JuniorDr Issue 18 by JuniorDr

CYCLING THE SIX CONTINENTS

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

ike most decisions of great consequence, I happened upon the route for my journey in a pub garden, beer in one hand, mini-atlas in the other. The plan hatched was to travel solo across six continents, covering a distance roughly equal to twice the circumference of the earth, all by bicycle. I would leave my home, my job, my whole life behind and start pedaling and I would be pedaling for the next five years. With ST training and PACES in my wake came the inevitable questions about my plans for the future. Some seniors reacted with raised eyebrows and looks of disbelief, but then a few would reflect “I wish I’d done something like that”. Whilst I probably moaned as much as the next med reg (and we all know that’s a lot), I enjoyed the job, but it was clear I needed an adventure. I wanted a brand new challenge and I hoped that I would find the world to be a friendlier place than it is frequently portrayed or perceived. Before entering Albania, for example, my

STATS FROM STEVE’S JOURNEY SO FAR Current location: Egypt Distance cycled: 7500 km

Tel - +44 (0) 20 7 193 6750 Fax - +44 (0) 87 0 130 6985 team@juniordr.com

Countries visited: 16

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.

Favourite song to sing whilst cycling:

© 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.

Most amount of Milka consumed in one sitting: 450 grams

“In the Summertime” by Mungo Jerry (particularly good to belt out if cycling through torrential rain, heavy snow or gale force winds). Most entertaining newspaper headline of an article about my journey: Italy, Ferrara:

“The Real Forest Gump”

Dr Steve Fabes – Cycling The 6

head was full of negative imaginings; a lawless place of landmines, terrorists, mafia and bandits. When I crossed the border if felt like a homecoming. Albanians working the fields would stop and shout, wave, cheer and even salute. I have been invited into stranger’s homes to eat and to stay the night many times and I have often felt unworthy of the hospitality I have received. The challenges so far have been robust, varied and very different to those in the NHS. I have cycled through temperatures from a perishing -19°C to a blistering 51°C. I have often come face to muzzle with menacing mutts and in rural Greece I was attacked by a large group of dogs. I have relished the challenge of continuous mountain ascents from 400 metres below sea level at the shores of the Dead Sea to a height above that of Britain’s loftiest peaks. I even survived a sustained snowball attack delivered without mercy by school children across Kent as I cycled out of the UK. I’ve dealt with these many tribulations as best I can, and I’ve probably made as many wise decisions as perfunctory ones, but all in all deciding to go in the first place was the best decision I ever made. It’s easy to get blinded by the race to stay competitive professionally, but I chose to look at the big picture. Five years may sound like a long time, but it’s around twelve percent of my working life. That’s a drop in the ocean to follow a dream.

If you’d like to keep up to date with Steve’s progress you can visit his blog at http://www.cyclingthe6.blogspot.com or follow him on Facebook. To sponsor his adventure go to http://www.justgiving.com/cyclingthe6. Every penny donated goes to the medical aid agency Merlin.

What’s inside 04 09 16 20

LATEST NEWS Working Overseas All at sea mercy ships

24 26 30

Secret Diary of a Cardiology SpR Sleeping Beauty gets a check-up Medical Courses and Conferences

TRIAGE

Tell us your news. Email team@juniordr.com or call 020 7193 6750.

working conditions

“shocking” lack of surgical posts

undreds of aspiring surgeons have been unable to obtain specialist training posts this year and are being ‘left adrift in the medical training system’, according to an investigation published in BMJ Careers. According to deanery statistics only a small number of this year’s core trainees in general surgery were even interviewed for a specialist training (ST3) post, and none were appointed at all across the Northern, and Yorkshire and Humber regions. Research by Dr Alison Carr, dean advisor for MMC England, also showed fewer than a quarter of doctors qualifying in 2005-6 were recruited to ST3 posts in 2010. Competition ratios ranged from 4.4 applicants per post to 14.9 applicants in some specialties. “Trainees are caught up in a system that is fundamentally deceptive. They might as well chuck their CVs up in the air,” said Richard Marks, Remedy UK’s head of policy. Dr Carr also showed there was a bottleneck of surgical trainees, some of whom have been waiting as long as 13 years for an ST3 post. A spokesperson for the Department of Health said surgical training had ‘always been highly competitive. The profession knows this and is supportive of it - competition

helps to ensure that the best candidates progress in the field’. The Royal College of Surgeons is now urging the Department to extend the surgical core training period from two to three years. The BMA will also be liaising with the College and the Department to ‘make sure the importance of career progression is prioritised in surgery’. Edward Davies, editor of BMJ Careers said this investigation is ‘merely the latest in a litany of mediocrity to afflict doctors at every single stage of their careers’. “At best it is poor planning, and at worst dishonest,” he says. “We’re effectively

throwing money at crippling the morale of junior doctors in our health service.” Davies believes certain core issues need urgent addressing: “Firstly, the Department of Health must decide whether junior doctors are supposed to be the consultants of tomorrow or cheap labour for now. There needs to be more joined up thinking about professional numbers, based around service needs, and there needs to be much more honesty around what is achievable in a medical career,” he said. http://www.bmjcareers.com

working conditions

Junior docs spend more time on admin than training J

unior doctors spend more time carrying out administrative tasks than they do in formal training, according to the results of a new BMA study. The report, which traces the career progression of 430 medical graduates who qualified in 2006, asked junior doctors in their first year of specialist training to indicate how much time they spent undertaking different activities at work. Whilst the majority of time was spent on clinical duties (66%), 14% of time was spent carrying out administrative tasks greater than the time they spent in formal 4

NEWS PULSE

training in a clinical setting (13%). Shree Datta, chair of the BMA’s Junior Doctor Committee said: “It is galling to find doctors spending more time filling forms than learning the skills they need to be the consultants and GPs of tomorrow.” “It is especially worrying, at a time when junior doctors’ working hours have fallen, to see so much of their time taken up on paperwork. Trainees should, first and foremost, be clinicians who are learning their trade. For the benefit of our patients, employers need to look closely at the

workload of junior doctors to ensure that their time is being used appropriately.” The cohort study also found that 15% of doctors felt that they had been asked to undertake tasks that were beyond their capabilities with this proportion rising to over one third (36%) for doctors on general practice placements. Many of the doctors surveyed felt there were times when they were placed in clinical situations of which they had no experience. www.bma.org.uk

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Working conditions

‘Burned-out’ medical students more likely to cheat

edical students with high levels of burnout are more likely to self-report unprofessional conduct related to patient care, according to a study published in the Journal of the American Medical Association. The study of 2,682 medical students found that those with burnout were significantly more likely to have engaged in cheating or dishonest clinical behaviours, such as copying from a crib sheet or from another student during an exam; or reporting a physical examination finding as normal when it had been omitted. 52% of those questioned experienced burnout. It found that this group were more likely to report engaging in one or more unprofessional behaviours than those without burnout (35% vs. 21.9%). “Professionalism is a core competency for all physicians. Professionalism includes being honest, acting with integrity, advocating for the needs of patients, reducing barriers to equitable health care, and adhering to an ethical code of conduct,” say the authors. “Despite the widely acknowledged importance of professionalism, how personal distress

and professional distress relate to professionalism is largely unexplored.” Burned-out students were also less likely to hold altruistic views regarding a doctor’s responsibility to society, including personally wanting to provide care for the medically under served (79.3% vs. 85.0%). JAMA. 2010;304[11]:1173-1180. What is burnout? Burnout is a psychological term for long-term exhaustion and dimished interest. The Maslow Burnout Inventory uses the three components of exhaustion, cynicism and inefficacy. Research has shown that general practitioners have the highest levels of burnout of all professions (40%).

clinical care

Religious beliefs strongly influence doctors end of life decisions

theist or agnostic doctors are almost twice as willing to take decisions that they think will hasten the end of a very sick patient’s life as doctors who are deeply religious, according to research published in the Journal of Medical Ethics. The study also found that the most religious doctors were significantly less likely to have discussed end of life care decisions with their patients than other doctors. Specialty was strongly related to whether a doctor reported having taken decisions which were expected, or partly intended to, end life. Doctors in hospital specialties were almost 10 times as likely to report this as palliative care specialists. But irrespective of specialty, doctors who described themselves as “extremely” or “very nonreligious” were almost twice as likely to report having taken these kinds of decisions as those with a religious belief. The findings were based on a postal survey of more than 8500 UK doctors, spanning a wide

range of specialties, which was designed to see what influence religious belief - or lack of it - had on end of life care. The doctors were asked about the care of their last patient who died, if relevant - including whether they had provided continuous deep sedation until death and whether they had discussed decisions judged likely to shorten life with the patient - their own religious beliefs, ethnicity, and their views on assisted dying/euthanasia. www.jme.bmj.com

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Working conditions

Half of hospital trusts have no chaperon policy

nly half of acute hospital trusts in England have a formal chaperone policy, according to research published in the Postgraduate Medical Journal. The results showed that just 56.5% of hospital trusts had a chaperone policy in place. Just over 17% had accredited training for chaperones, and 42% still had no designated management lead. The findings come despite the recommendations of the Ayling Inquiry in 2004 which recommended that acute hospitals put in place an explicit and adequately resourced and managed chaperone policy to help ward off potential sexual impropriety and subsequent litigation. “Despite a public inquiry, only a small majority of acute trusts in England have a chaperone policy in place, which may have severe medico-legal repercussions in the future,” warn the authors, adding that such a policy is a “must for acute trusts.” This could have “severe medico-legal repercussions in the future”, particularly as the NHS seeks to rein in its budget and might consider monies for a chaperone policy could be better spent elsewhere, warn the study authors.

www.npsa.nhs.uk

The Ayling Inquiry resulted from the case of Clifford Ayling, a family doctor who was convicted on 13 counts of indecent assault on female patients between 1991 and 1998. He was subsequently sent to prison and struck off the medical register. The researchers surveyed all the medical directors of acute hospital trusts in England in 2005 and again in 2007, to find out if they had implemented a chaperone policy by the end of those respective years. Only half (52%) of those without a chaperone policy in 2007 said they planned to put one in place. The study points out that 35 complaints directly attributable to a lack of adequate chaperoning were brought to the GMC between March 2006 and August 2009.

Donate blood? Not ME

pmj.bmj.com

Father to four million

1 In 10 Doses Of Prescribed Medication Missed

NEWS PULSE

Patients with Myalgic Encephalitis/ Chronic Fatigue Syndrome (ME) will be permanently banned from giving blood in the UK as of 1 November. NHS Blood and Transplant say the move is a precaution to protect the donor’s safety by ensuring the condition is not made worse by donating blood. In October 2009 a study from the United States suggested a link between the virus XMRV and Chronic Fatigue Syndrome. The change brings ME into line with other relapsing conditions or neurological conditions of unknown or uncertain origin, such as Multiple Sclerosis (MS) and Parkinson’s Disease. www.blood.co.uk

Robert Edwards, the man credited with developing in-vitro fertilization, has won the 2010 Nobel Prize in medicine. 85-year-old Edward’s work led to the birth of the first “test-tube” baby, Louise Brown, who was born in the UK on 25th July 1978. There have been around 4 million individuals born via IVF since. Edwards is currently professor emeritus at the University of Cambridge.

clinical care

ospital inpatients are likely to miss out on almost 10 percent of their medication doses, according to a study presented at the Royal Pharmaceutical Society’s annual conference. Research at Bradford Teaching Hospitals showed that on average a total of 9.7% of prescribed medications were omitted. Drug non-availability accounted for missed doses in 2.4% of cases. The highest proportion of doses missed through nonavailability happened at the 9am drug round that followed a patient’s hospital admission. “This audit is an example of many likely to be taking place in hospitals across the country following a ‘rapid response report’ from the National Patient Safety Agency in

Fifty-seven patients had operations on the wrong part of their body last year, figures from the NPSA show. Wrong-site surgery was the most common of the 111 so-called ‘never events’. Misplaced feeding tubes were the second most frequent. Other incidents included surgical instruments left within the patient, wrong route administration of chemotherapy and incompatible blood transfusions.

www.nobelprize.org

Febr uar y 2010 on the issue of missed medication,” said Nina Barnett, spokesperson for the RPS. “There is a real need to raise staff awareness around medicines which must not be delayed or omitted.” Other reasons for a missed dose included ‘nil by mouth’ policies after surgery, specific advice from a health professional to withhold doses and frequently patients themselves refusing to take medication. www.rpsgb.org

Beards and breathlessness win Ig Nobels In the alternative Ig Nobels the medicine prize was awarded to the paper “Rollercoaster Asthma: When Positive Emotional Stress Interferes with Dyspnea Perception” published in the journal Behaviour Research and Therapy. The public health prize went to “Microbiological Laboratory Hazard of Bearded Men,” published in Applied Microbiology. The Ig Noble prizes are intended to celebrate the unusual, honor the imaginative and spur people’s interest in science, medicine, and technology. www.improbable.com/ig/winners

public health

Sunderland, Blackburn Rovers and Fulham have the unhealthiest supporters in the Premiership

underland, Blackburn Rovers and Fulham have the unhealthiest supporters in the Premiership, according to an NHS survey. Over a third of all Blackburn Rovers fans smoke, Fulham fans drink the most alcohol in the country, and over half of Sunderland supporters are of unhealthy weight. Arsenal, Manchester United and Chelsea are joined by newcomers Blackpool when it comes to having the healthiest fans.

The survey of 25,000 football supporters revealed that Blackpool are crowned champions with over half of their fans being a healthy weight, while 81% of Wigan fans are non-smokers and 85% of Tottenham Hotspur fans drink within the recommended daily limits. Public Health Minister Anne Milton said: “Over the summer players such as Spain’s Cesc Fabregas and Argentina’s Carlos Tevez dazzled the world with their skill and ability to play high tempo football in South Africa. By highlighting the gap between their own health and these Premiership stars, we hope young people will be inspired to get active and adopt a healthy diet.” Lower down the leagues, QPR, Peterborough and Burton Albion fans top their respective tables for being the healthiest supporters, while Hull, Hartlepool and Stockport immediately leave the pitch for being the unhealthiest. www.nhs.uk/Tools/Pages/Football-BMI-league.aspx

Premier League table of unhealthy fans Team / % of fans who are an unhealthy weight: Sunderland: 51.3% Everton: 51.16% Wigan Athletic: 48.21% Manchester City: 47.25% Fulham: 47.17% Blackburn Rovers: 45.0% West Ham United: 44.99% Tottenham Hotspur: 44.87% West Bromwich Albion: 44.63% Aston Villa: 43.23% Birmingham City: 41.49% Liverpool: 40.5% Newcastle United: 40.32% Chelsea: 38.48% Manchester United: 36.39% Arsenal: 36.3% Blackpool: 30.33%

Specialty Training in Scotland 2011 Get ready... On 3 December 2010, the application process to Specialty training in Scotland will begin. It’s an important stage in your medical career so good planning and preparation are critical.

Set... w w w w

Think about the specialties and the type of training that interest you. Find out about the person specifications for each training programme. Make sure your portfolio is up to date. Register your interest and subscribe to our e-Newsletter.

Go! Visit: www.scotmt.scot.nhs.uk

JuniorDrs ad.indd 1

15/09/2010 09:56:51

NEWS PULSE

L Mencap Snap! Awards

Little Fighter

ittle Fighter’ is one of the winning photographs from the 2010 Mencap Snap! Photography competition. The images and their accompanying stories will go on display in London’s Soho Square from 28 September to 12 October, before travelling the UK in a major touring exhibition.

Story behind the ‘Little Fighter’ picture This is our six-year-old daughter, Elizabeth. She has Down’s syndrome, cerebral palsy and has undergone major heart surgery. She can’t walk or communicate, but is forever laughing and everyone says what a ‘little fighter’ she is. This inspired the photo, using my boxing gloves - which she found hilarious! http://www.mencap.org.uk/snap Copyright Mencap

Global Medicine F acts

and

figures

1/23 China has the most hospitals (60,784) and the most doctors

(1.97 million) of any country in the world.

6,790,062,216 people in the world as of end 2009. 33,400,000 have AIDS/HIV. There are

One in every 23 of the working population in the UK is employed by NHS.

By 2050 the number of people with

82.6 79.4 31.88

Japan has the highest life expectancy at birth (82.6 years).

Swaziland is the lowest at (31.88). UK 79.4.

dementia worldwide will rise to over 115 million. 71% will be in the developing world.

1 in 10 of all deaths will be caused by tobacco. It will kill 8.3 By 2030

Belarus has the highest rate of suicide: 35.1 per 100,000 population

million people each year, up from 5.4million in 2004.

[UK 9.2]

NHS is the fifth largest employer in the world after WalThe

Mart, PLA, China National Petroleum, State Grid of China and Indian Railways.

NHS

TB remains the second biggest infectious killer

of adults worldwide in 2010.

Working overseas Section editors:

Ben Chandler and Ivor Vanhegan

Whether it’s Australia, New Zealand or Canada there are plenty of options for doctors wanting to escape the UK. For the more adventurous you might want to consider being a ship’s doctor, accompanying an expedition or working for an NGO. We’ve asked those who have made the move to tell us about their favourite overseas locations and their advice on making the transition. Read our guide then join the discussion with other doctors in our ‘Working Overseas’ forum at JuniorDr.com.

New Zealand

ooking for a position in the Antipodes was a breath of fresh air compared to the UK; the instant my partner and I, a fellow doctor, submitted our CV’s we were inundated with offers of work. We chose to enrol with a locum agency who really took the time to get to know us and we were placed following two telephone interviews. The agency helped enormously with all the paperwork, including our visa applications and medical registration, which smoothed the process of moving to the other side of the world. Working in the Far North of New Zealand in a rural hospital is as diametrically opposite from a UK based DGH as is humanly possible! We worked as a team of four doctors, all registrars, and between us covered the ward, theatre, clinics and A&E with very little senior supervision. We relied heavily on telephone consultations and the retrieval helicopter. The challenge of having to think on our feet, rely on clinical judgment and hone our practical skills has been invaluable and our clinical confidence has grown massively. Of course, the Antipodes aren’t exactly a stone’s throw from the UK, but flying really isn’t that difficult and spending short bursts of quality time with

friends and family is in some ways better than intermittent dribs and drabs. We’ve also found our significant friendships have been augmented in a really positive way by simply having to make more effort to remain in contact. Skype is the best invention ever! We would definitely recommend working overseas to any UK based doctor. x

Dr Clare Cooke

SCRUB UP DOWNUNDER. “Working in the Far North of New Zealand in a rural hospital is as diametrically opposite from a UK based DGH as is humanly possible!”

WORKING OVERSEAS

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 advice 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

Australia

t had always been a dream of mine to work in Australia and the reality has proved to be better than expected. My first experience of Australian medicine was working in a rural

“We dealt with a large range of cases, including plenty that were familiar, but a few that were more exotic, like snake bites!”

town called Gympie, in Southern Queensland. My fiancée and I were part of a team of 12 doctors providing cover to the 90 bedded hospital, which included both a maternity and a paediatric ward. On arrival we had a fantastic welcome, even being interviewed for the local paper. One thing that struck me was the broad skill base of the more senior doctors - local GP’s doubled as anaesthetists, obstetricians and even as pathologists. We dealt with a large range of cases, including plenty that were familiar, but a few that were more exotic, like snake bites! Thankfully a helicopter was available to retrieve the sicker patients. Working in such a small team made for a good social scene. Among the staff were some real characters, including a radiographer who had bought a very grumpy camel to keep his donkey company. However if rural hospitals are not your

thing, then Australia offers a more conventional teaching hospital environment as well. My current position is in a large teaching hospital, and other than the fact that some of our patients are transferred over a 1000 miles to get to hospital it is a bit more like the UK. Would I recommend Australia? … well as I sit overlooking the Indian Ocean sipping a cool ‘tinny’ I guess I definitely would! x

Dr Ben Chandler

Fill your gap year

DOWN UNDER

If you have completed your foundation years and are looking to advance your career and experience some of the best training and practice in the world then Queensland Health has you in its sights. We offer appropriately skilled junior doctors competitive remuneration packages and an adventure like no other. Talk to us today.

Adventure.

>n. an unusual or exciting experience

Senior Ho Dr Stephen Ellio use Officer Women’s Hospita tt, Royal Brisbane & l, Queensland He alth “Although I originally hale from Wimbledon, I undertook my medical ical ca train ttr training aining ain ing n a att Glasgow University. I worked in the he NHS he NHS fo NH fforr a fe ffew w yyears ear ars b but ut dec decide de decided ide ded d tto o fi fillll my my gap year with some sunshine and work experience Down Under. I took a job with Queensland Health and relocated to Australia in 2009. I’ve now been accepted on to the Queensland Health world-renowned emergency medicine training program that offers me exposure to an unparalleled scope of practice and an extraordinary case mix in a major tertiary hospital.” Senior House Officer, Dr Stephen Elliott enjoys the training programs with Queensland Health.

Do more ... see more ... be more. Queensland Health

www.health.qld.gov.au/medical Phone +61 1800 000 093 WORKING OVERSEAS

M270810

Working overseas

Canada

r. Shyr Chui, his wife Karenza, and their children Victoria and Daniel are originally from Worcester, England. They moved to Prince George in the summer of 2008, where Dr. Chui practises radiology at the Prince George Regional Hospital. After seven years as a radiologist in the UK, Dr. Shyr Chui was ready for a new challenge. He had attended a radiology conference in Vancouver, but it was at a medical conference in the UK when he first considered BC as a place to work. “I had just come out of a session that outlined the future of radiology in the UK. I didn’t like the look of how things were going, and walked out of the seminar feeling a little depressed. And there was the Health Match BC booth, with a beautiful picture of the mountains – that’s when we started talking about moving to BC,” said Dr. Chui.

A better lifestyle The Chui family was attracted by the promise of a better lifestyle with more time to spend with family and pursue personal interests. They considered several vacancies, but decided on northern BC for both personal and professional reasons. “Prince George is a good-sized town and has everything that we were looking for family-wise. And the hospital

Experience Experience Satisfaction Drama Junior Doctors – Christchurch NZ You’ve always been the type to challenge yourself - always up for adventure; keen to do more, see more, achieve more. And it’s a philosophy that applies to every facet of your life...work, play, whatever comes your way. So that said, there’s simply no better way to stay true to yourself – and to truly maximise your career and quality of life, than to join us at Canterbury District Health Board. Imagine it now...living in Christchurch, in New Zealand’s stunning South Island. With the ocean a couple of minutes away, and snow-covered mountains a couple of hours away, you’re literally in the middle of life at its best. Then there are the professional advantages. The variety, training and opportunities you’ll have at our leading tertiary hospital are world-class, so your medical career is set for serious enhancement. If you’re a qualified Junior Doctor looking to ramp up your career and really enjoy life, we can make it happen. To learn more about this unique opportunity, and to apply, visit

www.experiencecdhb.co.nz 12

WORKING OVERSEAS

“The work is much broader and more general than my practice in the UK. I’ve had to brush up on certain aspects of the practice, but I’ve also been able to share my more specialized knowledge with the team. It’s been a good change. I was ready for the challenge.” is a secondary referral centre for the region, with a comprehensive imaging department for radiology,” says Dr. Chui. Did the reality live up to perception? The answer is a resounding yes. After the initial upheaval of relocation, the Chui family has settled into their new lives and their second winter in Prince George. They enjoy skating on the outdoor ponds and lakes, cross-country and downhill skiing and ice fishing. Six-year-old Daniel is the hockey fan in the family. In the summer, with the great outdoors at their doorstep, they are canoeing, mountain biking and fishing. The kids settled into their second year of school and Karenza, who was an active volunteer in Worcester, is volunteering with local charities.

New challenges Dr. Chui is enjoying the challenges of his new job as much as the ski slopes at Tabor Mountain. “The work is much broader and more general than my practice in the UK. I’ve had to brush up on certain aspects of the practice, but I’ve also been able to share my more specialized knowledge with the team. It’s been a good change. I was ready for the challenge.” The family was put in touch with other people from the UK who moved to Prince George around the same time, and together they figured out the finer points of life in Canada. Tracking down the perfect tea bag was the first puzzle that these new friends faced together. “Now we know to look for the extra-strong bags. But we still bring back tea bags, whenever one of us goes to the UK for a visit,” says Dr. Chui. x

Dr. Shyr Chui

Enrich your career. Enhance your quality of life. Practise medicine in British Columbia, Canada. Variety and challenge. The chance to make a difference in peopleâ&#x20AC;&#x2122;s lives. A lifestyle most people only dream about. These are just a few of the advantages enjoyed by physicians in British Columbia (BC). With its natural beauty, recreational opportunities, and safe, caring communities, BC offers a quality of life that is envied around the world. Create your future in British Columbia. Competitive compensation may include signing bonuses, relocation incentives, fee premiums, retention bonuses and continuing medical education assistance. MEET HEALTH MATCH BCâ&#x20AC;&#x2122;s RECRUITMENT CONSULTANTS AT: BMJ Careers Fair Stand D, Business Design Centre London, UK October 1-2, 2010

RCGP Annual Primary Care Conference Stand 10, Harrogate International Centre Harrogate, UK October 7-9, 2010

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.

Telephone: +604.736.5920 welcome@healthmatchbc.org www.healthmatchbc.org

Health Match BC is a free health professional recruitment service funded by the Government of British Columbia, Canada.

Sun, Sand and Bureaucracy Working in Australia

You may have heard the stories of hoards of UK junior doctors awaiting visas to travel ‘Down Under’ due to restructuring of the Australian medical board coupled with an unexpectedly lengthy application system. Hannah Cookson, who is currently spending her F2 year in Queensland, describes her experience and offers some advice on how to reduce the stress of applying for Australian placements.

magine yourself spending the evenings on a sunny beach watching dolphins and underclad, attractive people frolicking in the perfect surf. Picture yourself working an 8am-4pm day, where rare overtime is well paid and the workload decidedly manageable. This is the life of many an Australian doctor and could be yours too if you can spare a few gray hairs for the ordeal of clearing the Australian authorities. I arranged my F2 year in Queensland a month into F1 and assumed I would have no issues with time. However, eight weeks ago I quite nearly gave up trying to get to Oz for my 16th August start date. I have put together a little information for those considering the move. Most hospitals in smaller cities and rural areas offer jobs either by direct contact or through agencies and will sponsor visa applications. The next step is to obtain clearance to work in Australia. Provided you are allowed to work in the UK clearance is fairly certain, however the process still needs approval from three separate government agencies. The first, and most straightforward, is to apply to the Australian Medical Council. They require a notary to certify your documentation and will not complete your application until you have full GMC registration. Once approved by the AMC, the second agency, AHPRA, will start processing your application to them. This medical board (created in July from the individual state medical boards) was the real hold up for me. It serves to identify who you are, the legitimacy of your credentials, English

WORKING OVERSEAS

language proficiency and criminal history (or lack of ). It is a substantial form requiring more notarised documents. Once AHPRA have taken your application to a fortnightly board meeting you will receive an email which you must forward to your new employer and to the third agency - Australian Visas and Immigration. The visa form requires more witnessed documents and a medical (which is only available in at six clinics UK wide). With all this done you are free to buy tickets (usually reimbursed by your new hospital). The lifestyle’s fantastic, the people are friendly and the jobs are less time intensive so it will be just seconds before the application process is just a vague, bad memory!

Top Tips Send your applications 3-4 months in advance for a less stressful experience. Recruitment agencies will do much of the work but may offer you less (eg. not paying airfares). Fill all your applications at the same time and get all the documents notarised together to save money. Also take the specific AMC wording to the notary, so they get it right first time. Set aside around $1750 for expenses. Approximately $350 for the AMC, $700 for AHPRA, $150 for the Notary, $150 for the Visa and $300-400 for the medical. Going to Oz after F1 means waiting for full GMC registration so send all paperwork in advance. Call the GMC to receive your certificate three weeks prior full registration date. Avoid flying on a tourist visa whilst waiting for registration – they may turn you back at the border.

A working holiday?

n the 9th August this year a young British doctor was killed in Afghanistan, while undertaking charitable work. Dr Karen Woo was amongst a team providing eye care to some of the poorest and most isolated people in Afghanistan when she was murdered, along with nine others. The tragedy highlights the dangers of helping the sick and needy in war-torn countries. She was working for International Assistance Mission, a Christian charity that has been undertaking projects in Afghanistan for over 40 years. Sadly although atrocities like this are extremely rare, they are certainly not unheard of. Médecins Sans Frontieres (Doctors without Borders) has unfortunately been the subject of numerous atrocities, most recently in Haiti where two MSF nurses were held hostage. MSF prides itself on its ‘first-in, last out’ approach, which may be reflected in some of its higher profile incidents. MSF did however withdraw from Afghanistan in 2004 following the murder of five members of staff, and only returned about one year ago. The organisation was formed in 1971 by a group of French doctors and journalists, in response to the suffering caused by civil war in Nigeria. MSF is currently involved in around 70 countries providing healthcare, but this is by no means the limit of their work. It is also involved with sanitation, nutrition and works to highlight the plight of those suffering in disaster areas, warzones and other areas of need. Giorgio Mariani of MSF admits that poor security is the greatest danger faced by MSF volunteers, however he points out that prior to deployment MSF volunteers undertake training and have on-going support throughout the mission, as well as debriefing and check-ups on returning home. “Our experience is that most communities we work with know MSF and recognise the work that we do, and so we benefit from a huge amount of acceptance from local populations,” he adds. Currently MSF are mostly in need of doctors with experience in tropical medicine, infectious diseases, surgeons, anaesthetists and obstetricians. As a minimum they prefer doctors to have at least one years’ experience following their foundation training. The ability to speak French and Arabic is understandably desirable when you consider possible destinations. Pre-deployment training also concentrates on using scarce resources and interacting

with unfamiliar cultures, as well as security. The top five destinations for UK doctors working with MSF include Sudan, the Democratic Republic of Congo, Zimbabwe, India and Ethiopia. Proving healthcare in disaster areas is not a new idea. The Red Cross movement is nearly 150 years old, having been formed by a Swiss businessman named Henry Dunant. During his travels Dunant arrived in Solferino in Northern Italy on the evening of a bloody battle. Over 35,000 casualties lay injured or dying in the surrounding area. Shocked at the suffering he witnessed he organised local people to help them. The next few years were instrumental in setting up the international Red Cross, as well as organising the Geneva Convention. In 1902 he jointly received the first Nobel peace prize in recognition of his work. Today the International Federation of the Red Cross and Red Crescent Societies has bases in 186 countries, including the British Red Cross. One of the core values of the movement is neutrality, as demonstrated recently in Afghanistan where the Red Cross has been criticised for giving first aid training and equipment to Taliban fighters. While operations such as the Red Cross and MSF partake in immediate disaster relief, others provide different services abroad. Groups such as Mercy Ships will travel to particular areas offering various types of surgery. Some charities will take specialists from the UK abroad to undertake specific procedures, such as cleft lip repair, while other charities focus on training and improving local health services. Deciding what type of organisation to volunteer with is an important choice, as they may have differing missions and values, and may require differing lengths of service. Some have religious ties, although participation in religious events is often not a key part of the job. There are many reasons for volunteering abroad, the desire to help others less fortunate, travel and escaping the rat race being amongst the most popular. Working in such a different environment develops medical and personal skills. Maryam Shamanesh agrees: “The two years I spent with MSF in northern mountains of Burma stretched my creative energy, organisation and diplomacy skills to the limit. I still crave the challenge and sense of achievement I felt with MSF. My work then has influenced all that I have done since”.

Taking some time out from the NHS may actually improve your employment options, as Steve Mannion, a volunteer with MSF explains: “As I contemplated my first overseas mission one senior registrar in the department I was working in suggested I was committing ‘career suicide’. Actually, on my return, the majority of potential employers viewed my involvement with MSF in wholly positive light; useful experience, valuable work undertaken and something more interesting to talk about at interview than the average candidate”. x

Ben Chandler

WORKING OVERSEAS

All at sea a ship’s doctor I

started on a fairly typical career path after qualification from the University of Leicester in 2001. I rotated through SHO posts in a variety of different specialities relevant to Emergency Medicine, my then career choice. Just as ‘Modernizing Medical Careers’ was being introduced in 2006 I was working as an A&E middle-grade in Manchester and studying for my membership to the College of Emergency Medicine (MCEM) exams. Once I had the exam I basically had two choices - apply for one of the last few ‘old-style’ SpR posts in emergency medicine or try something different. I chose the latter and applied for the position of ship’s doctor, having heard about the job from an old medical school friend who was presently working for the company and loving the experience. Up until I applied for the job at sea, I hadn’t done much travelling but had always wanted to; this job seemed to appear on the horizon at just the right time. I decided that before I ended up on conveyer belt heading towards A&E consultancy, I would take a break from the conventional path and try something very different.

“I would never have had the opportunity to see so many places and experience so much in a NHS position.”

Our ships carry anything up to 4500 people, a mixture of multi-national passengers and crew and we sail to the common ‘cruise’ destinations such as the Caribbean and the Mediterranean but also to places further afield such as Australia, South and Central America, the Pacific Islands, Alaska and our ‘Grand Voyages’ have amazing worldwide itineraries. I have been lucky enough to visit some amazing places and, in the equivalent of my lunch break, I have walked up the Sydney harbour bridge, stood gazing at the ceiling of the Sistine chapel, walked along the 16

WORKING OVERSEAS

Dr Philip Brooks is currently a senior ship’s doctor with Carnival UK, a company of well know cruise brands such as P&O Cruises, Princess Cruises & Cunard Line. He has been working at sea since early 2006 and was promoted to the rank of senior ship’s doctor in 2007. Philip explains why life on the open seas can be an attractive career.

Great Wall of China, seen the Pyramids of Egypt and climbed glaciers in Norway. I would never have had the opportunity to see so many places and experience so much in a NHS position. As the senior doctor (most ships have two doctors and between two and five nursing officers) I am accountable to the Captain and sit on the ship’s executive officer committee. I am in charge of the ship’s medical centre - my current ship has an eight bedded facility with three of those beds being intensive care/coronary care equivalent.

Working Life On a daily basis I run two open-access passenger clinics per day and my colleague runs a similar service for the crew. Out of hours we have a 24-hour emergency on-call with the nursing officers being the primary responders and the doctors taking the on-call responsibility in turns. We can see anything between five and fifty new patients per day depending on the age demographic of the passengers and the itinerary of the ship. Our case load can encompass anything from motion sickness or a cut finger right up to myocardial infarction, or cardiac arrest. We have extensive onboard facilities including x-ray and laboratory testing as well as the capability to perform cardiac monitoring, invasive & non-invasive ventilation, thrombolysis, central venous access, adult and paediatric life support resuscitation, blood transfusion, orthopaedic fracture management and minor surgical procedures. I am the public health officer for the ship and am actively involved in the ship’s operational management as

well as a member of the ship’s health, safety, hygiene and environmental committee. As a medical team we regularly practice our emergency response (for either a medical or other emergency such as fire) during mandatory drills and training exercises. Additional nonmedical responsibilities are more pleasurable and dining with passengers or entertaining passengers at cocktails parties is expected of the ship’s senior officers. As an executive officer within the company my remuneration package is very good. I have the company’s private health insurance and am a member of the pension scheme. My pay-scale is equivalent to a senior registrar/junior consultant’s wage in the NHS - the one added bonus being

that, as a seafarer working outside of the UK, I am exempt from UK income tax; hence my wages are paid gross. I have minimal onboard expense with essentially free (serviced) accommodation and no food bills. With that said, the clinical commitment is unyielding with a daily service (weekends no exception) and frequent nights on-call but this is balanced by the opportunity to travel to amazing worldwide destinations and serve as a high-ranking merchant seaman.

Carry on Cruising The perception of a cruise ship doctor is often clouded by thoughts of ‘The Love Boat’ or ‘Carry on Cruising’, but it could not be further from the truth. There is a new breed of younger, more emergency-focussed doctors coming through and whether they stay for one or two years or decide to make a career out of maritime medicine, they usually have a very enjoyable experience. I certainly have. My previous emergency and anaesthetic experience has certainly not been wasted as I have been involved in numerous cardiac resuscitations, intubated and

“You learn to become more resourceful when working at sea as the specialist opinion is a lot further than a phone call away.”

ventilated many seriously ill patients at sea and arranged emergency medical evacuations for critically ill patients to shore side hospitals by land, sea or air. No two days are ever the same and the pace can range from relaxed to frantic depending on what sort of patients you are seeing and where in the world you are. One memorable day was when, en route to Reykjavík in Iceland, we had a elderly man in complete heart block hooked up to our external pacer and then had to urgently call for blood donors when a young man presented to the medical centre with a towel full of fresh haematemesis. Both passengers were disembarked - one for a pacemaker and one for a laparotomy. We carry no blood stocks onboard so rely on those passengers who are known blood donors to come forward. We venesect and transfuse using special donor kits after performing onboard HIV and Hepatitis B tests. Shortly after sailing that same day passenger came down with sudden loss of visual acuity in one eye and features of a retinal detachment. We organised a medical evacuation via the Icelandic coastguard and he was airlifted for urgent retinal surgery which restored his sight to normal. During one busy clinic after sailing from Sydney we had over a hundred motion sick Australians to see as the weather leaving the Sydney harbour is notoriously rough. One man walked into the medical centre, vomited and collapsed. The nurses shot him looks of distain until we realised that he wasn’t breathing and his extensive anterior myocardial infarction had cause him to vomit, not the weather! He was intubated and remained in our medical centre for 24 hours on inotropic support until we could enter the nearby port of Newcastle and evacuate him to an intensive care unit.

You learn to become more resourceful when working at sea as the specialist opinion is a lot further than a phone call away. We image-link all of our onboard x-rays to a group of radiology associates in the USA, who provide reports by return e-mail. We have full internet access as well as a computer-based forum connecting all the ships in the fleet together - this is an excellent resource for sharing knowledge, obtaining a second opinion or discussing clinical management of cases. In certain circumstances we will ask for an opinion from a shore-based specialist by phone (if we are at sea) but often we simply make a referral to a hospital specialist in one of our ports of call with the assistance of our local manning offices and port agencies. In addition to the medicine you have to be skilled in basic dentistry which is something you learn on the job, much like how to perform the blood tests, maintain malfunctioning medical equipment and take and process x-rays - none of which falls into your remit as a land-based doctor. When I am on leave my time is my own and typically I will be at sea for four months and off for two. I am a medical director for the Advanced Life Support Courses and like to teach a couple of courses each time I am on leave - this keeps my resuscitation skills up as well. I also instruct on the pre-hospital care course run by the British Association of Immediate Care (BASICS) and I am currently studying for my Diploma in Immediate Care. I am lucky enough to have a long stretch of leave all together which permits nice holidays and time to catch up with family and friends I haven’t seen whilst I’ve been at sea.

No two days are ever the same and the pace can range from relaxed to frantic depending on what sort of patients you are seeing and where in the world you are.

If you have a love of travelling and like to challenge yourself clinically then working at sea may be for you. The lifestyle is very different and the pace and way of working takes some getting used to, but I have thoroughly enjoyed my time as a ship’s doctor and would wholeheartedly recommend the position to others. x

Dr Philip Brooks

WORKING OVERSEAS

The Everest Test

Cricket at 5200 metres Unsure what to do after FY2 Dr Ian Ditchburn decided to take a locum post and see what opportunities came up. What he didn’t expect was a phone call inviting him to be part of an expedition to play the highest ever game of cricket in the world. He tells JuniorDr’s Ivor Vanhean his story.

he Everest Test was to take place on a plateau next to Everest Base Camp at 5200m above sea level. The idea was to haul 30 players, three umpires, 10 supporters, an artificial wicket and all the cricket kit needed up to the plateau to play a game of Twenty20. We were also raising money for a couple of charities through sponsorship. The expedition had snowballed in size and they needed a medical team. Although I didn’t have any formal expedition qualifications I’d taken myself to Virginia earlier in the year to do an ATLS course (the difference in cost compared to the UK course paid for the flight) and at medical school I’d taken part in an altitude research expedition to Bolivia (www.apex-altitude.com). After a couple of phone interviews I was in. As it was a voluntary expedition I wasn’t paid and had to fund my own costs. However, with such a big group we had a goodsized discount and, of course, it was all in aid of a number of good causes. Another important consideration was medico-

WORKING OVERSEAS

legal cost - though most firms will provide free cover if you’re working for a registered charity.

Planning is key If you’re ever involved in an expedition the key is good planning. You can do a lot more from home than you ever can on the

“I think I probably broke the world record for the number of antiemetic injections given in the buttocks over 48 hours”

side of a mountain. We took detailed medical histories from every member of the expedition, spoke to specialists if necessary and prepared for any potential problems. It was surprising how many medical issues a group of 45 young people could have. We had a barrage of conditions ranging from endocrine to musculoskeletal to neurological. We meticulously organised two

medical kits: a general medical supplies bag and an emergency bag. I remember as a medical student being asked ‘if you were a GP what 10 drugs would you have in your bag?’. It was a little like that but on a larger scale. There was a lot to consider including antibiotics, a defib, resus meds, protective equipment, airway kit, dressings, sedatives, oxygen, fluids, IV access, anti-emetics, rehydration sachets and even the emergency contraceptive pill. A major concern was acute mountain sickness (AMS). The key to AMS is to ascend at a sensible pace but even then it can’t be completely prevented and there’s no way to predict who will be affected. We recommended that everybody took prophylactic acetazolamide before leaving the UK. The evidence is a little thin but the side-effects are minimal (other than a strange tingling sensation in the hands, feet and other extremities ... not totally unpleasant to be honest).

The trek The trek up took nine days and was hard work. We dealt with on-the-spot problems

and ran a clinic every night. The majority of our time was spent dealing with AMS, exposure, exhaustion, dehydration, gastroenteritis and musculoskeletal problems. AMS is difficult to differentiate from exposure but if in doubt the patient didn’t ascend further for 24 hours. Thankfully the closest we came to emergencies were fluid resuscitations. It was a challenge to be out of my comfort zone. Where was the lab when I needed it? Where was the registrar? How do you put up a bag of fluids? After nine days we reached our destination. Following a day of acclimatisation the game was played and we broke the world

“It was a challenge to be out of my comfort zone. Where was the lab when I needed it? Where was the Registrar? How do you put up a bag of fluids?”

record. As the team doctor for Team Hillary I like to think that our 36 run victory over Team Tenzing was due to the peak physical condition that their doctor had got them there in. The way back down wasn’t pleasant. We decided to try to get down in two days so we could have more time in Kathmandu but the group was struck with a norovirus-like infection. Infection control became an issue and we isolated anybody who was affected. Everybody had carried alco-gel throughout the trip and fortunately we had a couple of big top-up bottles in the medical supplies. We trekked for 14 hours a day and none of the doctors got much sleep on the nights. I think I probably broke the world record for the ‘number of antiemetic injections given in the buttocks over 48 hours’. I’m glad to say however that we got everybody back down in one piece. I’m now a GP trainee in West London. The Everest Test was the most challenging, enjoyable and rewarding experience of my brief medical career. I plan on getting involved in more expeditions over the years. They take you out of your comfort zone and I came back to the NHS a more confident and better doctor. I can’t recommend this sort of trip strongly enough and there are plenty of opportunities out there. x

Dr Ian Ditchburn

WORKING OVERSEAS

Mercy Ships

Short term volunteering overseas

originally heard of Mercy Ships via a senior colleague. I was particularly struck by their enthusiasm for surgeons and anaesthetists to volunteer for short placements - as little as two weeks in some cases. You may question the value of such a brief visit but it certainly does matter to the individual patients. Africa Mercy spends six to nine months docked in one port in West Africa. A team will have already contacted the government and health ministry to secure an official invitation. When the ship arrives calls are made on radio, TV, leaflets and posters, for initial screening in a stadium or similar venue. Screening is open to anyone who believes they may be helped by [free] surgery. Surgeons, anaesthetists and theatre staff are involved in giving out appointments determined by when particular surgeons will be available. Maxillofacial/head and neck, plastic/reconstructive surgery, general surgery, vesico-vaginal fistula repair, orthopaedics attend for at least a period, alongside dentistry and ophthalmology.

“Security is another hazard - many countries visited are on Foreign Office “caution” lists.” Often these specialties are unavailable in the host nation, or are limited by an absence of medical anaesthetists or of supplies. Follow-up is possible, as are staged procedures six months apart. With reliable electricity and water supplies, the ship supports familiar anaesthetic machines and other theatre equipment.

As you read this Dr Rachel Homer, an SpR in Anaesthesia, is in Togo for three weeks as a volunteer anaesthetist with Mercy Ships - her fifth and longest trip with them. She tells JuniorDr’s Ben Chandler about her previous experiences on the hospital ship, the Africa Mercy.

up to many years. Staff originate from the UK, USA, Netherlands, Germany, Antipodes, South Africa, and many other nations. The official ship language is English, but not all crew find this easy. Additionally, local people are employed in various departments including (crucially) translation.

Ship’s clock Patients are admitted the afternoon before surgery. Outline anaesthetic assessment will have been done at screening. Weekdays begin with a department or crew meeting around 7:30am, then theatre briefing at 8 or 8:30am. The preoperative checklist includes offering to pray for the patient. Mercy Ships is a Christian organisation; you do not need to share their faith to work with them, but not everyone would be comfortable in that environment. Most theatre lists end around 5pm dinner time! There is no planned evening or weekend operating, but we do take turns ‘on call’ which means remaining on board. Occasionally emergencies - such as a memorable post-thyroidectomy bleed might keep the entire theatre team working into the night.

Not all plain sailing

the benefits of being self-contained is that if there was a serious risk the ship could leave.

“Flexibility is also required as patients may show up a week or two early or late having travelled long distances.” Patients’ general health may also delay or complicate anaesthesia and surgery: malnutrition may compromise healing; active malaria increases surgical bleeding; many patients have a degree of chronic lung disease from cooking over open fires, and untreated hypertension alongside chronic dehydration. Decisions about proceeding with anaesthesia cannot follow quite the same rules as at home! Flexibility is also required as patients may show up a week or two early or late having travelled long distances; roads and bridges get washed out during the rainy season. Patients must also overcome their own fear of this strange high-technology environment. For UK anaesthetists, greater independence is required. There is not always an ODP-equivalent on board so we do our own set-up and restocking. There will always be one floating/supervising anaesthetist to give an extra pair of hands at induction or emergence, as well as breaks. Anaesthetists themselves come from different backgrounds (physicians, nurse anaesthetists who may be used to acting under direct supervision or more independently) so patience and clear communication are vital. In conclusion I find the repeated short trips an easy way to access the rewards of working overseas - and I believe I benefit just as much as I contribute.

Ship-shape

Communicating with patients and families remains challenging. The official language in Togo is French, but most will preferentially speak one of several tribal languages, or a dialect. Working through translators is a skill in itself. Security is another hazard - many countries visited are on Foreign Office “caution” lists. We are advised not to go ashore alone and there may be a curfew overnight. One of

There are six operating theatres on board Africa Mercy, coordinated and partially staffed by long term volunteers. Four wards (60 inpatient beds) plus a four bed intensive care unit, recovery, the laboratory and CT scanner occupy the same ‘hospital’ deck. Others on board run support services or are involved in land-based projects which may include building orphanages or clinics, HIV/ AIDS education, water/sanitation projects or road building. The onboard community is around 350 people, including families, couples and singles that all stay from a fortnight

Africa Mercy. The world’s largest non-governmental hospital ship, with six operating theatres, a 78-bed patient ward and accommodation for more than 450 volunteer crew members. Deployed 2007.

WORKING OVERSEAS

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Medicolegal Advice - in association with Medical Protection Society

Doctor overboard!

More doctors are setting sail for pastures new to share their medical expertise abroad, but dangers can lurk in uncharted waters so make sure you’re protected, says Sara Williams

ast year, suitcase in one hand and passport in the other, Dr Alex Naylor, a trainee from Leeds, walked through the doors of Heathrow Airport to check in for his one-way flight to Sydney to work at Westmead Hospital. But, a year on, was his quest for fortune and glory in vain? “My main reason for leaving was for a sense of adventure. Leaving F2, I didn’t feel ready to throw myself into a particular field; I wanted to gain further experience in anaesthetics and ICU. “I made the right decision. The pressures of work don’t feel as demanding as they were in the UK; you feel more of a team player, rather than a nameless drone. I have found working in the emergency department incredibly fulfilling; no four-hour waiting times, so you feel like a doctor, not just a triaging system. There will always be a place in my heart for England, but giving up the work, weather and the country would be hard.” Alex is not alone. Although the Department of Health (DH) doesn’t collate official figures, the GMC has issued more than 2,400 Certificates of Good Standing so far this year, which is a standard requirement About MPS infoembarking for articles.qxd:MPS Checkup before on clinical work in most countries, and is an indication of how many doctors are going to work abroad. Dr Clare Fellingham moved to New Zealand in 2007 because she was frustrated with the MMC

“fiasco”. She has since moved and currently works in Perth in Western Australia. “When I was a third year SHO in a busy DGH in the Home Counties, I realised that nothing fazed me anymore; I felt like I was working on autopilot. I moved to the Antipodes and found jobs that are without parallel in the UK. You could run a base hospital, work in a clinic 1,000km from the nearest tertiary referral centre, cruise with the flying doctors, act up a grade, make real life and death decisions, and gain infinite clinical skills and life experience.” Thinking ahead

Clare left the UK confident that she could achieve her dreams of working as a foreign doctor, but she now knows only too well the number of boxes she had to tick to realise them. From expensive medicals to police checks, it can take a long time to secure a ticket to work in another country. Thinking ahead is the key to organising a successful trip – getting important factors like travel insurance, flights, vaccinations and professional indemnity sorted early will 12/2/10 10:05 at Page 1 minute. help avoid problems the last What indemnity is needed?

Before practising it is vital to protect yourself: new countries mean new risks.

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.

Having a patient’s best interests at heart will not always protect that patient from harm. Likewise the best intentions will not always protect a doctor from human error and professional scrutiny. This is why having indemnity and access to 24-hour medicolegal advice is vital. NHS indemnity is limited to clinical negligence claims arising from NHS hospital care and the claim is made against the trust. It is essential for all doctors to have additional professional protection for the other medicolegal risks that can arise from practice. The NHS scheme does not extend to doctors working abroad, who will therefore need to make their own arrangements to ensure that they have adequate protection in place. Dr Pallavi Bradshaw, MPS Medicolegal Adviser, says that junior doctors must be alive to the ever-increasing risks of clinical practice. “Doctors travelling abroad should be alert to the current legal and ethical climate within a particular country. Being aware and managing these risks will safeguard you for the future. “Without a doubt, patients should be protected, but equally, we believe, so should doctors. MPS’s role is to protect the interests of members when concerns are raised about their practice, in any form – claim, complaint, medical council investigation. It is a common misconception that MPS deals mostly with clinical negligence claims. This

kind of work represents only about 20% of our caseload.” How should you inform MPS if you want to work overseas?

If you plan to work overseas you must contact the MPS membership helpline on 0845 718 7187, or email well in advance of your trip, to ensure that you have appropriate indemnity arrangements. This is particularly important because some countries – for example, Australia and Germany – have made it a requirement that all healthcare practitioners have insurance-based indemnity, as discretionary indemnity is not recognised in these areas. MPS is the world’s largest mutual medical protection organisation working internationally, operating in more than 40 countries. If you are planning to work overseas you may well be able to continue your membership with us. For practice in Australia, MPS has a reciprocal agreement with MIPS (an Australian insurance company) to arrange cover for non-Australian resident MPS members intending to work in Australia in state indemnified hospitals. When you contact the membership helpline to work in Australia, please provide them with the following information: • your UK address and telephone number • email address • Australian address and telephone number • Australian work address • dates of practice. Good Samaritan acts

MPS’s protection entitles members to request assistance with medicolegal problems arising from Good Samaritan acts in any part of the world. This is where a doctor provides medical assistance outside their usual clinical employment or work environment in a bona fide medical emergency, such as when passing a roadside accident, emergencies at public events and on aeroplanes. Where to go?

The Antipodes is a mecca for graduates from all trades, but Clare Fellingham argues that a lot can be gained from exploring faraway places. “It depends on who you are, your seniority, your outlook on life and your breadth of experience, but if you really want to, go for a far off land and get a great experience.” Sara Williams is a writer and editor at MPS. Read a fuller version of this article at mps.org.uk/new-doctor.

Guide to interviews How can you make an impact in your interview? Some candidates have an innate ability to sell themselves well, but many find it more difficult and are in search of a magic formula that will give them the job they seek. Forget the miracle cure; there is only one recipe for success: preparation.

What makes a good candidate? Good candidates display a wide range of attributes, but they always have 3 things in common: A good structure

Many candidates have good content; they say all the right words but they fail to impress the panel because the information is not structured. As a result, the interviewers fail to follow the arguments presented and good scoring opportunities are missed. Make sure that your answers contain three or four distinct points which you can develop in turn, and not a long rambling novel. A personal approach

Candidates have a tendency to waffle or “theorise” about topics. Questions on leadership contain a lot of buzzwords such as “vision”, questions on governance get answers discussing “frameworks”, etc. This sounds very theoretical and does not allow the candidate to demonstrate that he/she understands these concepts on a practical day-to-day level. Rather than theorise and focus on buzzwords, bring examples from your daily experience. Lateral thinking and maturity

Think about the range of issues that each question addresses. For example,

dealing with a difficult colleague does not just mean reporting the issue to a senior colleague; there is also a human and communication side to it. When you describe your teaching experience, do not limit yourself to the letter of the question; as well as your formal and informal experience of teaching, you can talk about the methods that you have used, courses you have attended, feedback that you have received and your future plans for teaching.

How to prepare It is crucial that you do not rush into mock interviews too early. There are hundreds of possible questions, but they all boil down to 10 or 15 themes. Take four or five questions from each theme (teaching, difficult colleague, etc) and brainstorm them. Then see how you can structure your answer using 3 or 4 bullet points. Look at what you do every day and see how your experience can be used to enrich your answers. Take your time! Once you have done all that, then you can start practicing. Attending a course can also help, but make sure that it has a small number of participants. With a small number of participants, you can discuss good and bad answers and obtain personal feedback on your own technique.

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Secret Diary of a Cardiology SpR Monday If you’ve been following this column then you’ll realise that I was just finishing up my last attachment in a DGH before starting my teaching hospital job as a new consultant. In fact, this is my last month as a registrar so I am savouring every possible moment. Monday morning was spent doing a ward round of our inpatients followed by some paperwork. I have finally been awarded my MD but was still tied up with a number of small papers and needed at least a couple of hours a day to make sure that I was on top of the work. The afternoon was in clinic. I have a consultant who is very nice but still insists on me discussing every patient with him. Whilst this would have been fine in my first month on the job it’s starting to get a little irritating now. Of course, there will always be times when I need a second opinion as even professors need help every now and again - but asking him if it was fine to put my post-MI patient on a beta blocker because it had been missed off his discharge summary is where I draw the line. I finish up some dictation and make it home early.

Tuesday CCU rounds this morning to cover one of the consultants who is on paternity leave. The patients are all pretty stable and have standard management plans so I take some time to teach the two medical students on the firm. The girl is hardworking and clever enough but the boy is very frustrating. He’s clearly extremely bright but also very lazy. I’ve noticed that he hardly turns up and when I ask him why he tells me that much of medicine can be learnt from books and that his exams are actually just opportunities to regurgitate some of that information. I find myself nodding along to what he is saying and then stop myself. I tell him that he needs to spend the entire day on call with the firm at the end of the week or else he gets to fail the firm. He starts to protest but I move on to the next patient. The afternoon is spent doing an echo list of inpatients. A colleague of mine went to do some charity work in India and he did forty to fifty echos in an afternoon. I do three. They are all normal. I leave early and go home where I spend the evening tidying my flat with the TV on in the background. I drink a glass of Merlot and am in bed by ten.

Wednesday Angio list in the morning. I can do these with my eyes closed (well, not quite) but I am still under close supervision by one of the consultants. I wonder what it will be like when I start my new post? I’ll probably watch my juniors like a hawk and make sure that I do all the procedures myself with them observing from the back of the room. No doubt they’ll hate me. I finish up the list and grab some lunch in the canteen where I spend a little while chatting to a couple of cardiac technicians. The afternoon is scheduled for paperwork but as I have none to do I get on the train to go shopping in the city. I meet some friends after work and we go out for dinner and then hit a couple of bars. I find myself throwing up at one in the morning outside a dingy club and feel much better for it. I stay with friends before getting up for an early start. 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!

Thursday Consultant ward round today. I try to make it through without falling asleep and he notices. He asks me afterwards if I’ve been out late and when I say yes he simply smiles and says I should enjoy it now as life is going to get a lot tougher soon. He leaves to go and see some private patients and I take the remainder of the team for a coffee. I sip my third of the day and my head begins to feel a little clearer. I spend the afternoon reviewing our ward patients and then doing some paperwork. One of our reviews has just been rejected from our third choice journal and it is starting to get disheartening. I spend a little while searching for a lesser impact publication before giving up for now. I go home around six and make a few phone calls before ordering a pizza, eat half of it and then go to bed.

Friday After microwaved leftover pizza for breakfast I make it to my oncall on time. Both our medical students are here and surprisingly they both seem very keen. I send them to clerk some easy patients and spend the morning fending off calls from GPs who want to dump their patents on us before the weekend. We have a quick sandwich with the students in the canteen. The girl goes off for some afternoon lectures but they boy decides to heed my warning about failing the firm and he tells me he’s going to spend the entire day on call with us. We leave lunch and go back to find some sicker patients in the afternoon. One of them is a young man with asthma and a sudden pneumothorax. Both the on call anaesthetists are in the trauma bay with an elderly lady who fell down some steps and looks like she’s in a bad way. I call over to the anaesthetic registrar and tell him that I’m going to intubate the asthmatic. He knows me well so tells me to continue but shout over if I have a problem. I get our student to assist me and we tube him easily. We hand him onto the critical care consultant who has just turned up. We get a crash bleep and run with one of the anaesthetists to the orthopaedic ward. We find an elderly man post hip replacement in VT. We shock him twice and then get him back. We work on him for an hour before transferring him up to ICU. By the time we hand over we are pretty exhausted. I ask our student if he learnt more in a day with us than he would have done spending a week reading in the library. Looking pretty shell shocked, he says that he did. As it’s his last week on the firm before he moves onto a psychiatry attachment, he tells me that he’s going to miss doing general medical on calls. So am I.

Focus on Finance - in association with Wesleyan Medical Sickness

Get Smart: Get Saving Y

ou might not see the importance of saving at this stage in your life, especially when there’s so many things you want to spend your money on. However remember that saving gives you choices - the choice of whether to buy a house, where to educate your children and ultimately the choice of when to retire. You might think you have years to start saving for these eventualities but the reality is, assuming you start working in medicine at 24 and retire at 65, you only have 492 pay days in your career. So if you only save £100 per month until you retire your total savings pot will amount to just £49,200. It’s never too early to start saving and the very least you should aim to have in place is what’s known as an “emergency fund”. This is essentially a reserve of cash that would keep you afloat in the short-term if for any reason, you were unable to earn an income. The size of the fund depends on your lifestyle but we suggest that you have at least the equivalent of three months salary after tax, in reserve. Once you have your emergency savings in place stash away some cash on a regular basis if you can. How much you save is obviously a personal choice but make sure you’re comfortable with the amount you choose. The key is to decide on an amount that you won’t miss too much. When you’ve decided on how much you can save then think about your savings objective. Are you saving for the short-term for example buying a new car or the long term - perhaps you’re thinking about funding a post grad or other training

course in a few years time. How long you plan to save for will impact on where you choose to house your savings, as will your attitude to risk. In reality every type of saving carries some risk but some choices are riskier than others. Generally the higher the risk you take, the higher the potential return and vice versa. So if you put your money in stocks and shares, you may ultimately get a good return on your investment but you are at the mercy of the market which can at times be extremely volatile. However you may think putting your money in the bank is the safest option, but remember the real return on cash deposits reduces over time because of inflation so your money may not be worth as much over the long term. Your attitude to risk may change as you get older, especially when you’re saving for real long-term plans such as your retirement, when you might feel happy taking a greater level of risk. However, generally you should stay with lower risk options for short term goals. It’s important to take into account any tax efficient savings options such as individual savings accounts or ISAs. You can save into an ISA on a regular basis or make a lump sum investment. When you come to withdraw your money you won’t have to pay any income tax on it in the way you do with a normal bank account where interest is taxed at regular intervals. There is a limit to how much money you can save in an ISA; currently the allowance is £10,200 of which up to £5,100 can be put into a cash ISA. The remainder can

be saved in a stocks and shares ISA or if you prefer you can put the whole allowance here. Stocks and shares ISAs are better for medium to longer term savings (more than five years) while cash ISAs are more suited to short term saving. There are other types of savings options available with different levels of risk and return and different tax implications. Talk to a financial adviser to make sure you have the right saving plan to suit your needs and that you’re making the most of your hardearned cash.

The above information does not constitute financial advice.

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FINANCE

Assessed by Gil Myers

Compiled by Farhana Mann

Medical Report

SLEEPING BEAUTY A

s a medical student at NeverNeverLand Hospital, I was always told that most diagnoses can be made on history alone. However, when your patient is asleep that doesn’t help very much. It is fair to say that SB didn’t contribute much to the diagnostic sieve. While there was the occasional snore I didn’t feel that these occurred with enough regularity to warrant them being classed as an ‘interaction’. As you can see, I have pruned the differentials to a short list. I am hoping that a good night’s rest will leave me refreshed and ready to tackle the problem tomorrow. Goodnight.

Across

3 This pox is a rare zoonosis occurring in villages of central and western Africa and the squirrel is likely to be the animal reservoir; potentially rather entertaining animal (6) 6 This disease was eradicated in 1977 following an aggressive vaccination policy and WHO efforts (8) 7 Name for mycobacterial ulcer seen in rural areas of the tropics (6) 9 This fly is the vector for sleeping sickness (6) 10 Visceral leishmaniasis is also known as ____ azar (4) 11 This viral illness is named after a town in Nigeria, was first dicovered in 1969 and is characterized by fever, myalgia, back pain and headache; humans are infected by eating food contaminated with rat urine (4) 14 This is the commonest arthropod-borne viral infection in humans (6) 15 In treating malaria, this is the drug of choice for susceptible parasites (11) 16 Virus causing a contagious pustular dermatitis in sheep and hand lesions in humans (3) 18 Country associated with this encephalitis which is mosquito-borne and caused by a flavivirus; anime classic Akira is set here (5) 20 Typhoid is the typical form of this fever (7)

Down

1 Malaria is spread by the bite of the Anopheles mosquito of this gender (6) 3 The vector for typhus is this arthropod on the human body; rhymes with Hugh Laurie’s famous TV doctor (5) 4 Human malaria is caused by four species of this genus (10) 5 Slang for ladies; Avian influenza is spread by these (5) 8 This type of diarrhoea is defined as passage of three or more unformed stoold a day in a resident of an industrialized country travelling in a developing nation (10) 9 This is the commonest cause of blindness worldwide (8) 12 Flavivirus causes this fever; Coldplay hit that started it all (6) 13 Along with the Marburg virus, this virus disease causes haemorrhagic fever and is often fatal. Epidemics have occurred in Sub-Saharan Africa (5) 17 2001 Kylie album; most common symptoms of malaria (5) 18 These criteria include major and minor features for diagnosing rheumatic fever; the rest of Catherine Zeta (5) 19 The viruses for this disease belong ot the group picornaviruses; they may affect the nervous system particulary anterior horn cells of the spinal cord and cranial nerve motor neurones; think Salk and Sabin (5)

You can find the crossword solution by searching for ‘crossword answers’ at www.juniordr.com 26

HOSPITAL MESS

Catalepsy Catalepsy is a nervous condition characterised by muscular rigidity and fixed posture regardless of external surrounding and stimuli. Sufferers show waxy flexibility (limbs staying in position when moved), slowing down of bodily functions such as breathing and a decreased sensitivity to pain. This would explain why this morning’s accidental miscalculation between the trolley and our examination bed which resulted in SB ending up on the floor was not enough to wake her. I see this as an important clinical finding rather than a medico-legal risk. There are many nervous disorders which can cause a state of catalepsy including Parkinson’s disease or epilepsy or, in some cases, extreme emotional shock. Catalepsy is also a characteristic symptom of cocaine withdrawal. It is my understating that SB is “a close friend of Snow White” which may mean she dabbled with recreational drugs. Anorexia Nervosa I won’t go into a detailed list of the signs, symptoms and presentation of anorexia nervosa but it is safe to say that a lack of food will leave anyone feeling tired and weak. As the body begins to shut down a coma-like state can be reached. Something not as well known is the association of anorexia nervosa with Narcissistic Personality Disorder. The essential feature of narcissistic personality disorder is a pervasive pattern of grandiosity, need for admiration and lack of empathy that begins by early adulthood. I mean, who calls themselves Sleeping Beauty? That shows a certain level of self-belief that most people don’t share. Fibrodysplasia ossificans progressive (FOP) This is an extremely rare disease of the connective tissue. When damaged, soft tissues are transformed permanently into bone. Injuries can cause joints to become permanently frozen in place but I hypothesise that in SB’s case the whole body was affected. Unfortunately, there is no known cure for FOP and so my advice is to avoid activities that increase the risk of falling. Clearly living at the top of a tall tower is a recipe for trouble.

Writing in the Notes W

icism

Sick of EWTD crit

Surgeons preDear Editor, Royal College of e th e se e w in Aga p the EWTD we should scra hy w on as re a ave in junior senting rates of sick le er gh hi es us ca supported by (EWTD - unsurprisingly ) p5 17 s Is s; nal. The study, doctor their own jour in d he esis bl pu research t my bigger qu little weight bu s e ie rr th ca of , e ad re entativ when are truly repres ey th of er r th be he m w nu tion is ect a large members? I susp in wishes of their working hours n e reductio in th t ed or ne pp y su el at ns surgeo We desper other colleges. tment of Health line with many D than the epar r he ot ns tio sa organi rner. fighting this co

leton Aaron Temp y ST3 Psychiatr

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 flapjack

70p Tissues

The NHS – ‘No H

ope Service’

Manchester

GP (via Juni orDr.co

se!

Concentrate plea

% of the Dear Editor, ti-task for 12.8 ul m ly on s or poorer Junior doct ve shorter and gi cs do ed pt t I contime? (Interru Really? I suspec ) p7 17 s Is s; my time care to patient than 12.8% of ss le r fo sk ta e eep goes centrate on on sleeping! My bl I’m n he w ly n’t able to – and that’s on utes so if I was in m ur fo y er off around ev done. ver get anything ne I’d sk ta tiul m kova

Anna Stri London SpR Gastro,

‘Writing in the notes’ is our regular letters section. Email us at letters@juniordr.com.

£1.40

Royal Free Hospital, London

Stuff yourself at:

(pocket sized)

Dear Editor, I whole-hearted ly agree with Je nny Simpson th ideas from juni at or doctors on th e frontline will our NHS (Innov save ating from the frontline; Iss 17 I am confident p3). that the ideas ar e there, it’s the ure of the orga failnisations to culti vate these which me with fear. Th fills e entrenched ‘w ell, that’s the w has always been ay it done’ attitude ne eds to change. need to move aw We ay from consul tants and manag presenting the N ers HS as a ‘No Hop e Service’. Organ sations such as iBAMMbino an d Agents for C (agentsforchange hange .bmj.com) shou ld have the supp from both juni ort ors and senior le aders.

Prices to get you in a flap at:

Harplands Hospital, Stoke-on-Trent

Just pray you don’t catch a cold at:

50p

St George’s Hospital, London

Prices not to be sneezed at:

35p Portion of chips

Mile End Hospital, London

Maybe consider a salad instead at:

90p

QEII Hospital, Welwyn Garden City

Just keep your cholesterol in check at:

40p

Harplands Hospital, Stoke-on-Trent

Next issue we’re checking the cost of parking for one hour, the cheapest ‘get well soon’ card and a bowl of porridge. Email prices to hospitalconfidential@juniordr.com

Colchester General Hospital Colchester Doctor’s Mess has a flatscreen TV with Sky, microwave, dishwasher, and coffee maker. Off the main mess is a room with three computers. The usual tea, coffee, toast and cereals are provided along with daily newspapers. One plus is having a cleaner. Mess fees are £10 a month with occasional subsidised mess nights out.

JuniorDr Score: ★★★✩✩

HOSPITAL MESS

Weekend Ward Escape to

OSLO

There are two facts everyone should know about the Vikings. First, they never wore helmets with two horns and second, they’ve progressed pretty far from their club-welding, rape-and-pillage period. Today Norwegians are hoping that you’ll flock to their fjords and rave about their reindeer in the hope of making their country one of the hottest destinations this year. Just don’t come back with a horned helmet - you’ll just look a fool to those in the know. Getting there BA (www.ba.com) fly direct to Oslo but check out Norwegian, Norway’s low cost operator, where you can pick up return flights for under £80 (www. norweigan.no). Ryanair also serve Norway but use Torp airport, a three hour bus journey away, so isn’t a great option for a weekend trip. Getting to the town centre is simple. Flybussen (www.flybussen.no) operate a coach service in 45 minutes or you can get there in half the time with an express train costing around £10.

Where to stay? Norway is ridiculously expensive and you’ll struggle to find affordable accommodation anywhere. One of the cheapest, P-Hotels (www.p-hotels.no), offer very basic double rooms for under £70. Breakfast is a baguette and carton of juice in a bag hung on your door, however the location is excellent just off

Oslo’s main street, Karl Johansgate. A little more expensive and ten minutes tram ride from the town centre is the Gabelshus Hotel (www.gabelshus. no). Situated in a residential area it offers renovated rooms, a huge buffet breakfast and free use of spa facilities in the basement for around £100 a night.

Eating For a traditional Norwegian meal take the metro 40 minutes up the mountain to the log and stone restaurant Holmenkollen (www.holmenkollen.no) but get there while it’s still daylight to enjoy the view. Reindeer, a tender meat, with a taste between beef and liver, is a top choice. Alternatively if you crave a more swish Scandinavian dining experience try Sult – which means ‘hunger’ (www. sult.no). This trendy venue attracts the fashion consciousness Oslo-ites and offers controversial but tasty foodstuffs like whale steaks.

Unfortunately eating cheap is impossible in Oslo where a Big Mac meal costs over £7 and you’ll struggle to pick up a bottle of water for less than £2. Do as the locals do and jump on a free bus to Ikea where you can munch without needing a to arrange a mortgage.

Key attractions Fjords: Oslo sits on a rather flat piece of land so you have to travel pretty far to get a glimpse of the spectacular fjords. A package called Norway in a Nutshell (www.norwayinanutshell.com) offers full-day train, bus and boat passes to get you there. If you’ve got time take the train one-way from Oslo to Bergen, ranked as the most picturesque in Europe, and catch a flight back to the UK from there. Vigelandsparken: 200 human sculptures, some mildly pornographic, fill this park on the outskirts of Oslo. Containing the world’s largest granite sculpture it’s a relaxing retreat from the city and a great way get some amusing holiday photos too. Edward Munch Museum: Famous for his Scream painting, which was even more famously stolen a few years ago. Worth a quick look. Find the full Oslo guide at JuniorDr. com.

Key facts • Population - 500,000 • Language - Norwegian • Currency - 1£ = 9.2NOK

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   

   

    

   



  

  

 

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CLASSIFIED



THE MEDICAL COURSE AND CONFERENCE DIRECTORY



 

 







 

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.

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 

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

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Mon 6th Dec

  

(5 days)

 

Mon 6th Dec

£790

London

£495

London

£495

London

£790

Manchester

£235

Lewisham

£400

London

£580

London

£650

London

£1450

London

£1450

Manchester

£1450

London

£650

London

 

  

(5 days)

Hammersmith Medicine Mon 13th Dec

   

  

(5 days)

Hammersmith Medicine Mon 13th Dec (5 days)

MRCP 2

Sat 16th Oct SURGICAL REVISION COURSE FOR FINAL YEAR MEDICAL STUDENTS

(2 days)

(APPEARING FOR THE EXEMPTING EXAM IN JANUARY 2011)

Dates: 27th and 28th November, 2010 Venue: Education and Research Centre, Wythenshawe Hospital, Manchester Course fee: £55

Applied Surgical Sciences and Critical Care Course for MRCS Part B

Mon 1st Nov (4 days)

Hammersmith Medicine MRCP Paces

Mon 11th Oct

Date: 20th January 2011 (Thursday) Venue: University Hospital of Wales, Cardiff Course fee: £125

(4 days)

Hammersmith Medicine Sat 16th Oct

Surgical Anatomy and OSCE for MRCS Part B

(2 days)

Dates: 21st and 22nd January 2011 (Friday and Saturday) Venue: Department of Anatomy, School of Biosciences, Cardiff University, Cardiff

Mon 17th Jan (4 days)

Course fee: £325

Mon 24nd Jan

Clinical Examination, Communication and Practical Skills for MRCS Part B/Part 3

(4 days)

Mon 24th Jan

Date: 23rd January 2011 (Sunday) Venue: University Hospital of Wales, Cardiff

(4 days)

Course fee: £145

PACES Ahead for more information please visit

www.doctorsacademy.org 30

EVENTSDR.COM

Sat 29th Jan (2 days)

Got an event to add? Do it free at EventsDr.com Mon 31st Jan (4 days)

£1450

London

Thu 20th Jan £125

Cardiff

Surgical Anatomy and OSCE/Viva

Sat 29th Jan (2 days)

Sat 7th May (2 days)

MRCPCH 1 10-15 January 26-28 January

London London

£325

Cardiff

16-17 October 15-16 January 22-23 January

£799

London

29-30 January 7-8 May

Kingston Hillingdon Kingston

£799

London

10-12 November 9-11 March

MRCS B OSCE

Psychiatry

London London

SpR Management

London London

web: www.pastest.co.uk telephone: 01565 752000

MRCPsych Paper 1

Sat 6th Nov (2 days)

Sat 13th Nov (2 days)

Sat 13th Nov Superego Cafe

MRCP 2 PACES

MRCPCH Clinical

Fri 21st Jan (2 days)

MRCPCH 1

17-20 January London 22-23 January Manchester 24-27 January London 29-30 January Manchester 31 Jan-3 Feb London

MRCs b (1 day)

courses 6-10 December London 13-17 Dec’ Manchester 7-9 January London

Surgery

Applied Surgical Sciences and Critical Care

Forthcoming

(1 day)

£325

Manchester

£345

London

£195

Manchester

Others

Number 1 for Medical Interviews & Applications

Leadership & Interview Skills

Mon 1 Nov st

(1 day)

£311.38

Manchester

£225

Manchester

£249

Birmingham

Management Excellence for Junior & Middle Grade Doctors

Mon 2nd Nov (1 day) Communication Skills for Junior & Middle Grade Doctors

Sun 28th Nov (1 day)

Sat 4 Dec (1 day) CT/ST interview skills

We offer a range of medical interview courses and services to optimise your chances of success at medical interviews

0845 266 9487

GPVTS/GPST interview skills

Courses in small groups for a more personal approach

£249

London

7 days a week

8:30am - 11pm

www.iscmedical.co.uk EVENTSDR.COM

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

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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.