. Innovation:
★★★✩✩ ★★★★★
Eccentricity:
Christiaan Barnard (1922-2001) Known as the “film star surgeon” Barnard became an overnight celebrity when he performed the first human heart transplant in 1967. Always pushing the boundaries of possibility, he also transplanted primate hearts into humans on two occasions (one from a baboon and one from a chimpanzee). His private life resembled that of a modern celebrity with rumours of numerous affairs with famous women. He married three times, twice to fashion models - the final time to a girl young enough to be his granddaughter.
★★★★★ ★★✩✩✩
Innovation: Eccentricity:
Werner Forssmann (1904-1979) Forssmann eventually became a urologist but in his earlier career he made his name by pushing catheters into places other than the urethra. His defining experiment was in 1929 when he inserted a catheter 65cm into his own cephalic vein before calmly walking up two flights of stairs to have an X-ray taken showing the tip in his right atrium. He published his feat along with suggestions for its use. However not everybody was impressed, and following disciplinary action for his self-experimentation he quit cardiology and pursued a career in urology. His work was eventually followed up and in 1956 he was awarded a Nobel Prize.
★★★★✩ ★★★✩✩
Innovation: Eccentricity:
medrepreneurs
17
Pre-hospital Medicine The good, the bad and the ugly
A career in pre-hospital medicine can be rewarding and challenging, as well as a drain on what little remains of your social life says Dr Chetan Trivedy, medical director of Southern Medical Services and lead clinician at the Oval Cricket Ground. JuniorDr’s Ivor Vanhegan asked him how he got involved in this field and the potential career opportunities.
I
have been involved in pre-hospital care for over four years now, starting off as many of us do as a doctor working for the Forward Incident Team (FIT) - part of the London St John Ambulance service. I would highly recommend this as a starting point for anybody with an interest in prehospital care. As a doctor you get the opportunity to attend high profile events and work with a multidisciplinary team of first aiders as well as develop your clinical skills - and by ‘clinical skills’ I mean the good old fashioned skills which do not rely on an x-ray, CRP or troponin. In most instances you’re on your own - the patient, their ailment and the environment.
Crowd doctor
Other opportunities involve working as a crowd doctor, which is a happy medium between working in the voluntary services and the dizzy heights of HEMS. I met Linda Rooke, the managing director of Southern Medical Services (SMS), during a 20/20 game at the Oval and over the next four years provided cover at the ground for the crowd and increasingly the teams. Last year I was the clinical lead for the ICC Twenty20 World Cup.
“In most instances you’re on
tachycardia (SVT) bought on by a couple of pints of beer, or who has a broken nose whilst attempting to catch a cricket ball.
“Working as a crowd doctor is a happy medium between working in the voluntary services and the dizzy heights of HEMS.”
Training
At present there is no mandatory training at present to work as a doctor for a voluntary organisation or as a crowd doctor but you would do well to have done at least six months in a busy Emergency Department (ED) and have at least ALS if not ATLS under your belt. For those who wish to formalise their training there are moves to develop pre-hospital care as a distinct sub speciality of Emergency Medicine (EM). You should look to complete your ACCS training and gain as much anaesthetic experience as you can whilst attempting the Diploma in Immediate Medical Care (Dip IMC) which is run by the Royal College of Surgeons in Edinburgh. Pre-hospital trauma life support courses (PHTLS) pre-hospital emergency care
courses (PHECC) are useful in preparing for the Dip IMC. For serious pre-hospital clinicians it is essential you have a broad portfolio of experience and you should try and arrange visits with your local ambulance service. Units such as HEMS and BASICS also offer a unique insight into the management of major pre-hospital trauma and this remains extremely competitive with these posts usually undertaken in the final years of EM/anaesthetic training. Pre-hospital medicine is a growing speciality which has the glamour and glitz (good) but in reality often involves sitting out in the freezing cold and rain waiting for something to happen (bad) and occasionally when things go wrong in the field they go very wrong like when one has to defibrillate a patient in VF in the stands during a game (ugly).” Dr Chetan Trivedy BDS FDS RCS (Eng) MBBS PhD MCEM FRSH
Useful links Diploma in Immediate Medical Care http://www.rcsed.ac.uk/site/534/default.aspx
St. John’s Ambulance http://www.sja.org.uk
Southern Medical Services http://www.southernmedicalservices.co.uk
your own - the patient, their ailment and the environment.” PRE HOSPITAL SECTOR
There is often as much work off the field as there is on the field with training and development of clinical protocols. As the medical director you have the responsibility of ensuring that the clinical standards are met and that you keep an eye out for any potential medical hazards on match day. Looking after 20,000 intoxicated fans and top athletes may sound daunting but it is exciting at the same time. You can never predict what is going to happen next and you may see a person with sunburn followed by someone with an supraventricular
EXPERIENCE/QUALIFICATIONS REQUIRED
Voluntary • St John • Red Cross
• ALS • ATLS • PHEC
Crowd doctor
• ALS • ATLS • PHTLS / PHEC
HEMS /BASICS
• • • • • •
ALS ATLS APLS PHTLS Dip IMC (Ed) *Competency in anaesthesia
Ophthalmology has traditionally been viewed by many as a small specialty tucked away somewhere in the curriculum. As a junior doctor it can all appear a bit dry and over-complicated often limited to sitting in darkened rooms grappling with an ophthalmoscope trying to focus on a fundus! Sameer Trikha, Andrew Turnbull and Meon Lamont explain why they feel ophthalmology is an exciting and diverse specialty and often under-explored as a career option.
What do eye doctors do? The majority of the ophthalmology workload occurs in an outpatient setting with a large proportion of ocular surgery conducted as elective, day-case procedures. The perception of an ophthalmic surgeon solely performing cataract operations is a myth – in reality the work is varied covering other areas such as glaucoma, retinal and oculoplastic surgery. Emergencies are typically seen by a junior ophthalmologist first with many units having a separate ‘Eye Casualty’ in their department. One of the challenges of the job is that you never know what could come through the door, with conditions ranging from conjunctivitis to penetrating, sight-threatening trauma. Most eye units throughout the United Kingdom consist of an eye department in a main hospital, although in some areas the eye hospital is entirely separate. Most departments are multi-disciplinary with optometrists, medical photographers, orthoptists and ocular prosthetists as well.
Is ophthalmology right for me?
Ophthalmology courses for junior doctors: (BOX 1) Basic Microsurgical Skills course (held at the Royal College of Ophthalmologists) FOCUS - Foundation Course in Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh Basic Eye Surgery Training course, Torbay Hospital (also available to final year students) Fellowship of the Royal College of Ophthalmologists (FRCOphth) exam structure (BOX 2) • Part 1 – Basic sciences, pathology and optics (no previous experience required; must be passed before OST3) • Refraction Certificate (must be passed before OST4) • Part 2 – Open to those who have passed Part 1 and Refraction (must be passed by end of OST7)
WH EYE
It can be difficult for junior doctors to make educated decisions about careers like ophthalmology with little exposure during the undergraduate curriculum. Most SHOs or registrars at your local Eye Unit will be happy to offer advice and support to those who are interested in their specialty. Even visiting one or two clinics or theatre lists can give a good idea as to whether ophthalmology is a specialty that may suit you. Besides enthusiasm for the speciality, a few specific characteristics are required by ophthalmologists. The surgery is incredibly intricate and requires a high degree of hand-eye coordination and, of course, a steady hand. Good corrected visual acuity and binocular vision essential if you are serious about pursuing ophthalmology. It is worth getting this checked before making too great a commitment.
Why and how ophthal
How do I get into ophthalmology? Speaking to most ophthalmologists the answer to tends to be: “With extreme difficulty!” A combination of job satisfaction and sociable working hours makes ophthalmology currently one of the most attractive and competitive specialties. Attendance at one or more of the courses aimed at junior doctors is an excellent demonstration of commitment to the specialty (box 1). You may also wish to consider sitting the Part 1 20
Careers
FRCOphth – the first stage in the new examination structure (box 2). It may seem premature whilst still a Foundation Doctor, but having Part 1 under your belt will confer a huge advantage when applying for a highly sought after place in run-through training. Traditionally, budding ophthalmologists completed a period of training in allied specialties before embarking on a senior house officer post in ophthalmology. With the advent of Modernising Medical Careers, training in ophthalmology is now through ‘Ophthalmic Specialist Training – OST’, a seven year run-through programme culminating in the award of the Certificate of Completion of Training (CCT) (fig 1). Entry into OST began in 2007, with the main entry point at OST1 level. It is one of the most competitive surgical specialties figures released on the MMC website showed that 440 candidates submitted 1400 applications for 75 posts at OST1 level in 2008, making it second only to cardiothoracic, plastic and paediatric surgery in terms of number of applications per post 2. A pre-requisite for entry into OST is the successful completion of the Foundation Programme or equivalent. Assessment for entry into OST1 then comprises a series of short interviews at most deaneries. Typically the questions asked are broad and designed to assess aspects of Good Medical Practice as outlined in GMC guidelines. A new curriculum has been created for the OST programme and trainees are expected to achieve set competencies to ensure progression from year to year. Although the training has been designed to be run-through, it is anticipated that ‘out of programme’ research and work experience may be possible, although this would require support from the deanery.
HY ES?
w to become an lmologist
– Working abroad
Opportunities exist to practise ophthalmology in developing countries and help alleviate the burden of poor vision. It is estimated that 45 million people suffer from blindness worldwide, 75% of which is curable or preventable. A further 269 million are affected by low vision – 85% of which is treatable. This is due to a number of common conditions such as cataract, trachoma, refractive errors and onchocerciasis 3. VISION 2020: The Right to Sight is a global initiative which aims to help eliminate global blindness by 2020 4. It was set up by the World Health Organization and the International Agency for the Prevention of Blindness (IAPB). A number of possibilities are available through VISION 2020 for ophthalmic trainees to work with charitable organisations, allowing one to enhance skills and experience the adventure of travelling to some of the most remote parts of the world.
The future Over the past few years there has been considerable uncertainty among junior doctors in many specialties, and ophthalmology is no exception. It has always been competitive, although the manner in which candidates for training posts are selected is currently undergoing some modification. Competition for Consultant posts has also recently escalated and the nature of future employment is probably going to change. In spite of this competition and uncertainty, ophthalmology remains a popular career choice. Combining the diagnostic skills of a physician with the manual dexterity of a surgeon is fascinating and immensely rewarding. With rapid advances in ARMD and cataract surgery, ophthalmologists are now able to do what was almost unthinkable a few years ago in terms of restoring sight to patients. The future appears even more exciting. Sameer Trikha, OST3, Wessex Deanery Andrew Turnbull, FY1 Doctor, Salisbury District Hospital Meon Lamont, Specialist Registrar in Ophthalmology, Wessex Deanery
Further information – useful websites www.mmc.nhs.uk – links to person specifications, numbers of posts, etc. around the country www.rcophth.ac.uk – website for the Royal College of Ophthalmologists, supplying general information about examinations and the curriculum. www.mrcophth.com – an excellent website for Ophthalmology trainees, with useful hints and tips for exams and training. www.nccrcd.nhs.uk – National Coordinating Centre for Research and Capacity Development website providing useful information for those with an interest in academic training.
Opportunities within ophthalmology
References:
– Academic ophthalmology
1. Guly CM, Olson JA, Williams GJ. A career in medical ophthalmology. BMJ Careers 2008: 139-40
A number of ‘Academic OSTs’ are available as academic medical training has also been restructured under MMC. These programmes combine extensive academic research work with clinical training and also lead to a CCT. It is likely that such programmes, which are funded partly by the National Coordinating Centre for Research Capacity Development, will involve a proportionately larger amount of time at the university teaching hospital of the programme, and ultimately lead to a Clinical Lectureship post.
2. Modernising Medical Careers. Level 1 Specialty Training Recruitment, Round 1 2008, by Specialty. [Online]. Available from: http://www.mmc.nhs.uk/pdf/ Competition%20ratios%202008%20by%20Specialty.pdf [Accessed 12th October 2009] 3. World Health Organization. Fact Sheet No. 282: Visual impairment and blindness. [Online]. Available from: http://www.who.int/mediacentre/factsheets/ fs282/en/index.html [Accessed 14th October 2009] 4. World Health Organization. VISION 2020: The Right to Sight. Global initiative for the elimination of preventable blindness. Action Plan 2006-2011. [Online]. Available from: http://www.who.int/blindness/Vision2020_report.pdf [Accessed 14th October 2009]
CAREERS
21
Medicolegal Advice - in association with Medical Protection Society
Getting caught in the media spotlight Any publicity is good publicity – or is it? Sara Williams explores what to do if the media train stops at your station
F
ew doctors would welcome being approached by a reporter on their doorstep with questions about a patient’s care. But it happens more often than you think, so it is vital that you know how to handle it.
What to expect
Local newspapers often run stories involving a complaint about a local doctor – this will usually be angled from the patient’s point of view and is unlikely to be balanced. On a national scale, some GMC hearings, being of a wider public interest, may attract high-profile national coverage. Responding to the media
is subject to legal proceedings. • If a patient has died, you may want to offer condolences or express regret to the family. • If the complaint has been made directly to the press, direct the journalist to the complaints procedure at your trust/ practice. • It may be worth adding that you always strive to provide the highest standard of care and encourage any other patients with concerns to raise them. What to do if a journalist phones you
• Stay calm and professional. • Buy time and prepare. • Take down the journalist’s details and publication. • Find out what the deadline is for the response. • Remember that anything you say could be printed. • Avoid saying: “no comment” – it appears defensive. • Contact the MPS press office.
When it comes to speaking to the press, doctors and patients are not on a level playing field. Doctors have an enduring professional duty to protect their patients’ confidentiality; those that breach this could face disciplinary and regulatory sanction. This can be frustrating, especially when what is being reported is inaccurate; however, there are ways to respond without getAbout MPS info for articles.qxd:MPS Checkup What 12/2/10 1 on your door to do if 10:05 the mediaPage knocks ting into trouble: • While you can’t give a lot of detail, you This can be intimidating but, by behavcan explain why this is the case, and why ing calmly, you can display a professional you can’t say any more because of paand dignified image. tient confidentiality, or because the case Avoid saying: “no comment”. Buy
About MPS MPS is the leading provider of comprehensive professional indemnity and expert advice to doctors, dentists and health professionals around the world. We actively protect and promote the interests of members and believe that education is an integral part of every health professional’s development. As well as providing legal advice and representation for members, we also offer workshops, conferences and a range of publications designed to aid good practice. MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.
MPS Members who would like more advice on the issues raised in this article can contact the medicolegal advice line on 0845 605 4000.
www.mps.org.uk The Medical Protection Society Limited. A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS.
yourself some time to prepare a response and/or to seek advice by saying something along the lines of: Dr Y: “I’m sorry but I’m not able to answer your questions right now, but if you give me your contact details, either I or my trust’s press office will get back to you.” Photographers
Do not run away or try to hide; this will create a negative image of you. Appearing in a programme
• Find out as much as you can about it before agreeing to appear. • Make sure that you’re comfortable that what is being asked falls under your sphere of expertise. • Ask the producer for indemnity in respect of any claims involving you arising from the programme. • Prepare by thinking of the key points you would like to make. • Talk more slowly than you would in normal conversation. • Body language and good eye contact is as important as what you say in a filmed interview. Writing for the medical press
• Don’t commit yourself until you know what the commission entails. • Negotiate a deadline that suits both you and the editor. • Request to see the article before publication. • Clarify the copyright arrangements.
Case study Following action by MPS, the Daily Mirror agreed to a settlement for substantial damages plus costs to a GP. The newspaper agreed to print the apology below: “In an article entitled ‘Girl scarred for life after GP blunder’, we stated that Dr X had wrongly removed a lump on a five-year-old girl’s head, which would not have happened if the diagnosis
Teaching others: a question of style! Have you ever found yourself trying to explain something to someone who stares at you blankly? In this feature, ISC Medical explains the different learning styles and their characteristics.
O
What if you don’t like the content?
• Unless a story contains factual errors or you have been misquoted, there is not much that can be done. • But if a story does contain factual errors, the publisher can be asked to print an apology and correction. • If you have been misquoted, you can seek an apology, or report the publisher to the Press Complaints Commission (PCC). • If a patient is painting an inaccurate picture, there is little a doctor can do. • The MPS press office can assist you with making complaints, seeking corrections and apologies. How can MPS help?
• Providing experienced advice on handling the media. • Speaking to the journalist on your behalf. • Liaising with the trust’s press office. • Assisting and liaising with practice staff. • Preparing press statements appropriate to the specifics of your case. Contact the press office Tel: 020 7399 1409/06 (8:30-5:30) E-mail: pressoffice@mps.org.uk Out-of-hours (open 24-hours a day, seven days a week) Tel: 0845 6054000 MPS has produced a guide to handling the media. It is available in the Publications section of the MPS website –www.medicalprotection.org/uk/education-publications
had been correct. These statements are wrong. We accept that the action taken and treatment prescribed by Dr X were correct and this was confirmed by the health authority after a thorough investigation. We wish to apologise to Dr X and are pleased to set the record straight. We have agreed to pay him damages for the harm he has suffered and his legal costs.”
ne famous categorisation of the different learning styles is the Honey-Mumford model. See if you recognise yourself in one of these descriptions: Activists enjoy themselves the most when they have new experiences. They will try anything once and are very open-minded. Their motto is “carpe diem” – Enjoy the present moment – and they like to get stuck in, troubleshooting and brainstorming. They don’t like sedate environments. They are sociable but mostly like to be the centre of attention. Activists can be disruptive to a group. They keep challenging, ask questions which are likely to be addressed later on in the teaching session and generally could take over a group. Theorists are ultra-logical. They don’t like the big picture and prefer to approach problems stepby-step. They analyse everything and are perfectionists who like to create tidy and rational systems. They tend to be detached and objective and hate ambiguity. They find it difficult to conceive lateral thinking. Theorists would come across as studious and thorough during a teaching session, and teachers may find that they sometimes spend far too much time focussing on unnecessary detail rather than the big picture, particularly when dealing with abstract topics.
Reflectors are cautious and thoughtful and like to collect and analyse as much data as possible, before coming to a decision. They are the type of people who like to ‘sleep on it’. They are usually the quiets ones at the back of the room, who prefer to observe and listen to others. Reflectors can be frustrating to teach because they rarely give you feedback, stare at you blankly, looking as if they are not enjoying themselves when they are in fact internalising. However, they may well give you the best feedback. Pragmatists are enthusiastic about trying out new theories and techniques in practice. They like to “get on with it”, acting quickly and confidently with their ideas. They don’t like wasting time with longwinded and open-ended discussions. They are very practical, enjoy challenges and solving problems, and are always looking for better ways of doing things. Pragmatists will enjoy sessions which progress at a good pace. Teachers often make the mistake to assume that their students have a similar style to theirs. A good understanding of the different styles and a strong ability to detect their students’ approach of learning is therefore key to being a good teacher.
Your 1st choice for interview skills & personal development coaching ISC Medical is the UK’s leading provider of interview skills and personal development coaching for doctors. Do you want to learn more about how to approach the various teaching styles and become a better teacher? Join one of our medical teaching & presentation skills courses Learn practical and innovative ways to teach effectively and present with confidence in this 2-day course in London. Maximum 12 people. Lots of personal attention & individual feedback. 12 CPD points
www.iscmedical.co.uk
Secret Diary of a Cardiology SpR Monday If you’ve been following this column then you’ll realise that my Californian dream was over. After a six month Fellowship on the east coast of the USA learning advanced techniques in interventional cardiology I was now back and ready to be a consultant at the same London teaching hospital where I had spent most of my years as a senior registrar. The job had been created for me by Douglas, my mentor in the department, and I was due to join a team of five white males, the youngest of whom was still technically, legally and medically old enough to have been my father. I guess they were hoping that I would rejuvenate the team or bring a little glamour, but either way they would have to wait a few months. The management at the hospital had agreed the job but I wasn’t able to start until the next financial year. This was only a few months away but actually suited me perfectly as I was able to tie up my loose ends as well as look to a place to buy in the city. That was how I found myself locuming at a small DGH with no out of hours radiology let alone angiography. Monday was spend on a ward round and doing paperwork. I went home early and was in bed by nine after a eating left over tuna sandwich and drinking a glass of Merlot.
Tuesday On call today. Whilst the junior doctors I’m with are reasonably good, the medical student is terrible. Perhaps I’m comparing him to the ones from the US who have a ridiculous amount of book knowledge and combine that with coming in for 6am ward rounds. In comparison the final year attached to our firm seems lazy, unkempt and and a little stupid. I review the clerking of a sixty year old male with shortness of breath but after asthma and COPD he can’t think of any further causes. I tell him to divide them up into the systems and he gives me a blank look. When I ask him if he can think of any cardiac causes of shortness of breath he says acute coronary syndrome then picks up his Oxford Handbook and actually asks me if I can “hang on for a mo”.
Wednesday Lots of paperwork this morning and then a few referrals to see on the echo rounds. Most of them are pretty simple and I stop for a quick bite to eat with a couple of the other registrars around noon. With a consultant job waiting for me I’m the most senior medical middle grade in the hospital and often find myself giving out cryptic career advice like Yoda. I note that both the girls I’m with graduated around the same time as me but have taken career breaks to start families. One of them tells me that she’d be happy not being a consultant as long as she could get away by five every day. I wonder if I had ever felt that way?
Thursday Consultant ward round today. He is a jolly fifty year old carrying too much weight and I wonder if I’ll see him in a CCU bed one day. He is, however, a half decent cardiologist and a very good teacher who spends the rounds passing on his words of wisdom to any one who will listen. I continue some teaching afterwards and 24
SECRET DIARY
* Names have been changed to try to keep our cardiology SpR in a job - though she’s doing a pretty good job of trying to lose it without our help!
try to explain ECG basics to the medical student. He makes lots of notes but I’m not sure that anything is going in. I head off for a quick lunch and to catch up on my emails. In the afternoon I get a call from resus to go and help out the endocrine registrar who’s struggling with a patient. She has a seventy year old lady with persistently elevated ST segments despite thrombolysis. The plan would normally be to send her down for an immediate angioplasty at the nearby cardiac centre but they are refusing to take her on the grounds that she may not be fit for a transfer. I have a chat with the patient and her family and whilst she is unwell, there is no reason for her not to go down. I speak to the registrar at the cardiac centre who tells me that he hasn’t spoken to his own consultant but that in his opinion our patient isn’t suitable. I try to explain that in my view she is when he cuts me off by telling me that as a DGH doctor I’m probably not best suited to make complex cardiac decisions. I decide not to shout so instead hold my breath for a few seconds. I then calmly tell him that I have been appointed a consultant at a particular hospital in London. I also mention the review paper that I wrote last year with his boss as co-author and that if he didn’t accept the patient in the next six seconds then I would just have to speak to someone else from his team. There is a silence and then a whimper as he tells me where to send our lady. I hand the phone back to the on-call registrar and head back to the wards. I finish up around six and head home for an early night.
Friday CCU rounds and then a morning spent reviewing inpatient referrals. I am done by lunchtime and as I have nothing to do I leave and head back to London where I have a meeting with Douglas, my mentor. We laugh at the registrar who refused to accept my patient and then over coffee we talk about my Fellowship in the States and what I’ve learnt from it. He agrees to buy some new equipment for me from the departmental funds so that we can start looking to do some more specialised interventional work. In addition, he promises me my own office along the corridor from his which, for a newly starting cardiologist, is a very nice gesture. We shake hands and I head out. I spend the afternoon shopping for a dress to wear to my cousin’s wedding at the weekend. They’re getting married in a stately home in the home counties. She is the same age as me and wanted to be a doctor but didn’t get the grades. She ended up becoming a scientist and now works in an office for a drug company. Her husband-to-be works in the city and no doubt they’ll have children within a couple of years. As I look in the full length mirror at the black strapless number I’m going to buy I wonder who’s more happy - me or her? I smile as I realise that although I don’t know the answer, I do know one thing. Only one of us can stent the left main coronary.
Focus on Finance - in association with Wesleyan Medical Sickness
Income Protection: Why Bother? In your line of work you’ll be more aware than most that sickness and disability can impact anyone at anytime. Have you ever stopped to consider how patients with protracted illness cope financially? In fact have you ever thought how you would cope if you found yourself in their shoes? You might not be able to pay your loans, bills, mortgage or rent and could potentially face financial hardship. You may think that NHS sick pay would be enough to survive on but it won’t replace all of your earnings. You should give serious thought to protecting your income with the right insurance product. Why do I need Income Protection? Income protection provides important cover at every stage of your career and the need for it arises even before you fully qualify. According to the British Medical Association, some medical students will graduate with debts of up to £37,000 - higher than the basic annual salary of a foundation house officer. If you fell ill at this stage you would be particularly exposed financially as debt repayments won’t just disappear. In addition, NHS sick pay for medical professionals in the early stages of their career starts at very low levels, increasing gradually over the years. For example, in the second year of service you are entitled to just two months full pay, followed by two months half pay. This only covers basic salary. It doesn’t include many of the other elements that can significantly boost your regular take-home pay, such as salary band uplift. You may therefore find yourself living on less than half your regular take-home pay. Income protection policies, on the other hand, are generally based on your full earnings and not just basic salary. Once NHS sick pay ceases you would be entitled to statutory sick pay, which runs for 28 weeks. After that, you could be entitled to Employment Support Allowance,
although the criteria are quite strict and payments likely to be no more than £91.40 a week. If you had an income protection policy however, you would receive a monthly tax-free income at typically 50% of your pre-capacity earnings. What should I look for when buying cover? There is a wide range of income protection products available. Here are some of the key points you should consider. • Your own specific needs and circumstances. You may have alternative ways of covering loss of income such as through savings or a partner’s earnings. You should take this into account when deciding exactly what level of cover you need under a policy. • Own occupation definition. ‘Own occupation’ means that the policy benefits will be paid if you are unable to carry out your specific job due to sickness or injury. Some income protection products offer an ‘any suited occupation’ definition, which means they won’t pay out if you can’t do your own job but could do other types of work based on your knowledge and experience. This is obviously less desirable as you have studied, trained and
worked hard to get where you are. • Deferred period. All policies have a set amount of time from the date you are incapacitated, after which income payments will start to pay out. You can opt to defer income payments for the amount of time that suits your situation, up to a maximum of 52 weeks. For example if you receive full NHS sick pay for two months, a deferred period that kicks in after this might be appropriate. In general, the longer the deferred period the cheaper the policy. • Guaranteed insurability option. This will enable you to increase your cover at key life stages, for example on the birth of a child, without the need for further medical evidence. Most income protection plans typically pay out until you return to work or you are no longer suffering from a loss of earnings for example if you start receiving a pension income, you reach the maximum age for the policy or you die. With careful planning, income protection can help you maintain the level of income you received before sickness or injury. You should take professional financial advice to ensure you find the right cover for you.
The above information does not constitute financial advice. If you would like more information or need general financial advice, you can call Wesleyan Medical Sickness on 0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk
Specialist financial services for doctors • Savings and Investments
• Mortgages
• Retirement Planning
• Motor, home and travel insurance
• Life and Income Protection
Motor, home and travel insurance is arranged by Wesleyan for Professionals.
0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk Wesleyan Medical Sickness and Wesleyan for Professionals are trading names of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Limited is wholly owned by Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham B4 6AR. Telephone calls may be recorded for monitoring and training purposes.
FINANCE
25
Assessed by Gil Myers
Compiled by Farhana Mann
Medical Report
SNOW WHITE & THE SEVEN DWARFS
Across:
3 Cervical intraepithelial neoplasia (3) 5 Professor Anthony ____, Irish media psychiatrist who died in 2007; a girl’s name (5) 6 Rene Theophile Hyacinthe ____: inventor of the stethoscope (7) 8 Term for corneal inflammation (9) 10 This structure is located behind the pupil and anterior to the vitreous humour; adjusted on a camera (4) 11 Second commonest disease group causing blindness worldwide (8) 12 Condition where the lid margin rolls inwards and irritates the eye (9) 14 Mild deficiency of will power (9) 16 John ____: pioneer epidemiologist who studied cholera; fluffy and white (4) 17 Nerve supplying the lateral rectus muscle (8) 18 Number of layers of the retina (3) 19 Surname of celebrity psychiatrist suspended after allegations of plagiarism in 2008 (7) Down:
1 Robert ____ : British doctor, scientist, politician and TV presenter born in 1940; also Churchill (7) 2 Charles Richard ____: African-American doctor who played a major part in developing large-scale blood banks; a famous Barrymore (4) 3 Commonest cause of red eye (13) 4 Jonas ____: developed a vaccine for polio (4) 5 The body that produces the aqueous humour (7) 7 Graham _____: English physician & member of the Monty Python comedy troupe (7) 9 Name for the opaque white structure covering 80% of the globe (6) 10 Sexual drive (6) 13 Short-sighted (6) 15 British surgeon and pioneer of antiseptic surgery; has a mouthwash named after him (6)
You can find the crossword solution by searching for ‘crossword answers’ at www.juniordr.com
26
HOSPITAL MESS
An unusual case this time, I was unable to see the patients in question as they have consistently been unable to attend any appointments. They claim that their occupation does not leave much time for such things and instead it’s “off to work we go”. I have used the collateral information from their carer, Ms White to inform my diagnosis. Dopey: An undiagnosed learning difficulty would be appropriate but my concern is that this may be a chronic exposure to relatively low levels of carbon monoxide. As a miner, work conditions are cramped and poorly ventilated. Chronic poisoning may cause persistent headaches, confusion and memory loss. Happy: Frequent laughter, smiling and an unusually happy demeanor can be diagnostic of Angelman syndrome - a neuro-genetic disorder. It is usually caused by deletion of genes on the maternally inherited chromosome 15 while the paternal copy, which may be of normal sequence, is imprinted. Grumpy: A controversial diagnosis but I think “Irritable Male Syndrome” (or the andropause) fits here. Stress, such as a change to the home environment by the arrival of a young woman to a traditionally all-male household, could have been an exacerbating factor. Bashful: Idiopathic craniofacial erythema (ICE) is a condition of unprovoked facial blushing which is severe and uncontrollable. A link is frequently described between ICE and social anxiety disorder. Sleepy: There are many causes of excessive daytime sleepiness, ranging from narcolepsy to fibromyalgia. For no other reason than it’s my favourite, I would suggest this is a “circadian rhythm sleep disorder”, due to an altered sensitivity to ‘zeitgeber’. As you already know, a ‘zeitgeber’ (from German for time giver) is any exogenous cue that synchronizes an organism’s endogenous time-keeping system to the Earth’s light/dark cycle. Sneezy: The autosomal dominant trait ‘photic sneeze reflex’ springs to mind. This causes multiple sneezing (due to naso-ocular reflex) when suddenly exposed to bright light. Doc: No diagnosis needed. Clearly this ex-orthopod had enough of job uncertainty and decided that training would be better suited to hacking minerals from rocks rather than bones from bodies. Good call I say. There has been a suggestion from Ms White’s step-mother that Snow may have “created these characters” to give us an insight into her own addiction to cocaine. As with most drug abuse, cocaine can produce symptoms such as changes in sleep/wake patterns (sleepy), highs (happy) then withdrawal (grumpy), personality changes (dopey, bashful), and allergies (sneezy) and then eventually a visit to me, the doc. 6-month follow-up: After being prescribed Ritalin, Modafinil, Propanolol, Prozac, Lithium and Benadryl the names of the seven dwarfs are now: Dwarf, Dwarf, Dwarf, Dwarf, Dwarf, Dwarf and Doc (I’ll leave you to work out their original order).
Writing in the Notes Why belly button
fluff is blue
bilical Lint” ur article “Um yo to se on sp In re s 16 p21), you mbilical Lint Is U : w ie ev R al gh the colour (Clinci fact that althou e th to e nc re fe no known reamade re ey blue, there is gr is t lin al lic of umbi clothing dyes son for this. vast majority of e th , ct fa al tu In ac dyes such as disblue tinted azo e th of n tio ria tact Dermatolare a va the British Con on d re es tu ea (f ue perse bl testing). Azo dy series for patch rd da otr an st ni y o et tw ci ted by ogy So atic rings connec om uar o do a tw by of consist nnected e themselves co ar och ss hi di w e s th l om s of al gen at ng pi component lti su ng re vi e gi Th k . lin nd ble bo e nitrogen merge to cross th ciated electrons strong colour. d n pattern an a tio rp ost so ab g in a strik in all but the m ue dye is found bl d e an th w of llo ix ye m A bright s*. Aside from ur lo dco lu nc of (i ng ng si oppo of clothi resulting colour own) is often a pure white, the an k, green d br ac bl , le derrp pu d, ing re ion for dark un . With the fash es obdy pr ue is bl th r of mix unt fo , this would acco en m vel t na gs e on th to am bis wear king from the pu ac tr ir el. ha av e tr th ay ith m lem w fibres k through which ac tr ur e (s s th te g in cy id prov ix of corneo m e th , is th natCoupled with s will provide a d clothing fibre an ) ct at lls lle ce co in d sk face s travel an phy as the fibre ra e to og at at ip m ss ro di ch e ural st hu all but the blue g in ak m l, ve na the vels. less noticable le al Specialist
Regi
gh Dr Avad Mu ology strar in Dermat
vel Fluff”. World of Na ker. “The Incredible od.net/fluff.html. Bar * Graham ://www.fearg ddock. http Graham’s Pa
Sweaty axilla dise ase I would like to respond to the ar ticle by saying it the most ridicul is ous ‘disease’ that I have ever hear Surely the risk fa d of. ctors for the ‘dise ase’ are (i) having umbilicus and (ii an ) poor personal hygiene. In my that does not co book nstitute a pathol ogical process ot wise surely we hercould also have similar ‘disease’ such as ‘dirt un states der the finger na ils disease’ or ‘sw axilla disease’. eaty I also find it in credulous that the author was prised at the de surarth of ‘medical ’ literature on th ject. I wonder, e subam I the only reader that hold opinion? s this Sophie O’Dow d FY1
‘Writing in the notes’ is our regular letters section. Email us at letters@juniordr.com.
W
hen your hospital food tastes like the remnants of a liposuction procedure and the price bears more resemblance to the cost of a PICU incubator things start to take the biscuit. Here’s our regular column of the best and worse hospital essentials you’ve reported:
Chocolate muffin
You’ll choke on the price alone at:
£1.19
Royal Free Hospital, London
Buy one for your favourite patient at:
79p
Colchester University Hospital, Colchester
Bottle of Coca Cola
It’s enough to make your top pop at:
(500ml)
Fizz-tastic prices at:
Banana
£1.20 70p
University College Hospital, London
Belfast City Hospital
The shop manager is bananas at:
£1.10
Whipps Cross Hospital, Leytonstone
Let the monkeys know about:
70p
Stafford Hospital, Stafford
Next issue we’re checking the cost of a chocolate flapjack, tissues (pocket size) and a portion of chips. Email prices to hospitalconfidential@juniordr.com
Trafford General Hospital, Manchester
The Mess has a newly decorated lounge, which includes a television and snooker table. Adjacent to the mess, a quiet area for study is available with PC, printer and Medline Search facility and CD-ROM texts (a laptop and CD-ROM can also be borrowed). The doctors also have their own dining area where Barbara the waitress serves breakfast and lunch. In the restaurant foyer vending machines sell snacks, drinks and chilled foods. The latter may be reheated in the adjacent microwave ovens.
JuniorDr Score: ★★✩✩✩
HOSPITAL MESS
27
Get your neural input to junior doctors. Advertise here. Call us on 020 7684 2343.
courses
Journalism Now in its fourth year, the School of Professional Development is proud to present the highly popular practical modular course for busy practitioners
Applied Clinical Ethics February - June 2010 6 x 1-Day Professional Training on Saturdays at Imperial College London
For hospital doctors, surgeons, general practitioners, nurses, managers and members of clinical ethics committees.
Programme: Day 1: Clinical Ethics in Theory and Practice (6 February) Day 2: Autonomy Issues in Clinical Ethics (27 February) Day 3: Ethical Issues at the End of Life and the Role of Context in Clinical Practice (20 March) Day 4: Law and Justice in Clinical Practice (24 April) Day 5: Sustaining Professional and Ethical Practice in the Clinical Environment (22 May)
The Medical Journalist’s Association brings together medical writers, the media, health professionals, and health charity workers. > Meetings on major health and medical topics of the day > A forum to meet colleagues > Recognition and cash awards for distinguished work > A website with your own address. Visit www.mja-uk.org > Professional advice when you need it Wish to join? For more information visit www.mja-uk.org
Finance View hospital contracts online View vacancies online at
Day 6: Moral Dilemmas in Clinical Practice: Oral Presentations and Case Analysis (19 June) For further information and to book a course please visit www.imperial.ac.uk/cpd/ace or contact: Marta Kowalewska, School of Professional Development, Imperial College London. Tel: +44 (0)20 7594 6884 Email: cpd@imperial.ac.uk Testimonials: ‘Essential teaching for all clinicians’ ‘Would wholeheartedly recommend this excellent course. One of the most stimulating, thought provoking and well informed courses’ ‘Excellent, really made me think’ CME / CPD approval sought for
28
Directed by: Dr Paquita de Zulueta (Imperial College London) Dr Daniel Sokol (Imperial College London) Speakers include: Professor Raanan Gillon (Imperial College London) Professor Michael Parker (Oxford University) Professor Carol Seymour (Medical Protection Society) Deborah Boyle (Royal Free Hospital) Dr Andrew Hartle (St Mary’s Hospital) Dr David Inwald (Imperial College London) Mr Martin Lupton (Imperial College London) Katy Peters (Capsticks Solicitors) Dr Chandak Sengoopta (Birckbeck College) Dr Suzanne Shale (King’s College London) Dr Julian Sheather (British Medical Association) Ronald P. Sokol (Sokol Law Offices) Dr John Spicer (St George’s, University of London) Dr John Tuohey (Providence Medical Centre, USA) Dr James Wilson (University College London) Organised in collaboration with the Department of Primary Care and Social Medicine, Imperial College London and the Medical Protection Society
CLASSIFIED
www.jcj.co.uk The Premier Doctors’ Agency
Covering all specialities across England, Scotland, Ireland and Wales
Call 0800 279 9482 Email info@jcjlocums.co.uk
working overseas
SCRUB UP DOWN UNDER.
Make your next career move to New Zealand or Australia 2010/11 Senior House Officers and Registrars. Geneva Health specialise in providing end-to-end recruitment of Doctors for hospitals. Our role is to: get to know you and secure your next ideal post, manage your medical registration, guide you through the immigration process,have ongoing contact during your contract and advise on future placements. So take the hassle out of finding the right job and let us work for you! Register today at www.genevadoctors.com Freephone 0800 051 6743; +64 9 353 5209 Email: ruthm@genevahealth.com
www.vitalinternational.jobs WORK & LIVE IN AUSTRALIA & NEW ZEAL AND
YOUR SKILLS ARE
Career development t t Bush walks t Cafè culture t t Beaches t Adventure t t Personalised service t t
NOW IS THE TIME TO MAKE A CHANGE... Enjoy living and working Downunder!
Enjoy summer all year round... Make the move to Australia & New Zealand Wavelength International are looking for Junior Doctors with a desire to travel, for a variety of excellent training positions in coastal, city & country locations. The combination of world class healthcare & unique range of lifestyle options makes Australia & New Zealand a great career move. Our dedicated team give career & salary advice, assist with registration, migration & relocation. Jobs in Medicine, Surgery, A&E and O&G
We have great jobs in fabulous locations all over Australia and New Zealand for Doctors of all grades and specialties.
Call Vital today.
6, 9 & 12 month contracts
Jun Doctioor needers d
A SAP
Refer a friend & earn a $500AUD voucher Apply today â&#x20AC;&#x201C; you'll be surprised what's out there! Call Rebecca (NZ jobs) or James (Aust jobs) on 0845 602 1498 or email rdoyle@wave.com.au or jhill@wave.com.au
progressive | professional | pro-active
UK Freecall 0808 2341 612 or email your cv/resume to craig@vital.jobs
Moving services
Relocation and home search specialists For medics, lawyers, accountants, and all busy professionals
A dedicated personal service We are always in need of good quality properties for our professional clients. Properties needed from one bedroom flats to five bedroom family homes. Our exemplary tenancy selection process delivers professional fully referenced tenants from individuals to families.
Please call Carole or Vickie on 0844 335 6955 www.medicsonthemove.co.uk
CLASSIFIED
29
WAV896B
V ITA L
THE MEDICAL COURSE AND CONFERENCE DIRECTORY
A
s doctors we hate scouring the web to find where and when we can attend the next exam revision course, training event or conference.
We think they should all be in one place - which is why we launched EventsDr.com as part of the JuniorDr network. We’re aiming to build the most comprehensive database of medical events. Below you’ll find just a selection of the full listings at EventsDr.com.
Medicine MRCP 1
Mon 23rd Aug (5 days)
£790
London
Tue 31st Aug (5 days)
£495
London
Mon 6th Sep (5 days)
£495
London
Mon 10th Sep (3 days)
£490
London
Mon 28th Jun (3 days)
£395
London
Mon 8th Jul (4 days)
£400
London
Mon 12th Jul (4 days)
£400
London
Sat 12th Jun (2 days)
£650
Ashford
Mon 21st Jun (4 evenings)
£580
London
Sat 26th June (2 days)
£650
London
Mon 13th Sep (4 days)
£1450
London
Hammersmith Medicine
Hammersmith Medicine
MRCP 2
&5452% %8#%,,%.#%
'ETTING INTO -EDICAL 3CHOOL $ATE #OURSE FEE a ND !UGUST 3UNDAY 6ENUE 5NIVERSITY OF -ANCHESTER
&5452% %8#%,,%.#%
)NTERNATIONAL -EDICAL 3UMMER 3CHOOL
Hammersmith Medicine
$ATES #OURSE FEE a RD !UGUST -ONDAY TO TH !UGUST &RIDAY 6ENUE 5NIVERSITY OF -ANCHESTER
!PPLIED 3URGICAL 3CIENCES AND #RITICAL #ARE #OURSE FOR -2#3 0ART " $ATE #OURSE FEE a TH 3EPTEMBER 4HURSDAY 6ENUE 0HYSIOLOGY LECTURE THEATRE #ARDIFF
Hammersmith Medicine MRCP Paces
3URGICAL !NATOMY AND /3#% 6IVA #OURSE FOR -2#3 0ART " $ATES #OURSE FEE a
TH AND TH 3EPTEMBER &RIDAY AND 3ATURDAY 6ENUE 3CHOOL OF "IOSCIENCES #ARDIFF 5NIVERSITY
#LINICALLY /RIENTED !NATOMY FOR &2#3 /RTH $ATES #OURSE FEE a TH AND TH 3EPTEMBER &RIDAY AND 3ATURDAY 6ENUE !NATOMY $ISSECTION 2OOM #ARDIFF
3URGICAL 2EVISION #OURSE &OR &INAL 9EAR -EDICAL 3TUDENTS
$ATES #OURSE FEE a TH AND TH .OVEMBER "OTH DAYS 6ENUE %DUCATION AND 2ESEARCH #ENTRE -ANCHESTER &OR FURTHER DETAILS AND TO REGISTER PLEASE VISIT
WWW DOCTORSACADEMY ORG 30
EVENTSDR.COM
Hammersmith Medicine
Got an event to add? Do it free at EventsDr.com Paces Ahead
Sat 18th Sep (2 days)
£650
London
Mon 20th Sep (4 evenings)
£580
London Junior doctors: agents for change
Hammersmith Medicine Mon 25th Sep (2 days)
£799
Manchester
Monday 7 June 2010 Hilton London Metropole Hotel, London
Junior doctors: pitch your ideas for improving patient safety
Surgery MRCs b
Junior Doctors are invited to pitch ideas for improving patient safety to be considered for presentation at the 2010 junior doctors: agents for change conference. If you have an idea for an initiative concerning patient safety which you believe could make a significant improvement within a clinical setting, or you have experienced success in improving patient safety, you are
Thu 9th Sep (1 day) Applied Surgical Sciences and Critical Care
£125
Fri 10th Sep (2 days) Surgical Anatomy and OSCE/Viva
£295
Cardiff
Sat 25h Sep (2 days)
£799
London
Cardiff
encouraged to submit your idea. Deadline for submissions: 15 March 2010. For more information and submission details visit:
bmj.com/campaigns/juniordoctors
Psychiatry MRCPsych Paper 1
Number 1 for Medical Interviews & Applications
Sat 3rd Jul (2 days)
£345
London
Sat 17th Jul (2 days)
£325
Manchester
Sat 24th Jul (1 days)
£196
London
Sat 7th Aug (1 day)
£395
Birmingham
Mentor Courses
Mon 16th Aug (1 days)
£380
London
Dr Una Coales
Mon 20th Aug (1 day)
£420
London
Dr Una Coales
Fri 6th Sep (1 day)
£420
London
0845 266 9487
Sat 12th Sep (1 day)
£350
Birmingham
www.iscmedical.co.uk
Superego Cafe
GENERAL PRACTICE nMRCGP CSA
Courses in small groups for a more personal approach We offer a range of medical interview courses and services to optimise your chances of success at medical interviews
7 days a week
8:30am - 11pm
EVENTSDR.COM
31
MEDICAL PROTECTION SOCIETY PROFESSIONAL SUPPORT AND EXPERT ADVICE
Take MPS on your travels Valuable protection if working overseas MPS is the worldâ&#x20AC;&#x2122;s leading provider of comprehensive professional indemnity and expert advice to doctors, dentists and health professionals. Medicine is an increasingly mobile profession, with doctors travelling the world to work. MPS is the worldâ&#x20AC;&#x2122;s largest mutual medical defence organisation operating internationally. We have members in more than 40 countries, so if you decide to work overseas, membership can be arranged easily. It is one less thing to worry about. The main jurisdictions where MPS operates besides the UK are Ireland, South Africa, New Zealand, Hong Kong, Singapore, Malaysia, West Indies, and Kenya. However, we do have smaller numbers of members in other countries, so it is
To find out more:
often possible to continue your membership, even in unlikely places, for example if you are doing voluntary work overseas. MPS has also made arrangements with Australian insurance company, MIPS, to cover members practising in state indemnified hospitals for up to one year (extended to a maximum of 24 months on request). MPS prides itself on being a flexible organisation with membership designed to suit you. If you are thinking of working outside of the UK, please contact membership services.
Call Membership services on 0845 718 7187 Email member.help@mps.org.uk Visit www.mps.org.uk
MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association. The Medical Protection Society Limited. A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London, W1G 0PS.