JuniorDr Issue 32 by JuniorDr

492 payslips over your career *

Make every one work for you Wesleyan has provided specialist financial solutions to the medical profession for over a century, including junior doctors like you. Times may change, but we make sure we’re ahead in understanding your needs, so we can offer the right advice across a broad range of financial solutions.

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* Based on a career of 41 years, retiring at 65. Advice is provided by Wesleyan Financial Services Ltd. ‘WESLEYAN’ is a trading name of the Wesleyan Group of companies. Wesleyan Financial Services Ltd (Registered in England and Wales No. 1651212) is authorised and regulated by the Financial Conduct Authority and is wholly owned by Wesleyan Assurance Society. Wesleyan Assurance Society is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Incorporated in England and Wales by Private Act of Parliament (No. ZC145). Registered Office: Colmore Circus, Birmingham B4 6AR.Telephone calls may be recorded for monitoring and training purposes. HD-AD-24-10/14

THE FUTURE OF DOCTORS IN THE UK 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 Yvette Martyn, Ivor Vanhegan, Anna Mead-Robson, Michelle Connolly, Muhunthan Thillai JuniorDr PO Box 36434, London, EC1M 6WA

Tel - +44 (0) 20 7 193 6750 Fax - +44 (0) 87 0 130 6985 team@juniordr.com Health warning JuniorDr is not a publication of the NHS, David Cameron, his wife, the medical unions or any other official (or unofficial) body. The views expressed are not necessarily the views of JuniorDr or its editors, and if they are they are likely to be wrong. It is the policy of JuniorDr not to engage in discrimination or harassment against any person on the basis of race, colour, religion, intelligence, sex, lack thereof, national origin, ancestry, incestry, age, marital status, disability, sexual orientation, or unfavourable discharges. JuniorDr does not necessarily endorse or recommend the products and services mentioned in this magazine, especially if they bring you out in a rash. © JuniorDr 2014. 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.

edicine is in crisis. The latest BMA quarterly survey shows junior doctor morale is staggeringly low and 41% of GPs planning to quit before retirement age (see p5). Poor working conditions, long hours and the changes in the NHS were all reported as the cause. In a separate study, one in 10 newly qualified GPs (12%) said they intend to leave the country in the next year (p6). After five or six years at medical school and tens of thousands of pounds in fees it’s not a career most would give up easily. But for those still convinced that medicine is not for them we look at Careers Beyond Medicine (p9-11) in this issue. Kunal Kulkarni analyses the top choices for doctors leaving to join other industries. From management consultancy and business, to law and medico-legal work, we look at alternatives to treating patients - whether leaving permanently or alongside a part-time medical career. Also in this issue we look at the financial matters of having a baby as a junior doctor (p12). When JuniorDr’s Sophie Emesih became pregnant as a junior doctor she found it difficult and time consuming to find all the information she needed regarding maternity financial issues. We asked her to compile a list of the top things you need to know. Finally, we have something for our medical student readers who have just started the long journey to becoming a doctor. We offer advice (p20) from doctors and medical students who have been there before on how to survive in the land of colonoscopy clinics, cardiac vivas and neuro MCQs.

What’s inside 04 09 12 18

LATEST NEWS CAREERS BEYOND MEDICINE HAVING A BABY AS A JUNIOR DOCTOR

22 26

DIARY FROM SIERRA LEONE COURSES AND CONFERENCES

STARTING MED SCHOOL GUIDE

TRIAGE

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

QUALITY OF CARE

HALF OF ALL JUNIOR DOCTORS HAVE CONCERNS ABOUT QUALITY OF CARE

ver half (51%) of newly qualified doctors have concerns about the quality of healthcare provided in their workplace, according to a major new survey by the Medical Protection Society (MPS). The survey of over 1,000 newly qualified doctors also found that 62% of FY1s had told a fellow trainee about their concerns in confidence. In contrast, of the 48% of FY2s who had concerns about the quality of care, 67% had raised the matter with a clinical manager. “We must harness this enthusiasm and build an environment which allows junior members of the team to raise concerns about patient safety. It is encouraging to see that those in their second year of training feel confident to report such matters,” said Dr Pallavi Bradshaw, Medicolegal Adviser at MPS. “Senior clinicians and clinical managers have a responsibility for creating an open culture and an environment where recognition and discussion of care quality issues is routine.”

time to give patients the care they require and 51% found it hard to manage patients with unrealistic expectations. “It’s really worrying that so many junior doctors feel they don’t have enough time to give patients the care they need and that many have had to raise concerns over the quality of care,” said Dr Andrew Collier, Co-chair of the BMA Junior Doctor Committee. “This shows that rising workloads are becoming a real barrier to patient care, something which was echoed in a recent BMA survey of doctors.” 60% of all respondents to the study said they chose a career in medicine because they wanted to help people and only 2% said potential future earnings was a driver for entering the profession. www.mps.org.uk

TIME TO CARE

In addition to concerns about the quality of care 82% of all FY1 doctors reported that they had struggled with long hours in the last 12 months - an increase of 7% from 2013. 85% were working beyond their contracted hours. Nearly three-quarters (71%) felt they did not have enough

PAY AND CONDITIONS

BMA CONDEMNS SIXTH CONSECUTIVE YEAR ‘PAY CUT’

he BMA has condemned government confirmation that most doctors will suffer a sixth year of effective pay cuts and said the government was making a ‘total mockery’ of the independence of the DDRB (Doctors and Dentists Review Body) by refusing to allow it to make recommendations on doctors’ pay for 2015/16. The government confirmed by letter that it would again increase pay by 1 per cent for hospital doctors at the top of their pay scale while counting incremental pay as a ‘rise’ for those progressing through the scales. “By repeatedly ignoring the DDRB’s recommendations, and now confirming it will 4

NEWS PULSE

not even be given the opportunity to feed into next year’s decision on pay, the government is making a total mockery of the independence of the pay review bodies and prevents them from working in a fair fashion

“The government is making a total mockery of the independence of the pay review bodies.” Dr Mark Porter BMA COUNCIL CHAIR

for doctors, staff and patients,” said BMA council chair Dr Mark Porter. “Given this comes at a time when doctors are working harder than ever before to meet rising demand, it’s not surprising that morale is being hit.” Chief secretary to the Treasury Danny Alexander said the case for public sector pay restraint in England remains strong and, as NHS trade unions are ‘not prepared to negotiate an affordable alternative’, the government would not be asking pay review bodies to make recommendations for the 2015 pay round. www.bma.org.uk

GMC

MAJOR CONSULTATION TO IMPROVE PUBLIC CONFIDENCE IN DOCTORS

octors who have harmed patients could face sanctions even if they can show they have subsequently improved their practice in serious cases, according to the GMC. It is one of a number of far-reaching proposals aimed to protect patients and uphold public confidence in the medical profession. Under the proposals, doctors could face restrictions on their practice, suspension or even have their registration removed if, for example, it is shown that they knew or should have known they were causing harm to patients in serious cases. This could happen even if they had subsequently improved their practice. “Doctors are among the most trusted professionals, and rightly so, and they deserve to be treated fairly. In the vast majority of cases one-off clinical errors do not merit any action by the GMC,” said Niall Dickson, Chief Executive of the General Medical Council. “But if we are to maintain that trust, in the small number of serious cases where doctors fail to listen to concerns and take action sooner to protect patients, they should be held to account for their actions.”

“Doctors are among the most trusted professionals, and rightly so, and they deserve to be treated fairly.” Niall Dickson GMC CHIEF EXECUTIVE

Doctors are expected to apologise to patients if they have caused them any harm, and in future failure to do so could affect the sanction they face. In the consultation, which launches today, the GMC is also seeking views on imposing more serious action in cases where doctors fail to raise concerns about a colleague’s fitness to practise or take prompt action where a patient’s basic care needs are not being met. The consultation will run until 14 November 2014 www.gmc-uk.org

WORKING CONDITIONS

JUNIOR DOCTORS REPORTING LOW MORALE

octors are reporting low morale amid rising work demands and the ongoing financial squeeze affecting clinical care, a BMA survey reveals. More than 40 per cent of doctors said their morale was low in the latest BMA quarterly survey. GPs reported the lowest morale, with an average score of 2.38 when ranking morale from one (low) to five (high), and there was a significant fall in morale of junior doctors from the previous quarter. Almost half (44 per cent) of the GPs surveyed said they were considering early retirement, and 41 per cent of consultants reported considering quitting work before retirement age. Doctors blamed work conditions, hours of work and changes to the NHS as the three biggest factors prompting them to consider changes to their career. Almost 500 working doctors took part in this quarter’s survey. www.bma.org.uk

NEWS PULSE

Junior rota payout

TRAINING

DON’T PRESSURE JUNIORS TO TRAIN LONGER, SAYS BMA

roposals to allow greater training flexibility must not pressure junior doctors to opt out of working-time rules, the BMA warns. It warned opting out of EWTD must not be the result of changes to working-time regulations suggested by an independent review, and approved by the government. The review, chaired by former Royal College of Surgeons of England president Norman Williams, suggests encouraging more widespread use of individual doctors’ rights to opt out of the maximum 48-hour working week, where it was safe to do so. It also recommends giving doctors more opportunities to train outside the 48-hour week and ensuring NHS trusts review working patterns and rotas to give doctors more access to training. Working-time regulations mean doctors must not work longer than a maximum of 48 hours a week when averaged out across a sixmonth period. However, the regulations have caused concern among some doctors, particularly those

in surgical training, about the impact on their training time. “We have to remember that the work and training of junior doctors are inseparable. This leads to unique pressures that can’t be resolved just by increasing working hours,” said BMA council chair Dr Mark Porter. “Having the right degree of flexibility in the system is important, but we must not create a culture in which doctors feel pressured into opting out of the 48-hour weekly limit that protects patients.” www.bma.org.uk

43 FY1s working on a surgical rota at Arrowe Park Hospital Wirral will share a £38,850 payout after a diary monitoring exercise of their working patterns found they were being underpaid. Following talks between the BMA and the trust, the trainees’ rota was uplifted from a 1B rota with 40 per cent pay banding to 2B with 50 per cent banding. Trainees who worked on the rota between August 2013 and May this year were unable to finish shifts on time or take natural breaks. www.bma.org.uk

New GMC chair Professor Terence Stephenson has been appointed as the new Chair of the General Medical Council (GMC). Professor Stephenson is current Chair of the Academy of Medical Royal Colleges. He studied medicine at Oxford Medical School and has spent most of his career specialising in paediatric medicine and paediatric emergencies. He was also President of the Royal College of Paediatrics and Child Health. www.gmc-uk.org

Private med school delayed WORKING CONDITIONS

ONE IN 10 TRAINEES PLAN TO EMIGRATE IN NEXT YEAR, SAYS SURVEY

ore than one in 10 newly qualified GPs (12%) is intending to leave the country in the next year, a survey shows. The finding from a survey of 2,000 GP trainees has sparked renewed calls from the BMA for urgent action to tackle the recruitment and retention crisis in general practice. The survey by Wessex local medical committees shows 12 per cent of the 700 doctors who became fully qualified GPs this summer intend to leave the country within 12 months. Around 5 per cent of those GPs cited

“It is very worrying that one in 10 doctors is thinking of leaving UK general practice in their first year of being a GP.” Krishna Kasaraneni CHAIR, GPC GP TRAINEES SUBCOMMITTEE

www.uclan.ac.uk

Mental health burden burnout or exhaustion in their comments and 83 per cent had negative impressions of general practice. “It is very worrying that one in 10 doctors is thinking of leaving UK general practice in their first year of being a GP,” said GPC GP trainees subcommittee chair Krishna Kasaraneni. “The fact that 83 per cent of comments about general practice were negative just shows how much of a problem burnout is in our profession.” www.bma.org.uk

NEWS PULSE

The proposed launch of a new private medical school at UCLAN (University of Central Lancashire) has been delayed by one year to allow recruitment of additional senior staff and placement opportunities. Up to 35 students were expected to join the new five year MB BS programme costing £35,000 per year. The first intake of students will now take place in September 2015.

Mental health represents 23 per cent of the national disease burden and should be treated by commissioners in the same way as physical illness, says the chief medical officer for England Professor Dame Sally Davies. The report, Public Mental Health Priorities: Investing in the Evidence, also highlighted a significant overall treatment gap in England which meant that up to 75 per cent of those suffering with mental health problems were failing to receive treatment. www.dh.gov.uk

NHS

JAIL FOR FRAUDULENT NHS JOB APPLICATION DOCTOR

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South Shields man who failed 1,000 times to get a job as an NHS doctor using false details has been jailed for 15 months following a fraud investigation by NHS Protect, the organisation which identifies crime across the health service. 46 year old Bai Bai Ahmed Kabia of Tyne & Wear was found guilty of 12 counts of Fraud by False Representation after making a series of applications to numerous NHS Trusts to work as a doctor. He was sentenced to 15 months’ imprisonment for each offence, to run concurrently. He admitted to making over 1,000 job applications, none of which were successful. Dr Kabia had submitted 245 unsuccessful job applications to numerous NHS trusts to work as a doctor. A sample of these applications was studied by NHS Protect investigators, and they all contained misrepresentations regarding his previous educational qualifications, professional memberships and employment history. Kabia claimed to be registered as a doctor with the General Medical Council, to have been awarded an MSc from University College London and to be a member of the Royal College of Physicians - none of these assertions were true. Kabia was then arrested in a joint operation with Northumbria Police. “Dr Kabia submitted job applications to the NHS that he knew to be false, trying to deceive his potential employers. Had he been successful, Dr Kabia‘s appointment would have given him direct access to treat patients,” said Dave Horsley, Anti-Fraud Specialist, NHS Protect. “It is pleasing that Dr Kabia was unsuccessful in his applications and that NHS employment procedures were found to be robust and effective. The custodial sentence reflects the seriousness of these offences and will serve as a powerful deterrent to others.”

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NHS

PHYSICIAN ASSISTANTS ROLE TO BE DOUBLED, SAYS DH

How to succeed as a junior doctor

www.dh.gov.uk

www.rcplondon.ac.uk/succeed

he NHS is to expand the use of ‘physician assistants’ and double the number of training places, the Department of Health in England has announced. There are over 200 physician assistants across the UK working in a range of different healthcare settings. Although limited in that they are unable to prescribe or order diagnostic tests they can assist with patient histories and basic examinations. The announcement to expand numbers has been welcomed by the Royal College of Physicians and the UK Association for Physician Assistants. Currently physician assistants undergo a similar two year programme to medical school following a national curriculum. It is designed to teach the basics in recognising, diagnosing and managing common clinical conditions under senior medical supervision. “Physician assistants can be a valued part of the NHS and, as long as the scope of what they do is clear, they can provide an intermediate level of care and help reduce workload pressures. It’s important that all healthcare professionals, including doctors, are clear about the limits on the care they are able to provide, and work within them,” said Dr Mark Porter, Chair of BMA Council. Other countries such as the US, where there are more than 80,000, have made greater use of physician assistants.

15 November 2014, London A complete ‘how-to-guide’ for the skills you will need to demonstrate at specialty interview.

#juniordoctor

FASCICULUS MEDICINAE ROYAL COLLEGE OF PHYSICIANS

ne of the first substantially illustrated printed medical books has gone on show at the Royal College of Physicians. The Fasciculus Medicinae dating from 1500, is one of the most spectacular examples of an early printed medical book. Exceptional in both its text and illustrations, the book is one of the first to contain practical medical illustrations in relation to a realistic depiction of the human body. Printed in both Latin and vernacular versions,

the book contains woodcut illustrations of a pregnant woman, a wounded man, a plague patient and a detailed illustration of an early anatomy class showing dissection. For more information and visiting times visit www.rcplondon.ac.uk Credit: Royal College of Physicians

CAREERS BEYOND MEDICINE Intrigued by what career prospects lie beyond the doors to your hospital, or want to supplement your clinical career with that ‘something else’? JuniorDr’s Kunal Kulkarni explores some of the many diverse options available to doctors that want to rediscover the excitement in their careers.

fter five or six years at university, thousands of pounds in student loan debt and a perpetual cycle of exams, you’ll hopefully have left medical school with a unique set of life-preserving skills. While Foundation Year jobs may hone skills in form filling rather than complex diagnosis, trainees do eventually get to practise ‘real’ medicine, rising through the ranks to specialise in their chosen field. While most aspire to life as a consultant, some seek to follow paths as consultants of the management variety, or indeed as members of a host of other professions, including law or banking. A medical degree can open far more doors than just those to the entrance of a hospital. As trainee supply-demand imbalances continue (there were 293 more applicants than places for Foundation Programmes commencing August 2014)1, the profession seems undecided on whether completing a vocational degree such as medicine should end with the promise of a secured job upon qualification2.

In the wake of Modernising Medical Careers, the European Working Time Directive and continuing professional reforms, the voices of those disillusioned with the profession have grown increasingly loud3. Whilst some may insist that trainees owe society a debt (estimates vary, but it costs over £250,000 to train a doctor through to full registration)4, others argue that the degradation of doctors’ professional autonomy may count as reason enough for doctors to seek alternative means to earn a living. As a result, while growing numbers of graduate entry courses have attracted individuals that have pursued different career paths before starting medicine, the reverse is also becoming increasingly popular - despite the eclectic world of medicine often leaving medics with little knowledge of what ‘normal people’ actually do. For those wishing to keep their options open, this article provides an introduction to some alternative career options.

MANAGEMENT CONSULTANCY AND OTHER BUSINESS ROLES

onsultancy is about pragmatic problem solving - a bit like medicine. Consultancy firms help organisations improve performance by analysing their current state and developing solutions to achieve a desired target state. They provide their clients with a temporary pool of external advisors and expertise at critical times - e.g. when they wish to expand, or to increase profits by improving efficiency. Accenture, McKinsey and Deloitte are examples of global firms. Other roles in business are broadly similar in terms of structure - albeit that you work for the ‘client’ rather than ‘advisor’. Managers with medical training are a rare-breed in the healthcare industry, with potential employers including pharmaceutical firms (e.g. GlaxoSmithKline, AstraZeneca), private healthcare organisations (e.g. BUPA, Nuffield) or the NHS itself.

HOW TO GET STARTED While some firms will hire experienced doctors for more senior ‘expert’ roles, junior doctors or students should consider the formal graduate entry programmes on offer. ARE EXTRA QUALIFICATIONS NEEDED? Finance/business backgrounds help, but strong A-level results and a medical degree should satisfy entry requirements. A Masters in Business Administration (MBA) from a reputable institution is a logical next step, particularly for those seeking entry at higher levels; however, this is an expensive and competitive course, with a tough entrance exam (the GMAT). THE SUNNY SIDE Junior consultants usually work in teams on a diverse range of projects of varying duration,

led by experienced project leads that specialise in branches of consulting (e.g. strategy) or industry (e.g. pharmaceuticals). With progression comes specialisation in particular industries and consulting sectors. Starting salaries are reasonable (usually £30,000+) and rise rapidly (partners often have triple figure salaries, with bonuses commonplace among the higher ranks). Perks include opportunities for global travel (on the corporate card, of course), many an end-ofproject celebration at Michelin-starred restaurants, and corporate boxes at major sporting events.

THE DARK DAYS Life will be like when you did your dissertation – of self-motivation and rapid desk-based research/absorption of information rather than the hands-on, practical style of clinical

CAREERS

CAREERS BEYOND MEDICINE medicine. For those not specialising in healthcare, projects can be diverse – for example, with one in the oil and gas industry and the next in financial services. This can be stimulating, although some find walking on constantly shifting sands to be unsettling. At the bottom of the food chain the work can be rather administrative at times. The working day can be long and demanding, with no such thing as set working hours or overtime pay. Bonuses are not an annual given – they

are a reward for sacrificing your spare time/ holidays to comply with the demands of bosses or clients. The promotion structure and career progression is pyramid shaped and ill defined; if you are risk-averse, then the cut-throat, “up-orout” style of the business world – or indeed the lack of a defined career path – may not be to your taste. ‘Networking’ is part and parcel of day-to-day life, so those less keen on schmoozing or maintaining superficial

appearances may not find this to their taste.

FURTHER READING • Top Consultant (www.top-consultant.com) : Discussion forum • Only Medics (www.onlymedics.com) : Pharmaceutical physician jobs • NHS Leadership Academy (www.leadershipacademy.nhs.uk) : Formal leadership and management training for clinicians

COMMERCIAL BANKING

ommercial banks (more commonly favoured by ex-medics over ‘retail’ or ‘central’ banks) help individuals, businesses and governments to acquire, distribute and invest funds. While salaries may be in a league of their own, banking is an incredibly demanding profession with a steep learning curve (which pharmacology lecture covered financial modelling again?) and ruthless corporate structure. Examples of investment banks include Goldman Sachs, UBS and Credit Suisse.

HOW TO GET STARTED Investment banking is an umbrella term for a range of different jobs (e.g. trading, equity research, advisory), so do some reading to find your best fit. Keeping up-to-date with the financial press is essential. There are far more applicants than jobs so knowing the right people can help; internships are competitive, but allow applicants to gain experience and contacts. An alternative approach is to apply through a specialist recruitment agency.

ARE EXTRA QUALIFICATIONS NEEDED? Your medical degree should fulfil requirements. An MBA or higher financial qualification (e.g. Chartered Financial Analyst, CFA) may be useful/necessary for progression. THE SUNNY SIDE Starting salaries are generous – usually £45,000+ for graduate roles, rising exponentially. There is a strong focus on quantitative skills. Banking is a high-risk, high-reward profession – those three years into the profession can earn far in excess of a hospital consultant, but those over 50 years are considered old so careers are short and unpredictable, with no set path. THE DARK DAYS There is a rather rude word that rhymes with banker, often used in conjunction by those outside the field; the horrendous reputation enjoyed by bankers in the current financial climate will unfortunately follow you everywhere. However, when you pay for your

friends’ drinks, taxis and tickets, they will rapidly forget what a soulless monster you have become. Hours are long and the job needs stamina – look at your medical rota and double it. The work can at times seem pointless – hours of research and a mammoth Excel-based financial model later and the client ignores your advice – and there is far less stability in the banking world, so no job is guaranteed for life. In the wake of the Lehman brothers collapse, the authors know of eager graduates that were told in week one that they could “complete induction training, but there is no longer a job waiting when you finish”.

FURTHER READING • City Jobs (www.cityjobs.com) : Financial jobs search • E Financial Careers (www.efinancialcareers.co.uk) : Financial careers database • Inside Careers (www.insidecareers.co.uk/ professions/banking) : About banking

LAW AND MEDICO-LEGAL WORK

awyers apply the principles and rules of law to help clients achieve justice. Like doctors, lawyers can play a crucial role for individuals at vulnerable periods in their lives. The main distinction in law is between solicitors and barristers, but there are other roles including those of a coroner or magistrate. Medico-legal advisors - often former doctors - work for the medical defence organisations. Their role is to assist doctors with a range of

CAREERS

issues, from ethical dilemmas to helping defend negligence claims.

HOW TO GET STARTED Work experience at law firms or barristers’ chambers helps, as can spending time in court hearing cases. Medico-legal posts are highly sought after, and taking relevant courses (e.g. part-time medical ethics and law training) can help demonstrate commitment.

ARE EXTRA QUALIFICATIONS NEEDED? For those without law degrees, the Graduate Diploma in Law (GDL) is a must. This is followed by either the Bar Vocational Course (BVC) or the Legal Practice Course (LPC), and then a solicitors’ training contract or barristers’ pupillage. Some of the larger/commercial law firms may pay the costs of conversion courses, but you will still be with without an income during this period. Coroners are usually qualified

solicitors. Medical defence organisations often sponsor their advisors to undertake relevant legal qualifications while they work.

THE SUNNY SIDE In this increasingly litigious climate, the Simpsons said it best with “if there’s one thing this country needs, it’s more lawyers” - so you are unlikely to be without a job. While medico-legal work may not pay as handsomely (salaries are comparable to medicine), commercial law is far more lucrative, with similar salaries to the higher-tier management consultancy firms. Barristers are self-employed and the route

to the top may be more financially rocky, although there is a certain kudos to standing before a judge and articulating a case with only words as your weapon, and successful barristers are in high demand.

THE DARK DAYS Law is full of jargon and it will take time to learn another language and to build a strong reputation. Completing the conversion course does not guarantee a training contract with a firm of solicitors’, and pupillages (i.e. house jobs for barristers) are exceedingly competitive. Furthermore, law - like medicine - is hierarchical and you will need to work your way

up. Beware - your doctor friends may severely dislike you if you pursue negligence claims against them.

FURTHER READING • Law Careers (www.lawcareers.net) : Guide to careers in law • Law Society (http://juniorlawyers.lawsociety. org.uk/career) : Legal careers basics from Law’s equivalent of the General Medical Council • Medical Protection Society (www.medicalprotection.org/uk/about-mps/ mps-careers/becoming-a-medicolegaladviser) : Medico-legal advisor careers

A LITTLE SOMETHING ON THE SIDE

f you don’t want to give up the day job, why not consider the following career adjuncts that will allow you to get more from your medical career: • Magistrate: No formal qualifications are required, although positions are voluntary and it may be difficult to fit commitments around your medical career. • Military: The Armed Forces allow medics to combine their medical training with a career in the armed forces, which provide excellent training opportunities. • Medical leadership and management: Consultants are thrust into managerial roles with little formal training. Distance learning/part time clinical leadership and MBA courses are increasingly popular

and relevant in developing skills not taught at medical school. The Faculty of Medical Leadership and Management (FMLM) host an excellent clinical fellowship scheme to get you started. • Medical-politics: Working clinicians can get involved with organisations such as the BMA or the Royal Colleges. • Part-time expert: Doctors have a specialist knowledge base, which can be utilised to support a range of other professionals – for example, as a medicolegal expert witness in negligence cases or as a part-time healthcare consultant to a business/ consultancy firm. • Research: Research budgets are increasingly tight, but there are posts for

A career change is not a decision to be taken lightly. Many of these professions are fiercely competitive and require commitment to be demonstrated before selection. However, medics are usually viewed as intelligent, rounded people with transferable skills, so there will likely be a home for you out there somewhere. If a change is what you are after, our advice is to complete your Foundation Training first in order to keep your options open. Despite the lure of a better life elsewhere, medicine for many is a uniquely fascinating profession and may come calling again when you least expect it.

OTHER LINKS • Diversify (http://medicalsuccess.net) : Run conferences and networking events on alternative careers for medics • Inside Careers (www.insidecareers.co.uk) : Graduate careers advice guides • Faculty of Medical Leadership and Management (https://www. fmlm.ac.uk) : Check out the ‘Clinical Fellows Scheme’ • LinkedIn (www.linkedin.com) : Facebook for professionals

doctors wishing to combine academia with clinical work. Academic foundation jobs or Masters degrees/PhDs are common entry routes. • Voluntary medical work: Organisations such as Médecins Sans Frontières and Voluntary Service Overseas provide medical aid to areas suffering from natural disasters or conflict, offering the opportunity to work in remote overseas locations. • Writing, Journalism & Media: From writing newspaper columns and editing medical journals to being the next in line of medical fiction writers or celebrity TV-doctors, a doctor’s unique experiences can be fascinating to the general public.

• Medical Journalists’ Association (www.mjauk.org) : For medical writers • Milkround (www.milkround.com) : Graduate job searches REFERENCES 1. Rimmer A (2014) Foundation programme for 2014 is oversubscribed by 293 applications. BMJ Careers. 21 January 2014. http://careers.bmj.com/careers/advice/view-article.html?id=20016124 2. Macdonald H (2011) Should UK medical students be guaranteed a job on leaving medical school? No.. BMJ Careers. 27 April 2011. http://careers.bmj.com/careers/advice/view-article.html?id=20002742 3. Dyer O (2007) Remedy UK loses court case over doctors’ training applications. BMJ 334(7603): 1079. 4. How much does it cost to train a doctor in the United Kingdom? BMA. January 2013. http://bma.org.uk/-/media/files/word%20files/news%20views%20 analysis/press%20briefings%20new/bmabrief_medicaltrainingcost. docx

CAREERS

HAVING A BABY

AS A JUNIOR DOCTOR

MONEY MATTERS

Congratulations on your new arrival! Having a baby can be a wonderful yet stressful time, especially as a junior doctor rotating through different specialities, changing trusts and even moving to different parts of the country. When JuniorDr’s Sophie Emesih became pregnant as a junior doctor she found it difficult and time consuming to find all the information she needed regarding maternity financial issues. We asked her to compile a list of the top things you need to know.

Brought to you by

1. Notify your employer In order to get maternity leave you need to inform your employer (via your HR department) by the end of the 15th week before the expected week of childbirth (EWC). EWC starts at midnight of the Saturday night of the week your baby is due, e.g. if your baby is due on Wednesday 2nd July, the expected week of childbirth starts on Sunday 29th June. Include in your letter/email that you are pregnant, the EWC/ due date, that you would like to take maternity leave, and the dates which you would like your maternity leave to start and when you wish to return (the latter can be changed later so long as you give your employer 28 days notice).

2. MAT B1 You should automatically get a MAT B1 certificate signed by your midwife or GP when you are 20 weeks pregnant - if not, ask for one! Hand this certificate to your HR department as evidence of your pregnancy and so you can claim maternity pay.

3. Maternity pay To be entitled to maternity pay under the NHS scheme you must have been in continuous employment with the NHS for 12 months. This entitles you to 8 weeks pay at 100% average weekly earnings, 18 weeks of half pay and statutory maternity pay (SMP), 13 weeks of SMP and 21 weeks of unpaid leave. If you haven’t been employed with the NHS for 12 continuous months but you have worked for the same employer for 26 weeks by the 15th week before the EWC you can still get maternity pay (6 weeks at 90% of your average weekly earnings, 33 weeks of SMP and 13 weeks unpaid leave). If neither of these applies you may be able to claim maternity allowance via the Benefit Agency/Jobcentre. The British Medical Association has a maternity calculator which can help you work out what maternity pay you could be entitled to. Maternity pay is calculated on your average weekly earnings of the 8 weeks ending with the qualifying week [which is the 15th week before your (EWC)]. The average earnings also include any bandings or supplements you received for those 8 weeks, so this may be different if you change rotations with different banding weighting. 12

MEDICAL MEDICALSTUDENTS STUDENTS

If you plan on taking all 52 weeks of maternity leave, approximately the last three months will be unpaid. You can, however, ask your HR department to annualise your maternity pay – evening it out over the whole 52 weeks so you always have some income.

4. GP trainees Whilst training in hospital posts, your maternity pay entitlements are the same as above. Once you have started your training within GP surgeries, it is the practice’s maternity policy which applies.

5. Academic Posts Your maternity entitlements depend upon who your contract is with. If your contract is with a NHS trust then your entitlements are the same as if you are working within the hospital, however, if your contract is with the University you will need to contact the HR department of the University to enquire about their maternity policy.

6. Holiday Whilst on maternity leave you accrue holiday, so find out from your HR department if there are any restrictions/preferences on how you take it and then inform payroll. In my instance I had to split my holiday, taking 9 days before starting maternity leave and taking the other 19 days before I returned. If you are returning to a different trust after your maternity leave, make sure the payroll department is aware of when you will be taking your accrued leave as it can be difficult to organise once they’ve done your P45.

S4D_Ad_2013.pdf 1 20/05/2013 12:09:47

7. Stop additional fees Monthly staff car parking charges and junior doctor mess fees soon add up when you’re on maternity leave for a year, so make sure you inform payroll/security that you would like these to stop from ‘x’ month.

8. Child Benefit Claiming child benefit can help you gain national insurance credits for your state pension as well as help make sure your baby gets a national insurance number, so it’s worth looking into. The form is completed online via the HM Revenues and Customs website. The form then needs to be printed off and sent along with your baby’s birth certificate. It can take up to 12 weeks to process so register your baby’s birth as soon as possible to speed things up.

Support4Doctors is an online portal of information for UK doctors. It offers specialist advice and support for doctors and their families on career, health and financial issues. The site also offers a database of organisations that can provide further help.

9. Tax Credits The amount you could be entitled to varies depending on a number of factors. You can check your eligibility and estimate how much you may be rewarded on the HM Revenues and Customs website. To apply you need to order a form and this can take up to 2 weeks to arrive. The claim can only be backdated one month from the date of the application, so order, complete and send the form as soon as possible. Or, if you’re super organised, you could order the form before your baby’s due date and fill in as much as you can before your baby arrives.

10. GMC, Indemnity Insurance and Society Memberships

The Royal Medical Benevolent Fund is the leading UK charity for doctors, medical students and their families. The RMBF provides financial support, money advice and information when it is most needed due to age, youth, ill health, disability and bereavement. C

There are two issues surrounding these. Firstly, check to see if you can freeze your memberships or if they have a reduced maternity fee and definitely inform them of your maternity leave. Secondly, remember that you can claim tax relief on professional fees and subscriptions. You can claim it by filling in a P87 form which can be found on the HM Revenue and Customs website. The relief usually comes in the form of an altered tax code, however, you may also receive a nice little return - when I sent them my P87 form they also calculated that I had paid too much tax on my earnings and a welcomed tax refund was issued.

11. Returning to work Contact your HR department at least 1 month before you are due to return and ask for an updated contract. After 12 months of being a doctor at the same grade your basic pay should go up incrementally – so make sure this is correct before signing your new contract. It’s also worth contacting your deanery and checking how your maternity leave and return to work dates have affected your training.

CMY

The RMBF aims to make a real difference to the lives of doctors and their families in times of need. The role of the RMBF is to help beneficiaries to become independent and self-sufficient again wherever possible, whilst maintaining longer term support for those for whom this is not possible. The RMBF also aims to make a real difference in the lives of medical students and their dependants facing financial hardship due to unforeseen difficult circumstances. The RMBF is committed to leading the way in providing support and advice to members of the medical profession and their dependants. To find out more about the work of the RMBF, or how you can get involved visit the RMBF website.

Most importantly enjoy that precious time with your little one! RESOURCES HM Revenue and Customs http://www.hmrc.gov.uk NHS Business Services Authority: NHS Scheme http://www.nhsbsa.nhs. uk/Documents/NHSBSACorporatePoliciesandProcedures/Maternity_Leave_ Policy.pdf British Medical Association: Maternity Leave Calculator http://bma.org.uk/ practical-support-at-work/working-parents/maternity-leave-calculator Women’s Medical Federation http://www.medicalwomensfederation.org.uk

www.rmbf.org Registered office: 24 King’s Road, Wimbledon, London SW19 8QN. A charity registered with the Charity Commission No 207275. A company limited by guarantee. Registered in England No 139113

MEDICALSTUDENTS STUDENTS MEDICAL

MAKING MAKING SENSE OF THE ECG 4TH EDITION The Making Sense... series began in 1997 with Making Sense of the ECG, which has won awards from the BMA and the Royal Society of Medicine, and has been published in 11 languages. Now in its fourth edition, our book has a completely new and larger format which allows for the presentation of full 12-lead ECGs throughout. We’ve thoroughly revised and updated the

text, with reference to the latest cardiology guidelines throughout. We’ve retained our step-by-step approach to ECG interpretation, but have restructured the chapters to make the approach to ECG interpretation even easier. There is a strong clinical emphasis throughout the book, as we think it’s important not just to be able to interpret the ECG, but also to know what to do once you’ve made a diagnosis.

CASES FOR SELF ASSESSMENT 2ND EDITION As well as updating our main Making Sense of the ECG textbook, we’ve also updated the companion volume Making Sense of the ECG: Cases for Self Assessment. The new second edition of this companion volume allows you to put your ECG skills to the test. We present you with 70 different ECGs for interpretation covering the whole spectrum of cardiac disorders. Each ECG is accompanied by a typical clinical scenario and a series of questions. This is followed by a full ECG analysis, with detailed answers to the questions and a commentary that expands further upon the material presented. By updating both books together, we’ve ensured 14

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Written by experienced cardiologists with over 17 years’ publishing and teaching experience, the Making Sense of the ECG books are specifically tailored to the learning needs of medical students and doctors in training. Our manuscripts have been extensively evaluated by students and trainees, and the text revised and restructured accordingly in order to optimise its clarity and readability. By writing the books in this way, we believe that these texts represent the best ECG teaching books on the market today.

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PERFECT FOR EXAMINATION REVISION Our books are written in a concise yet readable style with chapter summaries and frequent tip boxes, which makes them ideal for examination revision. For junior doctors on the wards, the clinical emphasis ensures that they are an invaluable resource not just for ECG interpretation but also for deciding how to act on the results. Available in both print and digital formats, the books are readily accessible wherever you are. Comprehensive indexing in both books makes it quick and easy to locate the information you need, and cross-referencing makes it simple to read more deeply on a topic after you’ve tested your skills in the self-assessment volume.

MAKING SENSE OF ECHOCARDIOGRAPHY 2ND EDITION If you’re moving on to specialty training in cardiology, Making Sense of Echocardiography is an essential text for your bookshelf. Maintaining the same readable style as you’ll find in the ECG books, Making Sense of Echocardiography will help you grasp even the most demanding topics in cardiac ultrasound. Designed with the British Society of Echocardiography accreditation examination in mind, the book comprehensively covers all the key topics on the BSE syllabus. Published in 2013, this second edition references the latest guidelines and evidence-based clinical advice, with fully-updated key references. The accompanying website contains images and video clips to complement the material contained in the book. This is an ideal echocardiography reference whether your preparing for accreditation examinations or simply looking for a reference book to improve your knowledge and skills. We hope you enjoy reading the Making Sense... cardiology books and find them as clear, up-to-date and clinically-relevant as we have designed them to be. We wish you the very best for your medical training. Andrew R Houghton is a Consultant Cardiologist and Deputy Director of Medical Education at the United Lincolnshire Hospitals NHS Trust.

View the entire series here: http://bit.ly/MakingSenseBC

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Medicolegal Advice - in association with the Medical Protection Society

RAISING CONCERNS WITH SENIOR COLLEAGUES Over half of junior doctors have concerns over the quality of care. Raising your concerns is important, says Charlotte Hudson.

PS surveyed 1,052 newly-qualified doctors to find out about their experiences – one of the biggest issues was quality of care, with 51% having concerns over the quality of care in their workplace. Over 60% of doctors in their foundation year 1 confided in fellow trainees about their concerns, whilst doctors in their foundation year 2 were more willing to discuss their quality of care concerns, with 67% raising the issue with their clinical managers. It is important that concerns about care quality are raised with senior colleagues. It is your responsibility as a doctor to do so, and patient safety should be your top priority. Dr Pallavi Bradshaw, MPS medicolegal adviser, says: “As a foundation doctor you have just as much responsibility as anybody else to raise concerns about patient safety. It is your responsibility to ensure there are safe processes in the hospital where you work.” MPS believes that a more supportive open culture in hospitals would encourage junior doctors to raise concerns about patient safety. Dr Bradshaw added that senior clinicians and clinical managers have a responsibility for creating an open culture and an environment where recognition and discussion of care quality issues is routine. MPS has produced a short video guide entitled Raising concerns to help you through your foundation years: www.medicalprotection.org/uk/foundation-doctors/video-raising-concerns

TOP TIPS • It is important that you use the trust’s governance processes, such as incident reporting. • It is not appropriate to say you’re “too busy” or you “don’t want to fill out the forms”. • Raise concerns within your team; discuss with a senior colleague; and ultimately, raise your concerns within the trust. • If you still have concerns, contact MPS.

OTHER SUPPORT AVAILABLE To those who have recently embarked on your first FY1 job, it is a scary time, with lots to learn, but remember there are places to turn to for help – you are not alone! MPS has produced a range of other short video guides for new doctors on: Preparing for a night shift; How to handover safely; and Why do junior doctors need medical protection. Our online guide for new doctors, Supporting you through your foundation years, features sections on good medical practice, how to manage risk, future careers and maintaining a work/life balance. Access the videos and the guide at: www. mps.org.uk/newdoctors

MPS is the world’s leading medical protection organisation, putting members first by providing professional support and expert advice throughout their careers. MPS supports members through the world’s largest network of medicolegal experts. We have a unique team of more than 100 specialist lawyers and medicolegal advisers (doctors with legal training). We are also committed to sharing our experience with members to help them avoid problems and provide the very best care for their patients. The educational portfolio available includes publications, conferences, lectures, presentations, workshops, E-learning and clinical risk assessments.

MPS members who would like more advice on the issues raised in this article can contact the medicolegal advice line on 0800 561 9090.

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.

MEDICAL PROTECTION SOCIETY PROFESSIONAL SUPPORT AND EXPERT ADVICE

Weâ&#x20AC;&#x2122;re here for you

Putting members first

You have access to support including: n

Emergency telephone advice 24/7

Complaints handling

Help with report writing

Media and press relations support

Support if you are the subject of a Garda investigation

Help with preparing for inquests

We also provide access to specialist legal advice and representation for disciplinary hearings and Medical Council Fitness to Practise proceedings The Medical Council received 400 complaints about doctors in 2013

Plusâ&#x20AC;Ś n Casebook journal n New Doctor magazine n Factsheets n Case reports n E-learning n Education and risk management workshops

Find out more about the benefits of membership

0800 561 9000 www.mps.org.uk member.help@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, 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. 1628: 09/2014

GET FRESH

STARTING MEDICAL SCHOOL GUIDE

Medical school can be a scary place. There’s the dissection room, angry hospital consultants and the student union bar on a Wednesday night. But don’t go running for home just yet. With the help of medical students and doctors who have been there and survived we’ll tell you how to survive in the land of colonoscopy clinics, cardiac vivas and neuro MCQs. So put on that white coat, swing that stethoscope round your neck and step out into the big bad world of becoming a doctor. We start with the essential induction to your new life. Trust me I’m a doctor Ask most patients what a ‘medical student’ is and they’ll screw up their eyes in confusion. Patients see you trailing around after the real doctors in your smart white coat and often view you in the same medically qualified club. As such, you’ve unwittingly become a privileged member of society’s most trusted profession. As a medical student you’ll spend more time with patients than any other person in the team. You’re in that middle-ground between being a member of the public and a medical professional. Patients won’t find you quite as scary as a proper doctor and you’ll be making an extra special effort to suck up in order to take their medical history. Because of this they’ll tell you things they’ve never told anyone and you’ll witness grown men break down in tears behind that thin, flimsy cubicle curtain. It’s all part of becoming a doctor - and a good one at that. Just don’t abuse it. Patients trust you with this information and you’re legally bound to confidentiality. So no blabbing about it down the pub, it could be the patient’s relatives at the next table. Medical students have been kicked out of medical school on a number of occasions for abusing this - and they’ve no defence.

Make friends Whether you like it or not you’re going to be stuck with that big hairy guy who picks his nose for at least the next five years. There’s also a high probability that you’ll end up marrying one of those drunken idiots who vomited over you during freshers week. You need to remember that medicine is a team sport. Refuse to play ball with your colleagues and your performance and experience will suffer. Medical school isn’t a competition, you either pass or fail - and the pass mark has already been set. It’s better to drag your buddies with you when you pass the final exams rather than fall flat on your face when you attempt to go solo. Work hard, play hard Unlike those other students studying embroidery or pole dancing, you’re going to have to do some hard studying during the course. You’ve made it to medical school which proves 18

MEDICAL MEDICALSTUDENTS STUDENTS

“AS A MEDICAL STUDENT YOU’LL SPEND MORE TIME WITH PATIENTS THAN ANY OTHER PERSON IN THE TEAM.”

you’ve got a few brain cells - but don’t let this go to that straight’A’ head of yours. Medicine is one of those subjects which trumps the ‘A-levels are the hardest exams you’ll ever do’ line - in fact, it rips this theory to shreds, throws it on the ground and stomps all over it. Medicine is tough and there’s no escaping that. But don’t get disheartened if you only scraped into medical school by the skin of your teeth and the number of zeros on daddy’s cheque to the alumni association, you don’t need to be a whizzkid to pick up a MBBS. A little common sense and good organisation is all you need. Medicine is a practical subject that requires lateral thinking and it’s the straight ‘A’ students who often struggle. The easiest way to fail is to fall behind with the curriculum. Remember that we’re learning about the human body

HOW TO SPOT A FRESHER A first year med student can be spotted more easily than a baby with chicken pox. Here’s what gives you away: 1. 2. 3. 4. 5. 6.

Can be spotted fighting over free tins of beans at freshers fairs. Conversation over lunch includes topics other than resection of the small bowel. Jump at the chance to sign-up for clinical trials to earn a fiver being injected with the Ebola virus. They turn up to all lectures - even those that aren’t compulsory. Commonly throw up in the tube/taxi on the way back from the union. Borrow every book on pathology from the library so no ‘proper’ medics can use them to revise for path exams. 7. Appear to drown when trying to do a ‘funnel’. 8. Clothes are badly stained with fat from the dissection lab. 9. End up on the floor after watching a surgeon make the first incision. 10. Still want to be a doctor because they ‘care deeply about mankind and want to repay their debt to society for their pitiful existence’

students to talk about you down the pub as a ‘great doctor’. That’s when you’ll know you’ve finally made it. You’ve got around twenty years to become this fantastic individual so start moulding yourself now.

- everything is linked. If you miss that lecture on the science behind gastric acid production then the GORD workshop will leave you with a burning pain in your chest - and you won’t understand why. Keep on top of the work and you’ll be fine. This means occasionally being prepared to ditch drinking games at the union for a night with your head in the books.

A little respect While other students will be playing with PCs we medical students get to play with people’s lives. Patients are often scared, in pain and may even be terminally ill. Put yourself in their position, treat them as you would want to be treated and you won’t go wrong. Watch out for the difference between consultants who treat patients like real people and those who think they’re just a piece of meat. Learn from it. By the time you finish medical school you should have a list of doctors who get the respect of both you and the patients, and a list of those who you wouldn’t want to treat a member of your own family. When you reach consultant grade you’ll want medical

Practice makes perfect Unlike A-levels your medical exams will test your practical skills and not just your academic knowledge. Sucking up pints down the union when you should be practising sucking up blood may appear the better option at the time but could land you in trouble in a few years. Sure, it’s difficult trying a new practical procedure, especially when it involves sticking sharp things into little old ladies but unless you force yourself to overcome this fear now you’ll struggle even more in the future - and no-one wants to be a venflon virgin forever. Watch someone experienced first and get them to talk you through the procedure. It doesn’t need to be the head of the anaesthetics department, one of your brave buddies is often a better bet as they can point out the areas where they struggled themselves. Most medical schools and placement hospitals have a clinical skills centre where you can practice procedures. Dummies don’t care if it takes seventeen tries to get an arterial blood gas sample. Ask at the centre for training workshops or times when you can practice by yourself. Always remember that it’s not just getting the needle in the vein that’s important, there’s going to be a terrified little old lady attached to it. You’ll need to hold a conversation about her granddaughter’s new baby whilst maneuvering that piece of metal in her arm. Just like riding a bike, practical procedures become easier the more you do. You’ll soon be able to simultaneously extract blood and recall all eight grandkids in order without any trouble. Enjoy it The last and most important point - enjoy it! You’re one of only a few thousand students accepted into medical school each year. With electives, the best student events and an almost guaranteed job at the end, your life’s looking great already. Live it up!

MEDICALSTUDENTS STUDENTS MEDICAL

FUNDING YOUR MEDICAL If you dare ask any doctor their best experience at medical school then you’d better be prepared for hours of recollections from their elective - and if you’re really unlucky they might even whip out their photo album to share. It can be a life changing experience, but so can finding the funding to get you there - and not for the right reasons. In this issue we look at some early steps you can take to help finance your medical elective.

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ight now you’re probably more scared than excited about your elective. You’re likely to have recently travelled hundreds of miles to medical school and that’s often traumatic enough. The thought of hitch-hiking 3,000 miles into the deepest, darkest depths of the Amazon rainforest to spend time at an isolated clinic probably doesn’t seem that appealing right now. Early financial planning is essential. Although it may be a number of years away, money can have a big impact on where you go and what you might be able to do on your elective. The average elective time allocated by medical schools is eight weeks. Most throw in a few weeks holiday afterwards so you can top-up your tan before returning home. If your curriculum includes special study modules there’s also a good chance you’ll be able to attach these to your elective period too. This extended time away from home means budgeting is critical. If you’re lucky, you’ll find free or discounted accommodation during your placement but make sure you account for any additional stay or travel plans before or after. With flights, accommodation and daily living expenses it can add up to be an expensive experience. Don’t panic though, fortunately there are tried and tested methods which past students have used to fund their adventures.

Royal College of Physicians Up to four grants are available each year to undergraduate medical students at UK universities. www.rcplondon.ac.uk/research/funding-and-awards/travellingfellowships-and-bursaries/rcp-medical-student-elective-bursary

Royal College of Surgeons

GRANTS AND BURSARIES A number of charities, colleges and endowments offer grants and bursaries specifically aimed to support medical student electives. Below you’ll find a list of some on offer - just remember that they’re not all going to be open to your plans but it’s worth checking which might support you. Contact those that are appropriate or check their website for criteria. In return they may ask you to submit a report on your elective experience, or make a short presentation at one of their events.

Beit Trust Medical Elective Bursaries Offers over 20 bursaries each year for students who plan to undertake self-organised medical electives in southern Africa. www.medschools.ac.uk/Students/electives/Pages/Beit-Trust-MedicalElective-Bursaries.aspx

Royal Society of Medicine The RSM runs a variety of competitions and awards for medical students. www.rsm.ac.uk/academ/awards/awardsstudents.php

MEDICAL STUDENTS

The Preiskel Prize is an award for clinical students wishing to pursue a career in surgery and planning to undertake an elective in surgery in the ‘developing world’. www.rcseng.ac.uk

British Medical and Dental Student’s Trust The BMDST, a registered charity in both England and Scotland, provides travel scholarships to help support medical and dental students going abroad for their electives. www.bmdst.org

You can find more grants and bursaries via www.money4MedStudents.com

OTHER SOURCES Still short of that all important total? Here are some additional ideas for raising those extra pounds Sell yourself - Many businesses have cash set aside to spend on good causes. Try smaller local firms first. Offer them something in exchange - maybe you’d come in after you return and give a slide show or write a blog for their website. I managed to cover the cost

ELECTIVE of an entire month’s desert expedition visiting clinics simply by offering to take photos of companies logos and products in the dunes - sure I felt daft holding up wet-wipes in front of a camel but it was worth it! Voluntary Service Overseas (VSO) - VSO is an organisation which will help support your travel and expenses if you get involved in one of their projects. They’ve many health attachments on offer from public education to local health development. Full details are available on their website - www.vso.org.uk. Local Education Authority - Depending on your current funding you may be able to persuade your LEA to cough up some cash. Your elective is a compulsory part of the medical curriculum and, as such, you should get support towards travel and living expenses. It depends where you live (and anecdotally seems more common in Scotland and Northern Ireland) but it’s worth a try. Take out a loan - Probably your last preference but if it’s the only option left then it’s worth considering. It’s better than looking back with eternal regret that you didn’t spend your elective how you dreamed. Check out the ‘professional study loans’ offered by most high street banks.

FINANCIAL TIPS OVERSEAS Bank Account - If you’re staying for a long time in one country it can be worth opening a local bank account and in many cases you can often open an account through one of their branches in the UK. Some UK banks also allow you to withdraw cash overseas for free. For example, with Barclays you can withdraw dollars free from Bank of America, Westpac Bank in Australia and many others. It means you won’t get charged expensive commission rates - or have to carry large amounts of travellers cheques with you. Vaccinations - Don’t pay for travel vaccinations unless you have to. Most GP practices still offer them for free for medical electives. Move if necessary. Alternatively check with your medical school GP co-ordinator. Avoid walk-in travel clinics, they’ll charge you over £100 for some vaccinations. Get mobile - It’s great to have a mobile phone when you’re away though not so nice when you get the bill on your return. Text messages are usually free to receive overseas but calls can cost a fortune. A mobile phone can be invaluable for booking tickets, meeting friends and giving your number to colleagues. The advice is to buy a pre-pay SIM card for one of the local networks which usually only cost a few pounds. You’ll also find that some networks, like Three, let you use your UK phone plan overseas without any roaming costs so it’s worth checking before you travel. Travel insurance - It’s definitely worth getting good quality cover while you’re away. Most med students take out a policy with BMA Services which costs around £100 for the duration of your trip. Unlike most other travel policies it offers emergency HIV prophylaxis for needlestick injuries. Remember you won’t be covered for ailments you have before you leave so make sure you take enough inhalers, oinments and pills with you.

Practical, unbiased information and advice on alternative sources of funding, tips on saving money, how to borrow sensibly and getting the most out of medical school on a budget. Money4MedStudents is your one-stop-advice-shop to help you manage your money whilst studying.

Sources of funding Tips on budgeting Top ways of saving money Free online money advice

www.money4medstudents.org The good news is that, no matter whether you can afford to travel to the other side of the globe or have settled for somewhere closer to home, your elective is likely to be one of your best medical school experiences. It’s a unique experience you’re unlikely to encounter again in your career. Organising your elective finances is one of the biggest headaches past students report. Early preparation and budgeting should mean you can spend your time enjoying your adventure not looking at your bank balance.

Money4MedStudents is a project of the Royal Medical Benevolent Fund, 24 King’s Road, Wimbledon, SW19 8QN. A charity registered with the Charity Commission of England and Wales No. 207275. A company limited by guarantee No. 00139113.

MEDICAL STUDENTS

MAKING THE BEST OF IT IN SIERRA LEONE FY2 Dr Mikey Bryant is in Sierra Leone with healthcare charity Mercy Ships. He has been volunteering in a children’s clinic for a year in a country where one in five children don’t live to see their 5th birthday. In this regular column he gives us an update on his experience.

“Q

uickly, hold this retractor!” I grasp the rather small metal piece between my hands and pull it backwards, tightening the pressure on the skin. The underlying fat caves in around the retractor like quicksand around a child’s foot, and Karen sighs. She arrived here three weeks ago after her project with another NGO collapsed, and she has been become increasingly frustrated with our ever disappearing equipment, particularly large sized retractors. Beloved of junior surgical doctors everywhere from Tasmania to Timbuktu, we were mystified at what they could possibly be used for - at least until I walked past a garage and found several of them holding up the back of a defunct looking bus, while men buzzed about changing the wheel. In spite of the obvious problems caused by the theft, I had to admire the innovation. I am snapped out of my thoughts by Karen pushing the retractor out of the way and doing the rest of the procedure the old fashioned way, both hands delving deep inside the patient the way a hungry leopard tucks into a gazelle. Thankfully, she is far more skilled than I am, and we are soon pulling the baby’s head out through the uterine wall. Remarkably, the baby is crying almost straight away and we are looking at a healthy boy thrusting his arms out into the air and grabbing for his mother. I have always been fascinated by obstetric surgery, especially the ability to put everything back after a long procedure involving more incisions than Jeremy Paxman on Newsnight. The whole bundle of organs seems to flow out like too many clothes from a suitcase, and I’m still in wonder as to how all the bowels get sandwiched back inside, leaving patients with such small scars. A young girl, Kadijah, came to the clinic yesterday. She had been suffering from a high fever with vomiting for the previous three days, and had been to see the traditional healer, who had given her a mixture of green and yellow herbs, a concoction straight out of the jungle book. Unsurprisingly, her condition had not improved a great deal and by the time she had turned up at the clinic, I would have admitted her, had it not been for the family’s insistence that she should be treated at home. I had pleaded with the family to get to the clinic 22

MEDICAL STUDENTS DIARIES

“EVERY TIME I MENTION GOING INTO HOSPITAL, THERE ARE FLOODS OF TEARS FROM MUM AND TORRENTS OF ANGRY DEFIANCE FROM DAD.”

early today and get in ahead of the queues, and had been worried when she hadn’t turned up this morning. Her family lead me to their home, a ramshackle lean-to held together with old pieces of rope and palm fronds, with no flooring to speak of. Inside, Kadijah is barely conscious, lying on a wooden cot covered by small pieces of material, curled up into a pale ball. Someone has put a drip in her arm, attached to a bag of fluid hanging from one of the palm branches. It takes me a few moments to work out what is wrong with this picture, until I see that the drip still has the needle attached, and most of the fluid is just dribbling onto the floor. Her Mum looks up at me blankly, and I ask her how Kadijah has been doing and why they didn’t come to the clinic this morning. Her only answer is to point at the drip, clearly believing this magic injection is the key to everything.

I try to pick up the conversation from where we left off yesterday, and try to talk the ominously calm parents into taking their child into hospital. I might as well be trying to run through quicksand, both parents are haunted by memories of their first child dying four years previously after a three day admission. Every time I mention going into hospital, there are floods of tears from Mum and torrents of angry defiance from Dad. I feel utterly devastated, trapped by Sierra Leone’s limited of understanding of illness, while my own medical ethics and everything in me just wants to pick the child and sprint into the hospital, knowing we can probably still save her. There is no way that they will let me take her in, so all I can do is sort out the drip properly, get some more fluid to treat her with overnight and train the mother to check the pulse and temperature. I struggle not to feel too unwell as I leave the house, and wish there was more I could do to change the outcome. The ethical struggles here are so much rawer; how far to push a family that essentially don’t trust Western medicine? When to cut our losses and give the family what they want? Am I setting up a precedent for more patients deciding to treat their children at home?

Focus on Finance - in association with Wesleyan

WHAT TO CONSIDER WHEN TAKING OUT A PERSONAL LOAN

ver the coming years, you may find you need to take out a personal loan. This could be for a number of reasons, such as buying a car, going on holiday or making improvements to your home. There are plenty of lenders out there who may be prepared to let you borrow money, but it is important to do some research first to make sure you get the best deal that is right for you. Here is a guide to help you get the best deal when you take out a personal loan.

eligible for. For example, they might only be for members of a loyalty scheme or be available for a limited time to new customers. It is also worth noting that if a lender’s promotional material describes the interest rate as ‘Representative APR’, this too might not be the rate you will receive. Regulations state only 51% of customers need to have received that rate for the loan or a similar product during the previous 12 months. The rest will have had a different rate, which could have been higher.

1. ONLY BORROW WHAT YOU CAN AFFORD

4. FIXED RATE OR VARIABLE?

It sounds obvious, but many people are tempted to over extend themselves when they borrow money. When you take out a loan, consider the interest rates and monthly repayments and ensure you can afford to cover them.

Check whether the interest rates are fixed or variable. A fixed rate will apply throughout the term of the loan while a variable rate can go up or down depending on what happens to the Bank of England base rate. 5. LOW INTEREST RATES COULD BE COMING TO AN END

2. SHOP AROUND FOR THE BEST DEALS

Many people stay with their bank for a lifetime and automatically go to them for a loan. However, your bank might not offer you the best loan deals, and you may find some banks have special offers for new borrowers that are not available to their existing customers, so it makes sense to shop around. 3. CHECK THE RATE OF INTEREST YOU WILL BE PAYING

It is important not to be drawn in by a lender offering low interest rates, as this may not necessarily be the rate you will end up paying. You can find loans for £7,500 over four years with an APR (Annual Percentage Rate) ranging from 4% to 23.9%. While lower rates are attractive, they could have specific conditions that you might not be

The Bank of England base rate, which is an important factor in how banks set their loan rates, has been at its historic low of 0.5% for more than five years. However, this interest rate cut was put in place at the height of the recession in an attempt to stimulate economic growth and was never intended to be a permanent position. In fact, in recent months the Governor of the Bank of England has indicated that interest rates could soon start to rise, perhaps before the end of the year. While it is not known when rates will rise and to what levels, it is expected they will go up as the economy continues to recover, and so will increase the cost of borrowing. This means now might be a good time to take advantage of the low costs of borrowing. 6. BORROWING MORE COULD COST YOU LESS

While sensible borrowing should always be the main consideration, there are occasions where it could work out cheaper to borrow more. Most banks charge higher interest for what they class as smaller loans, typically up to around £7,500. A difference of six percentage points between the rate for smaller loans and larger loans is not uncommon. If you are near the threshold, borrowing

slightly more could mean you actually end up paying less over the term of your loan. For example: • A loan of £7,000 over four years at 13.9%* APR has monthly repayments of £188.09, meaning the total amount payable is £ 9,028.32. • A loan of £7,500 over four years at 7.8%* APR has monthly repayments of £181.46, with the total amount payable being £ 8,710.08. * Based on Wesleyan Bank interest rates, August 2014. 7. CLEAR YOUR DEBTS

It is good financial practice to ensure you do not build up too much debt and clear loans as soon as you can. Some banks allow you to make overpayments in order to pay off a loan early. While some, like Wesleyan Bank, do not charge a fee for early repayment, other providers may, so you need to be mindful of any charges if you clear your loan early. 8. CONSOLIDATE YOUR DEBTS

Another way to reduce the amount of interest you pay could be to consolidate your debts into one larger loan rather than have a number of smaller ones. This will also leave you with a single repayment each month, which could help you to manage your personal budget. As long as you keep up with your repayments, a consolidation loan shouldn’t affect your credit rating. Again, check whether your loans have fees for early repayment, as any charges for paying them all off to consolidate may cancel out any advantages. It should be noted that, in consolidating a number of debts then it is likely the repayment term will be longer in order to make the loan affordable. This can mean that while the monthly repayments will be smaller than you were paying previously, you will ultimately be paying back more over the period of the loan. CONCLUSION

Many people will have to take out a loan at some point and it is important to research carefully to get the best deal.

The above information does not constitute financial advice. For further information please speak to a financial adviser. For more information call 0800 072 3749 or visit the website at www.wesleyan.co.uk/bank.

FINANCE

Carla Barberio

In fact, I’m not sure which I was more excited about – watching an operation or getting to wear scrubs!

ith a new year, I was greeted with a brand new set of chaloperation process from start to finish. Then it was time for the surlenges in my journey to becoming a doctor. Firstly, I surgery to begin. vived my first medical school exams - much to my shock It was fascinating seeing the surgeon cut through the layers of and delight! Secondly, I survived Prosection - I had been dreadskin, fat, fascia and muscle - all of which I had learnt about and ing this, having naively believed gory stories from older students, seen in Prosection, but which looked so different, (and far more but I ended up thoroughly enjoying it and finding it very useful. interesting!), in a real, living patient. The assistant surgeon showed Thirdly, I passed the Basic Life Support exam, which although me the X-rays and explained how the patient’s hip replacement had was probably nowhere near the standard needed in a hospital, failed but that they couldn’t know exactly how until they looked made me feel a tiny bit closer to becoming an actual doctor. To inside as the problematic part was plastic. It turned out that it had top it off, we began new topics of muscles & joints, respiratory just worn away through use and so after much delicate manoeumedicine and digestion which I found far more interesting than vring, drilling and hammering it was removed and a new one was the topics we had studied previously. fitted. Two and a half hours passed without me realising and thankAnother exciting part of this semester was the first year’s Hospifully, I think I must have been too engrossed to feel faint, which tal Orientation Day. First year students get paired with a fifth year was a relief. student and go to their hospital to shadow them and see what it The team asked me if I would like to stay with them for the rest will be like to be a medical student in the clinical years. of the day which I would have absolutely loved to, but I had said Much to my excitement, my fifth year student, Khalida, was that I would meet Khalida straight after. However, this was easiplaced in the surgery department. I had watched a knee replaceer said than done - I didn’t quite appreciate just how many corriment operation before, but from a neighbouring room via a video dors that hospital had or just how maze-like they were! After finally link, so I was absolutely thrilled at the prospect of watching in the finding her, we headed to the Clinical Skills centre where we were theatre for the first time. In fact, I’m not sure which I was more going to spend the rest of the day. excited about – watching an operation or getting to wear scrubs! Here, we got to see a plastic model of a patient, used to examine I’m only joking, of course I was more excited about the operation, doctors. It could talk, breathe, imitate diseases and tell which drugs but getting to wear scrubs just added to the thrill. were being injected into it, which I found really interesting. Even After changing into the scrubs and taking a sufficient amount more remarkable, was a female one which gave birth to a plastic baby of pictures to send to family and friends back home (see photo), - seeing that was a little bit strange! After this, we got to practise all Khalida dropped me off at the theatre, where I met Lucy, one of the types of intubation, (on a model), as well as seeing a real AED and the lovely nurses. resuscitation demonstration. We finished off with the two best parts Lucy explained that the first operation would be a ‘hip revision’ of the afternoon: learning how to take blood (or maybe just water and let me help her prepare the theatre dyed red) from a model arm and from preparing the bed and sheets how to put in a cannula. to carrying all the many trays of All in all, I had such a instruments into the theatre. fantastic day. Seeing a The sister in charge had told snapshot of the clinme that Orthopaedic Surical side of medigery was one of the bloodicine and meeting est types of surgery which, Khalida really incombined with having to spired me to keep wear a face mask and conmotivated with sequently breathe in more the pre-clinical CO2, made many stustudies. I think Carla Barberio dreams of being a doctor. We dents feel faint. So despite that as I progwere all there once; struggling with exams, my excitement, I was very ress to the cliniapprehensive. After evcal years I’ll enjoy trying to perfect UCAS forms and longing to erything was ready, I was the course even swing a stethoscope around our necks. We’ve taken to the anaesthetist more - but until been following Carla since sixth form and in this so I could meet the pathen, it’s back to column she’s part way through her first year at tient and see the whole the textbooks!

MY JOURNEY TO BECOMING A DOCTOR:

YEAR TWO medical school.

DIARY

Writing in the Notes e

It’s all in the nam

(Shortening Dear Editor, ith your article w e re ag lly ta I to thcare, warns may affect heal n io at uc ed al e that newmedic ; p5) as I agre 31 s Is s; er ad le nt to pracBMA are not compete s or ct do ed ifi ly qual 1 – but I feel r completing FY te af til un e on ! Since we tise al clature all wrong en m no e th t go we’ve the GMC’ on registered with lly ‘fu e ud cl in and assume don’t nts see the ‘Dr’ tie pa es dg ba t every other our ID ble of doing wha pa ca lly fu e ar FY1s sense only to it makes more ly re Su . es do pleting FY1 doctor successfully com r te af S B B M a year early award full registration g in ak m an th rather ports? as the article re DAVE F (FY2) .CO VIA JUNIORDR

M COMMENTS

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:

Ballpoint pen

NAME WITHHELD VIA JUNIORDR.COM COM MENTS

95p

St Bartholomew’s Hospital, London

Doodle-tastic at,

40p A birthday card

The name game Dear Editor, Let’s all be on first name terms – that will go a long way to reducing bu llying at work! (One in four doctors feel under mined at work; Iss 31; p6) It’s bizarre that as a pro fession we still refer to our superiors as Dr, Mr or Mrs. I can’t think of any of my non-medic friends who have the same situation in their wo rkplaces. I don’t know if there’s any evidence for this but I imagine using first names would make my consultant more approachable – and as your article states – I would be more likely to int erject when I feel my consultant is about to do something to compromise patient safety.

Use it to write a complaint at,

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Not such a happy birthday at,

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Ask for just one finger at,

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Just watch the calories at,

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Next issue we’re checking the cost of a box of tissues, bottle of water and a jacket potato with cheese. Email prices to hospitalconfidential@juniordr.com

ma article

Five stars for cine

edicine: Dear Editor, a great article (M as w is th t gh to culI thou d from camera an e av gr to le ngratulate From crad just want to co d an ) p9 ; 31 t society ture; Iss s how importan ce or nf -i re It . derstandthe author management/un lfse d an a m em to be is to stig and television se a em in C . ss ne mething ing of ill althcare and so he in l tia en flu hugely in aware of. we all need to be LONDONECHO .CO VIA JUNIORDR

M COMMENTS

IPSWICH HOSPITAL Extensive seating areas, including sofas and a dining area. Kitchen stocked with unlimited cereal, toast, biscuits and squash. Two hospital computers in a computer room. Locker rooms. A full size snooker table. A ping-pong table. A dart board. A foosball table. 42” TV with Sky. A Playstation … and not to forget our very own bar!

JuniorDr Score:

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

HOSPITAL MESS

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THE MEDICAL COURSE AND CONFERENCE DIRECTORY

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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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