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The adventure of medicine 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 2013. 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.
R
emember back to secondary school when your teacher would ask you what you wanted to be when you grew up. You replied ‘a doctor’. Inside you were never too sure you would make it and what becoming a doctor actually meant. Simply getting to where you are today has been a big adventure. Carla Barberio, who we’ve been following in her regular column, has only just started hers. In this issue she tells us about the nerve-wracking medical school interviews (p24). Now that you’re here, one of the great privileges of being a doctor is that it gives you a passport to huge opportunities around the world. In this themed issue we look at where this passport can take you, whether it’s for work or pleasure. In October 2012 three junior doctors, Sebastian Wallace, Richard Wain-Hobson and Daniel Nuth, set out from Cornwall in a Land Rover to journey to Cape Town. Along the way they spent placements in hospitals and supported African charities. We asked each of them to write a diary entry along the journey so you can read about their adventures (p9). Africa too hot? Well maybe you’ll be inspired by FY2 Ian Ditchburn who accompanied a team up Everest for the highest cricket match in the world at 5,200 metres (p14); or Philip Brooks who decided a life on the open sea as a ship’s doctor was for him (p16). If you’re dreaming about your own adventure we offer some helpful advice on p18 to get started. Whether it’s working on Australia’s Gold Coast or volunteering in a remote village hospital in Africa we help you make best use of your medical degree - your passport to adventure. Bon voyage! The JuniorDr Team
From Cornwall to Cape Town, p9
What’s inside 04 09 14 16
LATEST NEWS
18
Cornwall to cape town everest: cricket at 5,200m
26
a guide to working overseas Courses and Conferences
a ship’s doctor: all at sea
TRIAGE
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Tell us your news. Email team@juniordr.com or call 020 7193 6750.
Training
Long hours and poor handover remain biggest concerns for junior doctors
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ver half of junior doctors (58.5%) work beyond their agreed hours, and one in five say handover arrangements are either informal or absent in their organisation. The concerns come from the GMC’s annual survey of 54,000 junior doctors - one of the largest of its kind anywhere in the world with 97.7% of doctors in training responding. Overall 80% were satisfied with their training. GP trainees were most satisfied (87.8%) in contrast to surgical trainees who rating their training lowest (76.2%). At the time of the survey in March 2013 almost three in four (73.8%) trainees described their post as ‘excellent’. Worryingly 58.5% said they worked beyond their rostered hours on a daily or weekly basis, and 22.2% said their working pattern left them feeling short of sleep when at work. “Almost 98% of doctors in training have
told us about their experiences and we are greatly encouraged by the continued increase in satisfaction with their training,” said Niall Dickson, Chief Executive of the General Medical Council. “Doctors in training provide frontline care to patients so it is vital that we use these results to make sure their training environment continues to improve and to be safe for patients.” One in twenty respondents raised a patient safety concern in their organisation through the survery. The GMC has committed to investigate all submitted concerns and a further report on patient safety issues will be published after further analysis this autumn. www.gmc-uk.org
Key messages • Over half of the doctors surveyed (58.5%) said they worked beyond their agreed hours on a daily or weekly basis • 20% surveyed said handover arrangements before and after night duty were informal or that there were no arrangements at all • Over 80% knew who to talk to in confidence if they had personal or educational concerns compared with 77% last year • Over 90% felt they were supervised by someone who was competent to do so • Just over 80% said they were very or fairly confident that their job would help them learn what they needed at this stage of their training
working conditions
Junior doc rest rooms re-open at Aintree Hospital J
unior doctor rest rooms have been brought back into use at Aintree University Hospital NHS Foundation Trust following concerns raised by junior doctors at the BMA conference. The trust re-introduced the facilities for doctors to use at the end of a long shift. Trainees were concerned about feeling too tired to drive home at the end of a long shift or a shift that finished in the early hours of the morning. The rest rooms had previously been taken out of use following changes to doctors’ shift patterns, which meant doctors were no longer resident on call. 4
NEWS PULSE
FY2 doctor, Latifa Patel, who raised the issue with the Trust and BMA local negotiating committee said: “This is a great gesture from a trust that recognises the importance of junior doctors’ safety. I hope it encourages other employers, where possible, to do the same.” Trust medical director Gary Francis said: “Aintree believes that it is essential to support junior doctors through a range of measures, and by engaging with them to understand their issues.” “Tired drivers are not safe drivers, for themselves or for others. This was a practical suggestion which we were happy to adopt.”
www.aintreehospitals.nhs.uk
Patient care
Juniors don’t have time to deliver quality care
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ore than one in four junior doctors feel they do not have the time to deliver the high quality care patients deserve, according to a survey by the BMA. Half said there was a problem with staffing shortages in their workplaces which has an impact on care delivery. Rising levels of stress are also revealed among trainees who are struggling to find a decent work-life balance. The research was part of the BMA Cohort Study which follows the career pathways of 430 doctors who graduated in 2006 over a 10-year period. For the first time this year, participants were asked questions on workplace morale and well-being. Of the 376 respondents, 105 doctors (28%) said they did not have the time to deliver the quality of care patients deserve. It also finds 44 per cent of doctors feel their stress levels have become worse or much worse in the past year. “It is shocking that one in four junior doctors feel they do not have the time to offer the highest
Your helping hand on the wards.
“It is shocking that one in four junior doctors feel they do not have the time to offer the highest quality of care to patients.” Dr Ben Molyneux BMA junior doctor committee Chair
quality of care to patients,” said BMA Junior Doctor Committee Chair Ben Molyneux. “Sadly, it is not surprising when you discover that so many doctors in training are working in unacceptable, stressful environments where understaffing is commonplace.” The study also found that two in five doctors say there are ‘feelings of negativity’ in their workplace and that six in ten think changes to the NHS have harmed morale.
Gantz’s Manual of Clinical Problems in Infectious Diseases, 6e Myers, Moorman & Salgado November 2012 ISBN: 978-1-4511-1697-7 656 pp • 8 illus. & 207 tables Paperback
www.bma.org.uk
Patient care
Half of all patient complaints are about 3% of doctors
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alf of all formal patient complaints concern just 3% of doctors, with 1% accounting for a quarter of all complaints, according to research published in BMJ Quality & Safety. The study in Australia of 19,000 formal patient complaints filed against 11,148 doctors during 20102011 found that doctors complained about more than three times are highly likely to be the subject of a further complaint - and often within a couple of years. Over 60% of the complaints concerned clinical aspects of care, while almost one in four (23%) concerned communication issues, including the doctor’s attitude and the quality or quantity of information provided. The authors argue that the problem is unlikely to be confined to Australia and point out that while regulators often know about these problem doctors, patients usually don’t. They believe the approach they used to predict complaint risk could be used to spot problem doctors earlier, so improving the quality and safety of patient care.
qualitysafety.bmj.com
Handbook of Nephrology Leehey & Moinuddin March 2013 ISBN: 978-1-4511-7547-9 234 pp • 72 illus. & 30 tables Paperback
Pocket Medicine, 4e Sabatine September 2010 ISBN: 978-1-4511-0335-9 304 pp • 77 illus. Loose Leaf Binder
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Worries over intercalation
Patient care
Death risk from surgery higher at end of week
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atients who have elective surgery at the end of the week or at the weekend have a greater risk of death, according to a study published in the BMJ. The research by Imperial College London found that death rates for planned surgery are lowest on Mondays and increase for each subsequent day of the week. Odds of death were 44 per cent higher for patients who had planned operations on a Friday than on a Monday. The study looked at 27,582 deaths out of 4.1m elective surgeries carried out in England between 2008 and 2011. It found that 5.5 per 1,000 hospital procedures on Monday died within 30 days rising to 8.2 on Fridays.
The researchers from Imperial questionned whether the findings may be due to lower staff ratios and poorer care at the weekend: “Unlike previous studies, we included both deaths in hospital and deaths after discharge, so this eliminates a potential bias of counting only in-hospital deaths,” said Dr Paul Aylin, who led the study, from the School of Public Health at Imperial. “This leaves us with the possibility that the differences in mortality rates are due to poorer quality of care at the weekend, perhaps because of less availability of staff, resources and diagnostic services.” Previous research had found worse outcomes for patients admitted to hospital as an emergency at weekends, but the new study finds a much stronger weekday effect for elective procedures. As well as looking at the data as a whole, the researchers studied death rates for several specific high risk procedures, and found the same trend for higher mortality close to the weekend. www.bmj.com
Training
Target for half of junior docs to be GPs
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target of 50% of all medical students becoming GPs has been announced by Health Education England (HEE) as part of its mandate for NHS staff training and education. HEE is the new public body which oversees the education and training system of healthcare trainees in England. Under these new objectives it aims to ensure half of all junior doctors enter GP specialty training. The mandate was welcomed by Dr Clare Gerada, Chair of the Royal College of GPs, but she called for more funding and resources to turn the aspirations into reality. “The College has long been calling for more GPs and longer training for GPs so we welcome Health Minister Dan Poulter’s pledge to encourage more medical students to continue into general practice - and the commitment that Health Education England will work with us to secure extended and enhanced training
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NEWS PULSE
for GPs in the future,” she said. The HEE pledge is aligned with national NHS priorities in England to tackle preventable deaths; empower and support people living with long-term conditions; introduce a culture of caring; and for the diagnosis, treatment and care of people with dementia in England to be among the best in Europe. hee.nhs.uk
“The College has long been calling for more GPs and longer training for GPs so we welcome Health Minister Dan Poulter’s pledge to encourage more medical students to continue into general practice.” Dr Clare Gerada Chair of the Royal College of GP
Medical schools expect intercalation numbers to fall over the coming years. The BMA conference of medical academic representatives heard there was anecdotal evidence of a decreasing interest from students taking a year out within their degree to conduct research. One of the reasons given for the fall was the expense of intercalation in light of the increase of tuition fees to £9,000 a year. www.bma.org.uk
RCP fees rise 2.6 per cent The JRCPTB (Joint Royal Colleges of Physicians Training Board) which includes the Royal Colleges of Physicians of Edinburgh, Glasgow and London has decided to increase its annual membership fees by 2.6 per cent from August this year. This will mean specialty and core medical trainees will pay £169, and SpRs on the pre-2007 curricula will pay £149, rising from £165 and £145 respectively. www.jrcptb.org.uk
Rise in ambulance diversions The number of hospitals which have forced ambulances to turn away patients in need of emergency care has risen by 24 per cent, according to data obtained by the Labour party. The data from the House of Commons library disclosed that there were 357 occasions when hospitals in England were no longer able to accept any new patients brought in by ambulance - apart from cases deemed to be life threatening - in 2012-13. This was up from 287 in 2011-12. www.labour.org.uk
Commissioning help The Royal College of Physicians has launched a Clinical Commissioning Hub - an online resource for those commissioning secondary care services in England, service planners and clinicians designing these services across the UK. It aims to help those wanting to find out more about the new health structures in England, including how they can get involved. www.rcplondon.ac.uk
nhs
Public satisfaction WITH NHS STABILISES AFTER RECORD FALL
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ublic satisfaction with the NHS stabilised last year after a record fall in 2011, according to British Social Attitudes survey data published by The King’s Fund. Satisfaction with the way the NHS runs now stands at 61 per cent, the third highest level since the survey began in 1983. This follows a record fall in satisfaction, from 70 per cent in 2010 to 58 per cent in 2011, when the survey coincided with the first year in a four year NHS spending squeeze and sustained media coverage about the government’s “With no real change in satisfaction NHS reforms. with the NHS in 2012, this suggests the The survey also measured record fall in 2011 was not a blip and satisfaction with individuthat the ground lost may take some time al services. Satisfaction with to recover.” A&E services increased by 5 percentage points from 54 to John Appleby 59 per cent while satisfaction Chief Economist at The King’s Fund with outpatient services (64 per cent) and inpatient services (52 per cent) showed no real change from 2011. Satisfaction with GP services (74 per cent) and dentists (56 per cent) are also unchanged. In contrast to the high levels of satisfaction with the NHS, satisfaction with social care services was much lower, at only 30 per cent. John Appleby, Chief Economist at The King’s Fund, said: “The British Social Attitudes survey has provided an important barometer of how the public views the NHS since 1983. With no real change in satisfaction with the NHS in 2012, this suggests the record fall in 2011 was not a blip and that the ground lost may take some time to recover.” The main question asked in the survey was ‘All in all, how satisfied or dissatisfied would you say you are with the way in which the National Health Service runs nowadays?’. Satisfaction was judged by those who answered ‘very’ and ‘quite’. The survey was undertaken by NatCen Social Research, with the majority of interviews taking place between July and September 2012. The sample size for the health questions was 1,103. Interviews were carried out faceto-face with a random sample of adults. The data is weighted to ensure it is representative of the general population.
www.kingsfund.org.uk
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The Lullaby Factory
Great Ormond Street Hospital
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he Lullaby Factory is a collection of musical drainpipes installed on the exterior of Great Ormond Street Hospital for Children that plays lullabies to help patients sleep. Hackney-based Studio Weave constructed this fantasy landscape reaching ten storeys in height of listening pipes in a back courtyard of the childern’s unit. The architects were inspired by the messy pipes and drainage systems that already cover the surface of the brick walls. Instead of covering them up, they chose to add to them with a widespanning framework of pipes and horns.
www.studioweave.com/projects/the-lullaby-factory
Credit: Studio Weave
From Cornwall to Cape Town In October 2012 three junior doctors set off with the aim of driving Tess, their 1992 Land Rover Defender, from Cornwall, their home and place of work, to Cape Town. At the time of writing, they were in their 28th country and 19,973rd mile, having traversed Europe, negotiated the Mediterranean by way of a ferry from Turkey to Egypt, tracked up the Nile through the Sudan into Ethiopia, and followed the great rift valley south from Somalia.
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ebastian Wallace, Richard Wain-Hobson and Daniel Nuth aim to raise money for Medicins Sans Frontiers and Gondar Ethiopia Eye Surgery (GEES) - a UK based charity that is establishing a centre of ophthalmological excellence in northern Ethiopia. They are also visiting a number of hospitals and health organisations along the journey - including a one-month general medical placement in Iganga Hospital, Uganda and participation in the C.R.A.D.L.E. Project in Malawi - an Africa-wide screening and referral project for pre-eclampsia. So far they have almost lost the car to a sinking Turkish salt lake, found themselves in the thick of the political upheaval in Greece and Egypt, repaired 16 punctures and a high speed blowout on the mountain roads of Ethiopia. We asked each of them to write us a diary entry whilst on the road -
ADVENTURE MEDICINE
9
From Cornwall to Cape Town Bandits – Richard Wain-Hobson
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oday we reached our first tarred road in Kenya. Crumbling, potholed - we didn’t care. It has taken us thirteen days of driving from Addis Ababa, Ethiopia’s capital, and the road has been long and hard. After 800 remote and barren kilometres following the east coast of Lake Turkana, we reached our first Kenyan settlement. A few kilometres west of the village one of our tyres succumbed to the sharp terrain. As we stopped to swap wheels, a group of children from church bounced past, the priest driving. We were tightening our last wheel nut as the distinctive crack of gunfire rang out ahead. After a quick discussion we decided to investigate. We rounded the next corner cautiously. Their 4x4 was splayed at an odd angle across the road. The children were cowering behind the car, silent with terror. The priest staggered towards us, cradling his arm. His brow was split and bleeding; he looked dazed. Despite the language barrier, we managed to quickly ascertain what had happened. Six bandits with AK47s had opened fire indiscriminately. No one was hit. They had assaulted the priest, and stolen what they could. Seconds before we had rounded the corner they had fled into the bush. Without hesitation we bundled everyone into our Land Rover. We sped back down the treacherous piste with eleven people aboard, and were soon back at the military base in the village we had just passed. The Captain had also heard the gun fire, but the army had no vehicles with which to respond. They begged the use of our Land Rover, and under their protection we returned to the stricken 4x4, armed soldiers on the roof. On closer inspection it was riddled, bullet holes through the engine block, children’s compartment, and two inches above the driver’s head. The priest uttered a prayer under his breath. We rigged up a line, and cautiously towed it, full of children, to their village some 30 km away. Looking back, I’m surprised how calm and functional we all were. None of us have a military background training. I’m sure that the training we have received during our medical practise enabled us to cope with the pressure of the situation and keep communicating. We are now far into Kenya. I don’t think the gravity of what happened has sunk in yet…
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ADVENTURE MEDICINE
We were tightening our last wheel nut as the distinctive crack of gunfire rang out ahead.
Iganga General Hospital, Uganda – Sebastian Wallace
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he midmorning sun glares onto the corrugated-iron roof. I am already sweating in my shirt as we reach the last male patient. We are joined by the ward sister in a Nightingaleera uniform and a throng of nursing students, competitively eager to learn. The white-coated Clinical Officer (CO) puts a casual hand on my shoulder as he tells me about the new admission. With his three years of training, the CO is the only other medical staff on the ward. A government pay dispute means that consultants only appear sporadically for ward-rounds and complicated cases. Among the usual caseload of complicated malaria and fractures from the road lies a man drenched in sweat. We have been waiting all week for certain laboratory reagents to arrive and finally a test has revealed brucellosis. Fortunately, this is something we can treat here. Some of these mysterious fevers are turning out to be trypanosomiasis, which is making a comeback from its virtual eradication. The drug to treat it is no longer profitable to produce. To my relief, the bed of a boy admitted yesterday is now empty. He had fallen from a mango tree, sustaining a left-sided, depressed skull fracture. He was fitting regularly and his right leg showed weakness. Having controlled his seizures, we had quickly referred him to a larger hospital. However, his family were unable to pay the expensive ambulance fees. In the end, they had managed to borrow the money for the long journey. Cost to patient is a continual hindrance, many disappearing untreated rather than burden their family with debts. Our last patient is in a coma, although breathing spontaneously and seemingly stable. The only history we are able to illicit is his positive HIV status. We do what we can, but he needs referring. We have learned that research projects will often fund patient treatment so we make an urgent referral to the Cryptococcal Meningitis Research programme in Kampala. He is accepted the following day. Over coffee, conversation drifts from medicine to our work on the Land Rover. We are doctors by day and mechanics by night, working in our spare time to undo the ravages of our journey so far. We have repaired the suspension, replaced a legion of bushes, gaskets, oil seals and wheel bearings, serviced the engine and installed new tyres; furiously scouring the dirt and grease off our hands each We are doctors by day morning before the round. and mechanics by night,
working in our spare time to undo the ravages of our journey so far.
ADVENTURE MEDICINE
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From Cornwall to Cape Town Somalian Excursion – Daniel Nuth
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omaliland is a region in the north of Somalia and an old British Protectorate. The Somalilanders fought a war with Mogadishu in 1991 and broke away from their chaotic neighbour to the south. Their independence remains, however, unrecognised by the international community and the UK foreign office advises against all travel there. During our visit, however we felt quite safe, indeed we found the atmosphere quite welcoming. When we arrived in the capital, Hargeisa, we were soon captivated by the charms of the place. The women bob along the streets in vibrant burkahs that complement the brightly painted shop fronts. Camels plod down the road alongside men pushing wheelbarrows piled head-high with currency that no international bank deals in. The moneychangers lounge like princes before a wall of their wares, counting the bricks and chewing green sprigs of Khat. Near the Port town of Berbera we found deserted golden beaches, the turquoise sea washed away the dust and sand of what had seemed an endless desert. The sun began to dip and we went searching for a spot to camp. Instead we found the police. The captain took issue with us exploring the bush unescorted and we soon found ourselves under house arrest. We were lead to a hotel by two men with mirrored sunglasses and Kalashnikovs. On arrival, the hotelier Abdulkader Mansoor, a charismatic Somali entrepreneur was so surprised to find tourists in his hotel that he contacted the national news. Mouthfuls into our fresh fish suppers we found ourselves before a bright light and a camera lens. Abdulkader was delighted to hear us tell the people of Somaliland we had felt safe there. He said “I worry that many Somalilanders have lost confidence that their own country is safe simply because the rest of the world tells them it isn’t.” Next day we were escorted back to the capital where we were caught in an unexpected wildfire of fame. On our arrival we were pushed through a mass of people and journalists to enter the government press office. Inside was a circus of encounters with political dignitaries, tribal leaders and military bigwigs culminating in a televised meeting with the Prime Minister. The following day we left Somaliland and our strange notoriety behind us but took away the impression that such a beautiful, friendly country would not remain quite so untouched by tourism for long.
You can find more about the team, support their charities and read about their journey at www.cornwalltocapetown.com
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ADVENTURE MEDICINE
Inside was a circus of encounters with political dignitaries, tribal leaders and military bigwigs culminating in a televised meeting with the Prime Minister.
New Zealand Choose your own adventure as a Registrar on New Zealand’s South Island
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he South Island of New Zealand is an adventurer’s playground showcasing the best that nature has to offer, with towering Alps, majestic fjords and sounds, and rugged coastlines merging into sweeping plains. Where else in the world would you find an area so blessed with unique wildlife, world class ski fields, renowned vineyards, spectacular scenery offered by no less than 10 national parks, and some of the most down-to-earth people you’re ever likely to meet? The South Island covers a geographical area of 151,215 square kilometres and is home to a population of just over 1 million. There are four main regions that make up the island - Nelson-Marlborough, Canterbury, West Coast and Southland. The distance between the North and South Islands is 24km at its shortest, however the ferry route between Wellington and Picton is 92km. Up the top of the South Island you will enjoy the country’s highest average sunshine hours per year, the world-renowned wine making region of Nelson-Marlborough, famous for its Sauvignon Blanc, as well as the stunning Abel Tasman National Park. The Canterbury region is host to the island’s largest city, Christchurch, which forms the gateway to the majestic Southern Alps, and a hub for exploring the South Island. Over the Alps is the untouched rural haven of the West Coast, with heritage-listed National Parks and the spectacular 12km long Franz Josef Glacier. The southernmost part of the island, Southland, is an absolutely stunning region with the idyllic “Remarkables” mountain range, the breathtaking Milford Sound, and the adventure and ski hub of Queenstown.
The area is home to a large number of International Medical Graduates, allowing for an easy and supported transition into the New Zealand Health System. Credentialing and relocation processes are exceptionally transparent in New Zealand and are often far less strenuous than those of neighbouring Australia, with agencies like International Medical Recruitment on hand to guide you through every step. If you love the outdoors and are looking for a welcoming work environment that promotes quality training, close working relationships with Consultants, and an unbeatable work/life balance, then a Registrar role on the South Island is the perfect option. The main Registrar intake commences in December each year, but there are opportunities available at different times dependent on department requirements. You can look to take on a fixed period role, or even consider a more permanent move - who knows, you might fall in love with the place. This is the adventure capital of the world, and with career opportunities to match, what is stopping you from starting your own South Island adventure in 2013?
Australia & New Zealand Great Rates, Better Hours, and an Unbeatable Lifestyle
This is the adventure capital of the world, and with career opportunities to match, what is stopping you from starting your own South Island adventure in 2013? As a doctor, the South Island has plenty to offer. A haven for Registrars, there are plentiful opportunities across all specialties in a range of urban and regional/rural settings. Positions exist in large departments in tertiary teaching hospital environments, as well as community outreach services and smaller rural Accident and Emergency facilities. New Zealand enjoys a well-structured medical system, and District Health Boards offer world-class training with a number of teaching hospitals, a focus on career progression, and close collaboration with local Universities. Many Registrar roles are recognised and accredited by the Australian and New Zealand specialty colleges for advanced specialty training.
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The Everest Test
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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-legal cost - though most firms will provide free
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WORKING OVERSEAS
“I think I probably broke the world record for the number of antiemetic injections given in the buttocks over 48 hours” 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 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, antiemetics, 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
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.
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 noroviruslike 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
15
All at sea 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.
“I would never have had the opportunity to see so many places and experience so much in a NHS position.” 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. 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 Great Wall of China, 16
WORKING OVERSEAS
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 & noninvasive 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 non-medical responsibilities are more pleasurable and dining with passengers or entertaining passengers at cocktails parties is expected of the ship’s senior officers.
a ship’s doctor 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.
“You learn to become more resourceful when working at sea as the specialist opinion is a lot further than a phone call away.”
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.
My previous emergency and anaesthetic experience has certainly not been wasted as I have been involved in numerous cardiac resuscitations, intubated and 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 No two days are ever the none of which falls same and the pace can into your remit as a range from relaxed to land-based doctor. When I am on frantic depending on leave my time is my what sort of patients you own and typically I are seeing and where in will be at sea for four the world you are. 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 prehospital 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. 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
17
Advice on working For adventurous junior doctors there are plenty of opportunities to work overseas - from locum placements in the coastal towns of Australia to volunteering in remote villages in Africa. One of the greatest benefits of being a doctor is that it gives you an easy passport to work around the world. Wherever you have been dreaming of escaping to we offer some advice to help you get there.
E
ach year hundreds of junior doctors leave the UK with their passport in one hand and stethoscope in the other to experience healthcare overseas. It’s not just for the sunshine; working in another health system can develop new learning and practical skills which you can bring back home with you. But before you start booking those flights here are three key things you should consider first -
Choosing a placement Be prepared to do plenty of research. Many doctors rank location as their primary concern but it is important to accept a job which is appropriate to your clinical experience and career needs. Ending up in a post which is significantly different to your grade and competence in the UK can lead to a stressful experience. One of the first decisions you will need to make is whether you want a salaried post in a developed country, or a voluntary position working in a developing country with a charity. For voluntary posts you can browse the opportunities at Voluntary Services Overseas (www.vso.org.uk) or the websites of overseas medical organisations, such as Médecins Sans Frontières (www.msf. org.uk). Be aware that most of these organisations do not accept doctors in their foundation years and require clinical experience relevant to the post. For locum clinical posts you can find a large selection in BMJ Careers (www.bmjcareers.com) or by browsing the numerous locum agency websites. Be aware that visa requirements have changed in recent years and countries, such as Australia, have tightened up their requirements for overseas doctors. Both developed and developing country placements offer different experiences but bear in mind that you may need to make additional financial arrangements if you work for a charity as these only pay a living allowance in most cases. Whichever post you choose do make sure to check the terms and conditions in detail and ask for a copy in writing. It is highly recommended to speak to another doctor who has been on a similar placement with your proposed organisation to learn of their experience. You can also read diaries and experiences of doctors who have made the move at www.juniordr.com.
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You’ll need to apply for an Out Of Programme Experience (OOPE) which can take some time, so starting the process before you’ve confirmed your plans is advisable. Try also to ensure the timing coincides with finishing a rotation when you leave the UK and that you return in time to start another. Overseas posts will only count towards training if permission is granted prospectively so ensure you have this agreed before you leave. Placements in English speaking countries with a similar training programme and health system to the UK are more likely to be accepted.
“It is highly recommended to speak to another doctor who has been on a similar placement with your proposed organisation.” Bear in mind that if you will be applying for a new post when you return that this may be difficult to do from overseas and attending interviews may need plenty of planning.
Before you leave Once you have a post confirmed you’ll still have a number of things to organise. Make sure you start long processes like visa applications early. You can find current requirements on the website Essential checklist before you leave • Confirmed a post • Carefully reviewed the terms and conditions • Obtained permission or OOPE from your deanery • Met any visa requirements
Getting permission If you’ve got a National Training Number (NTN) you’ll want to ensure you don’t lose this when you take a placement overseas. Speaking to your postgraduate Dean early is essential. Most are supportive but you may find difficulty if you’re in your foundation years or in the first year of a specialty training programme. 18
MEDICAL STUDENTS Support
• Obtained a Certificate of Good Medical Standing from the GMC • Collated copies of all your qualification and registration documents • Organised medical indemnity cover • Checked your medical insurance • Registered with the local equivalent of the GMC • Obtained any immunisations
S4D_Ad_2013.pdf 1 20/05/2013 12:09:47
overseas 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. 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. of the relevant country - a full list can be found at the Foreign and Commonwealth Office website (www.gov.uk/foreign-travel-advice). You will also likely have a number of financial arrangements to make before you leave. Depending on your current financial arrangements you may also have to notify Inland Revenue, and if you have a mortgage you will need to apply for permission to let if you plan to rent it out. Once your overseas placement is confirmed you should inform NHS Pensions (www.nhsbsa.nhs.uk/pensions) as you can make arrangements for this break from contributions. It is essential you arrange medical indemnity insurance before you leave. Most UK providers offer cover either within your existing policy or for a supplement. Additional cover may be required for some countries, such as the United States. Health and travel insurance cover is also essential. Remember that if you are planning winter or risky sports to ensure that your cover is sufficient for this.
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Finally, enjoy it. Working overseas can bring a new perspective to your professional and personal life. With a little planning your medical degree can be a passport to that destination you’ve always dreamed of going to. If you want to find out more about working overseas and get further information visit the careers section at JuniorDr.com.
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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.
Useful resources BMJ Careers - www.bmjcareers.com MedicsTravel - www.medicstravel.com Support4Doctors - www.support4doctors.org.uk Health Professionals Abroad: A Directory of Worldwide Opportunities Tim Ryder, Vacation Work Publications (2000) The Medic’s Guide to Work and Electives Around the World (2nd Edition) Mark Wilson, Hodder Education (2009)
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
MEDICAL STUDENTS support
19
Medicolegal Advice - in association
Working abroad – what you need to know Leaving the UK for pastures new is an attractive option for new doctors, but new countries present new risks, says Charlotte Hudson
W
ant to broaden your experience? Have a sense of adventure? Perhaps you have a passion to practise medicine in less-developed communities? Whatever your reason for wanting to work oversees, ensuring you’re well-prepared is a must. Working abroad has become an ever more popular option for junior doctors, with the majority heading to New Zealand and Australia. Below are some tips to help you realise your dream.
Essential items
• An up-to-date CV • Scanned copies of your original documents: ☐ passport ☐ driving licence ☐ GMC certificate ☐ degree certificate ☐ FY1 and FY2 certificates of completion/competency ☐ letters showing name and address. Planning in advance
You should gather as much information as you can about potential jobs, ensure your CV is up-to-date and make sure you sort your medicals and police checks. It can take a long time to get everything sorted to work in another country, and planning ahead is vital in organising a successful trip. Ask yourself – where you want to go, what you want to do, and why you want to go – what are you hoping to gain from this experience? Demonstrate your strengths for the job
A medical qualification is a passport to the world – it enables you to transport your skills anywhere, should you wish to enhance them. Roles in developed countries will be more competitive, therefore you must be able to clearly demonstrate your clinical and managerial skills. Clear research and publication experience will also be helpful. Registration in another country
In the UK, all doctors must be registered with the General Medical Council (GMC). In addition, the GMC regulates all aspects of medical education and sets the standard for higher specialty medical training through the Postgraduate Medical Education and Training Board. Before going to work in another country, it is essential to obtain a certificate of good standing from the GMC, 20
and also to inform the Council of any change in your correspondence address. Protect yourself with appropriate indemnity
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
with the Medical Protection Society
How to inform MPS if you want to work overseas Talk to a membership adviser before travelling if you are planning to work overseas. Use the helpline number 0845 718 7187, or email international@mps.org. uk. You should provide details of your scope of practice and where you intend to work, so we can confirm the correct subscription rate for your work. 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 leading medical defence organisation, with members in more than 40 countries around the world. 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
NHS scheme does not extend to doctors working abroad, so you will therefore need to make your own arrangements to ensure that you 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. “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. With members practising in more than 40 countries, if you are planning to work overseas membership can usually be arranged.”
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.
Plan your return to the UK
If you plan to return to the UK, you should make certain arrangements before leaving. It is advisable for UK medical graduates to have completed foundation training before doing a period of training abroad, and to ensure that any national training number can be retained on return to the UK. Good luck! Read more here: http://www.medicalprotection.org/uk/membership-benefits/ working-overseas. Read the New Doctor article: http://www.medicalprotection.org/uk/newdoctor/june-2010/spotlight-working-abroad
Useful links NHS Medical Careers www.medicalcareers.nhs.uk/postgraduate_doctors/medical_training_abroad/during_the_ foundation_programm/case_studies_-_severn_deanery.aspx NHS Medical Careers www.medicalcareers.nhs.uk/career_options/alternatives_to_working_in_nhs/working_abroad_-_ developed.aspx BMJ Careers careers.bmj.com/careers/advice/view-article.html?id=20000449
MPS is the world’s leading medical defence 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 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.
21
WIN an iPad
Your chance to WIN a new 32GB Apple iPad 3G*. Wesleyan Medical Sickness specialise in providing tailored financial advice to medical professionals. Our iPad competition is exclusive for medics. To enter visit www.wesleyan.co.uk/ipadcompetition *Terms and Conditions apply. See entry form for details. Model shown for illustration purposes only and may differ from actual prize. Wesleyan Medical Sickness is a trading name of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Ltd is wholly owned by Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham, B4 6AR. Telephone calls may be recorded for monitoring and training purposes. HD-AD-15 (02/11)
Focus on Finance - in association with Wesleyan Medical Sickness
Kick start your savings habit A
s a young doctor, your finances may not be in the best of health and you may have loans, overdrafts and credit cards to pay back. While saving may not be a priority at the moment, as you move through your career and start earning more, it will become increasingly important. It is worth noting that research carried out by Wesleyan Medical Sickness showed 51% of doctors wished they had started saving earlier in their career, so it is never too early to start.
Build up an emergency fund
One of the first things you should begin saving for is an emergency fund – essentially a reserve of cash that will keep you going in the short term. This should tide you over if you are unable to earn for any reason or face any unexpected expenditure, if the car breaks down for example. The amount you save will depend on your lifestyle and circumstances, but we usually recommend the equivalent of three months’ net income. Keep this money where it is easily accessible - in a bank or a building society account for example. Don’t let inflation eat into your savings
It’s easy to let your savings build up in your current account or a low interest savings account, but if the return on your savings isn’t outpacing inflation, the buying power of your money will erode over the long term. For example, if you have £10,000 in an account today paying interest at the Bank of England base rate of 0.5%, in five years its value would be the equivalent of £8,974
today and in ten years’ time just £8,053, based on the current inflation rate of 2.7%. Saving for the short term
If you’re saving for the short term, for something like a car or a holiday, you will probably want to keep your money easily accessible. In this instance it’s worth considering setting up a Cash ISA, which is like a normal savings account but you won’t have to pay income or capital gains tax on the interest or on your money when you come to withdraw it. Up to £5,760 can be paid into a Cash ISA in the current tax year, and the government has pledged to increase this allowance in line with inflation each year. Saving for the long term
If you have a long term saving goal, you might want to consider share, or equity, based investments. When investing in shares you should be prepared to leave your money in for at least five years. You should also be clear about how much risk you are prepared to take with your money – with higher risk there is the potential for greater reward, but it may also mean you get back less than you put in. There are also ISAs that invest in stocks and shares in a tax efficient manner, such as Wesleyan’s with profits ISA. You can invest a total of £11,520 into a stocks and shares ISA this tax year if you don’t use your Cash ISA allowance. By investing in a with profits ISA you are investing in a fund that has been designed to smooth out the highs and lows of the stock markets. The amounts paid out are therefore less volatile than the stock markets, which is an attractive feature of these policies.
Many people choose to invest in a fund which is a collective investment, where lots of people put their money together to access a wide range of investments. Spreading money in this way reduces the impact of loss from a single investment and funds are usually managed by an expert manager. As you build up your savings and investments portfolio you should look to keep your money in a range of assets so that if one type performs badly another may perform well during the same period. Also remember to review your portfolio on a regular basis so you can identify any underperforming funds. Conclusion
If you’re new to savings and investments or want expert guidance, talk to a financial adviser who understands the medical profession and can help you build up a savings portfolio that suits your needs.
The above information does not constitute financial advice. If you would like more information or need specialist financial advice, call Wesleyan Medical Sickness on 0800 358 6060 or visit the website at www.wesleyan.co.uk/doctors.
Specialist financial services for doctors • Savings and Investments
• Mortgages
• Retirement Planning
• Motor, home and travel insurance
• Life and Income Protection
Motor, home and travel insurance is arranged by Wesleyan for Professionals.
0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk Wesleyan Medical Sickness and Wesleyan for Professionals are trading names of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Limited is wholly owned by Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham B4 6AR. Telephone calls may be recorded for monitoring and training purposes.
FINANCE
23
My journey to becoming a doctor:
the interviews
Sixth former Carla Barberio dreams of being a doctor. We were all there once struggling with exams, trying to perfect UCAS forms and longing to swing a stethoscope around our necks. In her second column we join Carla as she tackles the medical school interviews.
“Y
es! I’ve made it to my first medical interview!” As I walked through the doors of the medical school, it felt like my dreams of becoming a doctor were one step closer to realisation. I was in awe of the fantastic surroundings and the students who I had long aspired to be, but I tried to persuade myself to not like it too much. With the notorious interview looming ahead and almost 2000 applicants for barely 300 places, I knew the chances of being accepted here were slim. My day hadn’t got off to a good start. I had shared a hotel room with my mum the night before, but ended up not sleeping most of the night while she suffered from a stomach bug. All night, thoughts raced through my mind of going into this crucial interview, introducing myself and then promptly throwing up. The interviewers would think it was due to nerves, I would be deemed as not resilient enough for such a demanding course and my dreams of becoming a doctor would be over. So I lay awake worrying with my scarf wrapped tightly round my mouth, ate no breakfast and stuffed sick bags into every available blazer pocket - probably not the best pre-interview preparation techniques! On entering the medical school, I vowed to smile brightly at every single person I encountered in case they might be an interviewer. The interview would be in multiple mini interview (MMI) format. This consists of short six minute interviews or ‘stations’ at which you either have to complete a task or answer questions based on the station’s theme. The best way of thinking about it is like interview ‘speed dating’, (although I’m not sure the interviewers would be so keen on that term!). The interviewers have not seen your application form so you have only six minutes per person to fully express yourself and convey how badly you want to go to their medical school. Then the whistle blows and you move on. No mean feat! After a talk from the friendly admissions tutor it was time to go in. My heart was pounding; I had been preparing for weeks and wanting to come here for years. The 24
INTERVIEWS
whistle blew and the two minutes of reading information on the station’s door began. The first station’s theme was about interpreting data. The numbers on the information sheet blurred and I just couldn’t make sense of the words under the pressure. With a page full of complex information and data, two minutes was not enough. I hadn’t finished, the whistle blew and I skimmed to the bottom of the page to see the question. It was about the disadvantages of a procedure which at that moment I could only think of as advantageous. I was madly trying to work out my answer whilst opening the door ... Oh! The interviewer was the lady who I had smiled at in the toilets. My hopes soared, one person who I had smiled at, perhaps somewhat overenthusiastically, might have paid off! I sat down, and my heart sank as she asked me that question. I finished my short answer, she prompted me to continue. I couldn’t think and so repeated myself. After prompting me again she said with a kind smile: “I think we’ll leave it there”. My smile froze on my face while inside I was frozen with terror - had I messed up already? But there was no time to think, some scary-looking graphs and complex tables were being pushed my way. I was asked to work out the percentage of people who had had cancer treatment and were cured. I looked around, but there was no calculator. I can still remember those dreaded numbers: 135/292. Most of you are probably thinking that that’s easy, but the pressure, panic and my irrational fear of maths made it otherwise. After the lady had stared down at me for what was, in reality, only a few seconds but for what seemed, in my head, like a decade, I said “Around 45%?”. Phew, I’d got it. After a few more questions which I managed to survive, the complex-looking graph was pushed towards me. A calculation resulted in 0.1 of a person getting cancer ... I knew I had made an error, so I tried again. Again, 0.1. I explained why I was taking so long and picked up the pencil for another shot but - “I think we’ll leave it there”. Again, the dreaded “I think we’ll leave it there”.
Carla Barberio
I stuffed sick bags into every available blazer pocket probably not the best interview preparation technique!
The next stations consisted of a role-play testing communication and persuasion skills. Shockingly, the interviewers actually introduced themselves and seemed happy to talk to me! Feeling enthused I entered the last station, held out my hand and said brightly “Hello, I’m Carla”. The interviewer just snapped “Candidate number?!”. He proceeded to ask me some questions on my opinions and coping mechanisms. He did not smile, nod or make a noise. I’m not sure if he even blinked. I continued to waffle on… Was he even conscious? My words were sounding more and more ridiculous but then - a sign of life! - he raised a hand to shut me up. He asked me a question about a confidentiality situation but no matter what I said, all he replied was “And what if that couldn’t happen?”. Trying hard not to scream and with my hopes of getting in crashing around my feet, the whistle finally blew. I stood up, acting like it was a shame that our conversation had been cut short, and thanked him whilst looking down to see if he had offered his hand to shake. It was firmly on the table and his disconcertingly blank stare had returned. Right, (remembering my interview training), I wouldn’t offer my hand to shake then. I turned and took two steps away. But as if the situation had not already been full of enough awkwardness to last a life time, he raised his hand. So I made a U-turn, smiling sheepishly shook his hand, and at last headed out. What a relief. After crying into a large McDonald’s all the way home, (yes, I know that’s a sign of a weak character), I came to the conclusion that the next interview could be just as awkward and soul-crushing as this one, but positively thinking it couldn’t get any worse. So I might as well give it a shot but start mentally planning my gap year in the meantime.
Writing in the Notes A bad match ned in the Dear Editor, doctors who trai w fe e th of e on As K I continue to work in the U g in m co re fo t the matchUS be e inability to ge th by ed az am new doctors to be ors correct (148 ct do r fo s es oc UKFPO; Iss ing pr table’ failure of ep cc na ‘u by d programme affecte huge matching a is e er Th ). for the tac28; p4 le controversial hi w , ch hi w S U ems to work in the with ranking, se ay pl s de si th medical stutics bo year. Very few r te af ar ye ly ss ’. Surely it flawle to find a ‘match il fa so al e er th dents the UK with a icated to do in pl m co at th be can’t smaller cohort? Tanya Kelly
erpool Medicine, Liv CT2 General
GPs not A&Es Dear Editor, Are patients using A&E rather than attending their local GP? Well, it appears they are if your story is anything to go by (A&E departments see 4,000 patients per hour on Monday mornings; Iss 28; p6) - tw ice the typical number of hourly attendances than during the rest of the week. Surely this just demonstrates that people simply wait over the weekend until Monday morning to come to A&E with their ailments - the only other exp lanation is that there are just a lot of people wh o seriously hate work on Mondays! Dr D Morrison FY2, London
Keeping your face
off Facebook
e CT surgiDear Editor, response to th in g tin ri w le about I am ts to your artic en m m co e’s ne staff check cal trai 10 admissions in (1 ia ed m 27; p4). The social shortlisting; Iss ng ri du ia ed m unken Facesocial st because a dr ju at th es at st author the internet it ctor appears on do a of o ot ph ed surgeon. book rson isn’t a skill pe at th n ea m t tand that we doesn’ rtant to unders po im s it’ t bu e, I agre dence in our e public’s confi th t ec ot pr to be operated need u really want to yo ld ou W . on si profes Twitter photos ho you’ve seen w n eo rg su a ay night? I on by town every Frid nd ou ar ng ri ge of stag suspect not. K Kumar
ow, London Academic fell
‘Writing in the notes’ is our regular letters section. Email us at letters@juniordr.com.
W
hen your hospital food tastes like the remnants of a liposuction procedure and the price bears more resemblance to the cost of a PICU incubator things start to take the biscuit. Here’s our regular column of the best and worse hospital essentials you’ve reported:
Pocket sized packet of tissues
Rub it on your sleeve instead at,
79p
Addenbrooke’s Hospital, Cambridge
Prices not to be sneezed at,
40p Small salad
Newcastle General Hospital, NewcastleUpon-Tyne
Give up being healthy at,
£3.60
Royal London Hospital, London
Get takeaway for the rabbits at,
£1.29 Two slices of toast
QE II Hospital, Welwyn Garden City
Toast it with the diathermy instead at,
80p
Addenbrooke’s Hospital, Cambridge
Toast-tastic prices at,
80p
QE II Hospital, Welwyn Garden City
Next issue we’re checking the cost of four hours of parking, an apple and a packet of ready salted crisps. 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:
★★★II
HOSPITAL MESS
25
THE MEDICAL COURSE AND CONFERENCE DIRECTORY
A
s doctors we hate scouring the web to find where and when we can attend the next exam revision course, training event or conference.
We think they should all be in one place - which is why we launched EventsDr. com as part of the JuniorDr network.
We’re aiming to build the most comprehensive database of medical events. Below you’ll find just a selection of the full listings at EventsDr.com.
Medicine
MRCP part 1
Leadership, Management & Personal Development Training
Hammersmith Medicine
Tue 27
Pastest
Fri 30
Pastest
Sat 17
Hammersmith Medicine
PASTEST
PASTEST
Consultant Interview Skills (Includes access to online resources) Insights Intensive - Understanding the Implications of the White Paper
PASTEST
3-day Clinical Management & Leadership Management Excellence for Junior & Middle Grade Doctors
PASTEST
Communication Skills for Junior & Middle Grade Doctors
Ealing paces
Foundation Course in Leadership & Management for FY Doctors View all courses at:
www.medicology.co.uk/juniordr
Win Over A £1000’s Worth Of Training!
3 Day Clinical Management & Leadership Course worth £699+VAT! Advanced Communication Skills e-Learning course worth £275+VAT! Just register your details to enter!
www.medicology.co.uk/win
26
EVENTSDR.COM
August
August
Mon 9
december
5
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3
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1
day
5
£695
London
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London
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London
4
£1,395
4
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MRCP paces
Courses you should know about!
WIN
August
Ealing paces
Fri 20
september
Fri 27
september
Sat 21
september
Sat 28
september
Sat 28
september
Sat 5
october
Hammersmith Medicine
Mon 14
Ace Courses
Sat 27
october
days
days
2
days
2
days
2
days
2
days
4
days
London
London
£820
Manchester
£820
Manchester
£816
London
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London
£695
London
MRCog
Ace Courses
July
Sat 3
August
2
days
2
days
£395
Birmingham
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Birmingham
Got an event to add? Do it free at EventsDr.com
MRCPCH Clinical Pastest
Pastest
Sat 28
september
Sat 5
october
2
days
2
days
£849
Join us for Agents for Change 2013 the only national conference for junior doctors on improving patient safety and the quality of healthcare.
Hillingdon
£849
Kingston
Surgery
This year's theme is Speak, Act, Lead. We have exciting workshops, inspiring speeches, an online programme and a way to publish your own project - for you to become an Agent for Change. Speakers include:
MRCS Part a Pastest
Sat 24 August
1
day
£145
London
Professor Sir Bruce Keogh Robert Francis QC Fiona Godlee FIND OUT MORE AND REGISTER AT -
Psychiatry
www.agentsforchange.org.uk
MRCPsych CASC Revise Now
Sat 20
Spmm
Sat 20
July
July
2
days
2
days
£600
Manchester
£695
London
Others Leadership & Interview Skills ISC MEDICAL
Interview Skills Oxford Medical
Essentials of Medical Management and Leadership ISC MEDICAL
Interview Skills Oxford Medical
Essentials of Medical Management and Leadership
Tue 2 July
Fri 19 July
Sat 27 July
Fri 30 August
1
day
1
day
1
£349
London
£259
Manchester
£349
day
Manchester
1
£259
day
Oxford
Career fairs RCP Medical Careers Fair BMJ Careers Fair
Sat 21
September
Sat 19
october
1
day
2
days
£65
London
Free
London
Number 1 for Medical Interviews & Applications Courses in small groups for a more personal approach We offer a range of medical interview courses and services to optimise your chances of success at medical interviews
0845 266 9487 7 days a week
8:30am - 11pm
www.iscmedical.co.uk EVENTSDR.COM
27
MEDICAL PROTECTION SOCIETY PROFESSIONAL SUPPORT AND EXPERT ADVICE
The right choice for Education and Risk Management We are committed to helping you avoid problems and provide the best care for your patients
n We are committed to the value of education and training. We have a dedicated educational services department with a team of more than 100 people organising and delivering educational interventions to healthcare professionals worldwide. n Using our wealth of knowledge and experience we have developed a range of education and risk management resources that will assist members in reducing their exposure to complaints and claims. The portfolio available includes: n Publications n Conferences n Workshops n Online learning resources n Lectures and presentations n Clinical Risk assessments
Members
can find out more about the support we provide by visiting: www.mps.org.uk/JuniorDr
Non-members
can sample some of our support and publications by registering their details at: www.whymps.org.uk
T: 0845 718 7187 E: info@mps.org.uk W: 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, 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.