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“WE NEED YOUR SKILLS”
As a medical student, the TA Medical Services can offer you the chance to extend your skills and experience. If you can commit to 19-27 days a year we offer an exciting and challenging working environment, some of which may take place abroad. You’ll get the opportunity to meet many other medical professionals, attend professional courses and get paid. And because it’s your own time, we make sure you have fun too. The TA MS provide vital support for the Regular Army. TA MS volunteers are healthcare professionals who have a unique opportunity to gain a range of experiences that would be hard to find elsewhere. Please quote Ref: TRU
For more information call
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news
3
career news
newly registered junior doctors face unemployment
o
ne in three preregistration doctors face unemployment due to falling training places and increasing overseas applicants, warns the BMA this month. A survey one-week before the start of new SHO posts found that about 38 per cent of respondents had been unable to find a job. Mr. Simon Eccles, chairman of the BMA’s Junior Doctors Committee said: “The situation is far worse than anyone expected. We keep hearing from doctors who’ve been turned down for hundreds of jobs and now have no idea what they’re going to do.” disappearing posts
The BMA believes the problem is partly the result of ‘increasing demand, and poor planning’. Places at medical school have increased and applications from overseas are rising, but the number of postgraduate training posts has not increased at the same rate. It said that at the same time many jobs have been phased out as a result of the new Modernising Medical Careers training structure. The government has repeatedly stated that there has been no reduction in the number
inside news
The latest med school news from around the UK and the world. We bring you all the stories you need to know. p3 freshers guide
Medical school can be a scary place. We tell you how to survive in the land of colonoscopy clinics, cardiac vivas and neuro mcqs. SURVIVAL p6 GUIDE astronauts, shuttles and space doctors
of Senior House Office (SHO) posts but BMA argues this, presenting research showing that the number of SHO jobs advertised in BMJ Careers—the main source of adverts—fell by 50 per cent between May 2002 and May 2005. On average, more than 200 junior doctors applied for every training post, with some jobs in London attracting over a thousand applicants. waste
Training a doctor costs approximately £237,000 in the UK. Mr. Eccles feels this is going to waste: “It makes no sense that at
a time when the country is short of fully trained medical staff, we’re pushing doctors into unemployment. It costs around a quarter of a million pounds to train a doctor to this level. A lot of talent and taxpayers’ money is going to waste.” stressful
Around nine out of ten of the doctors said they were concerned about the job shortages, with nearly six in ten stating that they would consider going overseas to continue their training. One third stated that they would consider leaving the medical profession altogether.
student news
£64,000 cost of medical school
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ebt is the biggest issue for medical students who are facing up to £64,000 in costs for their training, said Kirsty Lord, new chair of the BMA Medical Students Committee this week. “Medical student debt is spiralling. The average fifth year owes
nearly £20,000, and the high cost of studying for a medical degree is one of the reasons so few students come from working class backgrounds,” she said. The rising debt is a result of increasing annual university fees following progressive deregulation in the higher education sec-
tor. Medical students are hit hardest due to the course length. “Top-up fees could mean debts as high as £64,000 for medical students, and there’s a real risk that we’re creating financial barriers that will prevent some very able students from becoming doctors.”
What happens to astronauts bodies when they get rocketed into space? How do you avoid travel sickness in a space shuttle? Victoria Wykes gives us a blast of knowledge from NASA that is out of this world. P12 “i’m not that kind of doctor”
Taking a PhD is often a common follow-on from a BSc and a popular career move for those contemplating a future in medical research or academic information. We find out the pros and cons from those who’ve taken that route. p14 mushroom-ing debate
Recreational drugs have always been a difficult subject within medicine. Here we look at the debate for the ban on magic mushrooms from both sides. p16 clinical skills
Venous cannulation is an important route for administering fluids and medication. This issue in association with PasTest we bring you a guide to this essential skill. p18
4
trauma
news student news
cancer cocktail Cancer patients at a hospital in North Hampshire are to be offered free spirits, wine and beer in their beds, according to a report in the Daily Telegraph. It’s the first time in a number of decades that alcohol is being offered to patients. The hope is that it will help ‘work-up an appetite, calm people down and help them sleep’. ah, the good auld days British people were happier in the 1930s than today, according to a team of researchers at Cardiff University. They believe this is because our expectations are higher today along with a lower feeling of fellowship and equality. words that leave asthmatics breathless Saying ‘wheeze’ to a person with asthma is enough to trigger an attack, say US scientists at the University of Wisconsin. They found, via MRI scanning, that emotive words such as ‘wheeze’ and ‘loneliness’ reproduced brain activity that can increase bronchial inflammation. teething problems Babies born by Caesarean section are more likely to develop tooth decay, according to a study by a team at New York University. These babies were found to be infected by a cavity causing bacterium, streptococcus mutans, a year earlier than those born vaginally. i hate mondays More suicides occur on a Monday than any other day, according to the Office for National Statistics. For both men and women the general trend was for a fall in suicide rate as the week went on with the lowest numbers at the weekend. dis-appointment Patients miss around 10 million appointments with their GP each year, according to a report by the Developing Patient Partnership. Simple forgetfulness is blamed as the main cause for the missed appointments which cost £180 million. Two-thirds of GP surgeries believe patients should be charged.
sleep training for medical students at warwick
m
edical students at Warwick have ended a pilot year of sleep training as part of their curriculum this month. For the ten pilot students they received over 30 hours of sleep study looking at the effect of sleep patterns on illness. It follows concern that undergraduate doctors in the UK receive only 5 minutes education on sleep medicine. “Problems sleeping are one of the commonest reasons a patient will present to their doctor and yet sleep medicine receives hardly any coverage in the undergraduate curriculum,” said Andy Currie, one of the students who took the pilot program. “Warwick Medical School is progressive in that it runs a special sleep study module where
students are exposed to all aspects of sleep and can see patients in sleep laboratories.” A new grant of £2 million from biopharmaceutical company Cephalon will allow Warwick to extend the sleep study
career news
module and to support additional sleep research. Sleep has been shown to affect both mental state and reduce recovery from physical illness. The study aims to look at ways to improve sleep effectiveness.
student news
more opportunities more students to experience less general practice medics
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ewly qualified Scottish doctors will now have a greater chance to experience general practice, according to a report in BMA News this month. The statement is the result of an increase in the number of available posts by NHS Education for Scotland. In total the number will increase by 35 per cent for those commencing in August 2006. It will allow 225 doctors in their second foundation year to experience a four-month placement in general practice. The news was welcomed by the BMA Scottish GPs committee chairman David Lowe, but he called for a further increase: “While this is a welcome increase, it still means that under 30 per cent of doctors in Scotland will be able to work in gen-
t
eral practice as part of their training compared to more than 50 per cent in England.” The announcement follows a longstanding battle by medics north of the border to redress the discrepancy between the number of opportunities for GP placement with those in England. Dr Love added that Scotland has fewer GP placements because England had allocated specific funds for this type of training.
he number of acceptances for pre-clinical medicine surprisingly fell by 2.4 per cent since last year, according to the latest figures from UCAS. The results come despite an 8.5 per cent overall increase in the number of UK students who have secured a place at university. Failure of many students to meet the offered grades was blamed for the fall. Entrance requirements have increased over the last decade despite a call for less emphasis on grades and more on vocational ability. The total number of female students continued to outstrip males contributing to 55 per cent of new places. Applicants from overseas also increased by 7.8 per cent.
career news
prosecutions for NHS assaults soar
p
rosecutions of people who physically assault NHS staff have soared by fifteen-fold, according to the latest report from the Department of Health. In 2004-05 there were 759 prosecutions compared with just 51 in 2002-03. The increase was attributed to a drive by the NHS to ensure effective sanctions were applied to those who attack hospital staff. Health Secretary Patricia Hewitt welcomed the statistics: “Violence against NHS staff is completely unacceptable. For a minority of people to show them such disrespect is intolerable. The huge increase in prosecutions demonstrated that we will take tough action against anyone who attacks them.” Over 750,000 NHS staff are currently being trained to defuse potentially violent situations. Keith Nicholles, a paramedic, explained how a patient who
punched him was sentenced to six months in prison: “It wasn’t the first time he was involved in assaulting people, and he’ll think twice before assaulting someone who is trying to help him in the future. Once the word gets out about this, hopefully assaults will be down in the future.”
career news
uk gps are top of europe pay league
u
K GPs take home almost twice the salary of their counterparts in Spain and Italy, according to a poll published in GP magazine this month. On average GPs took home around £50,000 in Britain after tax, with almost 18 per cent taking home more than £69,000. By contrast Italian doctors pocketed just £22,607 The poll of 200 doctors in each of the countries by research company Stethos also found that the French had average consultations of 17 minutes, compared to just Consultation times France - 17 minutes Italy - 16 minutes UK - 10 minutes Germany - 9 minutes Spain - 7 minutes
GP pay after tax UK - £49,947 Germany - £49,299 France - £42,037 Spain - £25,926 Italy - £22,607 10 minutes for the British. The survey found that despite the high pay of British doctors, it was the Germans who saw the most patients in a day—63 on average. The survey comes just a week after the UK government revealed that over 90 per cent of GP targets for vaccinations and screening had be met. As a result a record number of surgeries and their doctors picked up bonuses of up to £30,000.
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10 6 freshers
trauma
m
edical 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 who have been there and survived with most of their limbs intact, 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
freshers - are you scared? VAL SURVI GUIDE
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 confidenti-
ality. 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’ve got 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 you’ve got a few
check out the trauma medical school survival guide @ www.traumaroom.com
trauma 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 – everything is linked. If you miss that lecture on the science behind gastric acid production 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. get involved You may not be keen on chasing after a ball on the rugby pitch, or testing your tactics in the chess team but that’s no excuse for not getting involved in uni activities. It’s very unlikely that you won’t find at least one club or society that interests you, and in that rare case you can easily set up your own. Joining a club isn’t just about improving your ball passing ability or checkmating skills, it’s all about making friends and being part of university life. With the team environment of medicine and being away from home you’ll need all the friends you can get. Throughout your career you’ll realize that medicine is as much about who you know as what you know. Freshers week is the time when you’ll meet more potential doctors than any other. Work the crowds and get involved. Remember that students in the years above will be doctors soon. They’ll be able to bail you out of trouble, not just when you’re an incompetent student, but when you’re an incompetent doctor and they’re your boss.
freshers
7
practice makes perfect 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 want medical 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. 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 practicing 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 noone wants to be a venflon virgin forever. Watch someone experienced first and get them to talk you through the procedure. It doesn’t have 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
spotting 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 7 8 9
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. Appear to drown when trying to do a 'funnel'.
Clothes are badly stained with fat from the dissection lab.
End up on the floor after watching a surgeon make the first incision.
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 six thousand students each year accepted into medical school. With electives, the best student events and an almost guaranteed job at the end, your life’s looking great already. Live it up!!
trauma
10 8 coming to the uk
adapt The first thing you have to think about is how to adapt to a brand new environment: different weather, different culture, different food and people from different backgrounds all speaking different languages. You’ve got to be flexible and prepare yourself to be in tune with them.
destination
UK Coming to study medicine in the UK from overseas can be both exciting and stressful. Nichole Zi Zhen Chiang, a student from Malaysia, offers some tips for coping with the British weather, pubs and slang.
culture For the British, a pub is like a second home for them. If you come from a very conservative culture, you’ll find there is a more liberal attitude to alcohol here. How much you decide to follow is entirely up to you, but my advice is not to overdo it.
language Even if English is your first language you may have difficulty adapting to local slang and accents. Be patient and you’ll get the hang of it. If you need to improve your English you can attend English classes in your spare time. Some universities have free classes for international students.
get involved! Try to get involved in as many activities as you can. This way you’ll make more friends and cope better if homesickness kicks in. If you’re reluctant to join in with the Brits, get involved in international student associations first.
contact details Studying and Living in the UK (Booklet from the British Council) ► www.britishcouncil.org/ education/gdu/ info.htm#students Welfare Benefits and International Students ► www.ukcosa.org.uk/pages/guidenote.htm Department for Education and Skills Visa and Entry to the UK ► www.dfes.gov.uk/ international-students/ vaetuk.shtml
weather I found this to be the most difficult to adapt too. If you are used to lots of sunshine and wearing just a T-shirt the whole year round, you’ll have trouble here. Besides being quite cold, the weather here is generally gloomy and damp. As the daylight hours shorten during the winter it’s not unusual for people to start feeling depressed (‘winter blues’). My advice is just to get as much sunshine as you can when it’s there.
get help Student support services are on hand to deal with any sort of problem you might encounter. Approach them and discuss any problems.
“Most people settle in well and start to enjoy themselves quickly. The first few months can be tough, but with the right attitude, you will soon start loving life as a student in the UK and you’ll make these years, like I have, the best of your life.” Nichole Zi Zhen Chiang
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trauma
10 freshers
Soon you’ll be swinging your stethoscope round your neck and venturing into the big bad world of hospital life. Here’s how to look both cool and clever ... imagine this When your consultant can’t distinguish you from an RTA victim that’s been trailed through an articulated lorry sideways, there’s a problem. “Image is everything,” says Deborra Radcliffe, a professional image consultant. “Looking smart and dressing professionally can actually make you appear more intelligent than you actually are.” male magic “For men, wear a shirt and tie that complement each other with the same colour shades,” suggests Radcliffe. If you’ve less colour sense than a blind patient without a guide dog, high street chains such as Next and Debenhams sell pre-packaged matching combinations. “Shirts with cufflinks will improve your ranking but only if you wear a jacket or white coat on top.” Pokemon ties are only acceptable if you’re doing paeds … or if your consultant has the mental age of a five-year-old. winning as a woman If you’re a woman, forget the skirt advises Radcliffe, “Women who power dress are taken more seriously.” For women who have a soft voice and mild manner, wear darker colours to appear more confident. “Students who ooze confidence should choose paler
shades to help you take advantage of your womanly side—it will make you appear more in touch with the patient’s perspective.” role play Making small talk with a patient about haemorrhoids can often put you in more pain than they are. The fear of talking to someone for the first time is all about being scared of the unexpected suggests Radcliffe. “Having a practised introduction when you meet a new patient can help you through this difficult period,” she advises. “The first 30 seconds of conversion is the most stressful and yet the most important for making a positive impression.” Practise your speech and face expressions in front of a mirror, she suggests. escaping embarrassment Examining semi-naked patients can be an uncomfortable experience even for the most confident. You need to distance yourself from the reality of the situation suggests Radcliffe. “There’s nothing unnatural about nakedness—it’s just the human emotions we’ve attached to it,” she explains. “Treating the consultation in a purely clinical way is one way to deal with this. Removing the concept of the ‘person’ from the ‘body’ often works.”
sucking up up style
You’ve just moved into the thirteenth floor of halls. Your room is the size of a matchbox. The person next door plays music so loud that cracks are forming in the wall and someone’s stealing your milk. Don’t panic!! … here’s some advice. label your food If you have to share a kitchen then get your initials on your grub. There’s nothing more irritating than finding someone has eaten your pack of choccy biccies by mistake. be open minded You’ll meet a greater diversity of people than ever before. You’ll have to share your living space, the kitchen and even the shower. So what, they might eat coco pops for breakfast but the fact that you eat ricicles isn’t exactly normal either! don’t hide in your room The hairy guy in room 13 may be frightening but staying in your room isn’t the answer. Get out and meet people. Your first year in halls is the easiest way to meet other medics. If you don’t push yourself to meet new people this term you’ll regret it later.
Most of the water outlets on each floor are connected so turn off and on the hot or cold taps in the sinks or showers. The water going from stifling hot to freezing cold should speed him up. the clean team Share the laundry load. Team up with a mate and do a mass of laundry at one time. It’ll save you a fortune and you’ll have someone to hang out with while the machine goes round and round and round ... just keep your red boxer shorts out of her whites, ok? And, if you hang your CK pants up right away you might just escape the need to iron them. don’t shop till you drop Save yourself the torture of dragging five tons of shopping back from the supermarket by getting it to come to you. Get together with the rest of the guys on your floor and order your beer and pizzas online. Enter you shopping list at Tesco.com or Sainburys.com and they’ll cope with all the trolley trauma. As long as you request it they’ll bring it right to your floor … so your don’t even have to change out of your pj’s!
sort out any problems If you’re slowly going deaf because of the loud music played by your neighbour confront him about it. Don’t shout, yell or throw your dissection scalpel at him. Offer him a cup of coffee, explain calmly the problem and sort problems soon invite him to hear how loud the If you do have any problems music is himself. about living in halls get it sorted straight away. There’s no point letting things get you down. The shower power If one of your floormates spends staff in the student accommoda45 minutes in the shower each tion office have dealt with every morning shaving his/her legs then conceivable problem so don’t feel here’s a trick to get them out. embarrassed.
living in halls
trauma
freshers 11
beanz, meanz ... you’re a student Debt as a medical student is unfortunately inevitable these days, worse still it often starts right from the moment you enter university. What matters most is how you manage it. Here’s some advice to help you avoid a life of beans on toast. It’s commonly quoted that to live relatively comfortably for a year as a student you need a minimum of £6,000 (a little less if you’re outside London). For most people this will come largely from student loans, which for London students are up to £5,175 for 2005/06. The rest of your income will consist of parental contributions and parttime work. The bulk of this six grand will be spent on rent—the rest shouldn’t all be spent down the union bar! textbooks Text books take up another large chunk of your cash but trying loaning books from the library—it’s totally free (fines permitting). Also, keep a look out for used textbooks advertised around campus. Some bookshops, such as Blackwells and Waterstone’s offer buy-back options at some of their stores. You can advertise your books too on the pinboard section of the trauma website – www.traumaroom.com.
your next statement. Then divide your total yearly income by twelve. If you’ve spent more than your monthly budget then you should cut back by that amount the following month. in a crisis? If you do find yourself in genuine financial difficulty the first port of call will normally be the ‘Bank of Mum and Dad’. However, if they’re sick paying your phone bill and now wish you’d not even bothered with university you could turn to the welfare office. Professional welfare advisers can help you devise a plan to get you back in the black. Most universities have hardship funds with grants that don’t need to be repaid. banks Medical students are amongst bank’s most prized customers. Representatives from the four big high street banks will be scrambling for your signature at freshers fairs.
budget! get a student account Some people meticulously enter every single outgoing into an Exwith the biggest cel spreadsheet and fret no end if interest-free overdraft, they have splurged one week – but not the free toaster or what’s the point? You’ll only CD vouchers stress yourself out even more. As a medic you won’t have time to master micro-economics so stick to basic money management, and Get a student account because of let your bank manager do the hard the biggest interest-free overdraft work: look for the ‘Total out’ on not the free toaster or CD vouchVAL SURVI GUIDE
ers. Interest-free overdrafts can be up to £1,500 in the first year, rising to £3,000 in your final year. Be aware that you can apply for a larger overdraft although you will have to prove that you need it and may have to pay a reduced interest rate on some of the total.
Band
Salary
1
19,185
1B
26,859
1A
28,778
2
20.420
save it
2B
30,630
If you have savings, you might consider not taking out your full student loan allowance. Most experts would advise against this, since this is one of the best loans you’re likely to get in your life. A trick is to put any excess funds in a high interest account, such as an ISA (Individual Savings Account).
2A
36,756
Dargan Miller, a student financial adviser, offers the following advice: “Only invest in riskier investments such as shares if you can afford to. Don’t let it jeopardise your education, as this is the best investment you’ll make. You’ll need at least two thousand pounds to make it worthwhile, as the costs of buying and selling shares make any profit on smaller amounts unlikely”. reality check Debt is a part of being a medical student – so accept it and don’t let it curtail your fun. Keep in mind that you’ll be on a decent income from the moment you finish. You can find the current pay scales opposite to give you some idea.
Check out our online financial survival guide @ traumaroom.com
Most PRHOs are at band 2B or 2A (correct as at 2005). useful websites Support For Learning Find out which is the best student account with their up-todate list of interest rates. They also have a comprehensive database of grants and awards. www.supportforlearning.org.uk/ money Educational Grants Advisory Service Search for national grants, scholarships and access funds. A face-to-face support service is offered to students whose financial situation threatens the continuation of their studies. www.egas-online.org.uk Student Loans Company Check out the current interest rate on your student loan. www.slc.co.uk UKCOSA If you’re an overseas student, this is the website for you. www.ukcosa.org.uk NUS www.nusonline.co.uk
12 10 nasa
trauma
astronauts, shuttles, & space doctors
Victoria Wykes received a phone call whilst in a taxi crossing Tower Bridge on a cold January evening. “You have been selected for the NASA space medicine elective at Kennedy Space Centre September (KSC)”.
Little did she know that this was the beginning of an incredible adventure that would challenge her ideas about space exploration, and open up a whole new world of medicine. Soon after, she was having my finger prints taken at New Scotland Yard for FBI clearance and booking aeroplane tickets to Orlando. Here’s her story. Arriving in Florida just after hurricane Francis had swept through with winds up to 150 miles an hour was something I had not prepared for. Roofless houses, flooding, trees and power-lines down, and beaches that had been washed inland littered with baby turtles and gulls that had been the unlucky victims of the accompanying storms out in the Atlantic. KSC NASA’s launch site to space had not gone without damage. The Vehicle Assembly building had lost many panels as can be seen in the photo below, but I soon started the internship with two other American final year medical students. We were working with the Bionetics team, a group of medical doctors and nurses who gave us privileged insight and access to all aspects of the work that is carried out at KSC. Our days were typically divided into morning lectures on the medical problems associated with prolonged space travel and also crisis management should a
disaster occur during shuttle landing or take off. In the afternoons we had an extensive number of site visits and we worked on our research projects. Much of the current work at NASA is focused on the exploration of bodies within our solar system which can could have supported life. mars has been selected as it is the most accessible planet from earth, and is the most likely planet to have supported life at some period in its past Mars has been selected as it is the most accessible planet from Earth, and is the most likely planet to have supported life at some period in its past. Following initial rover and robotic investigation a manned mission to Mars is proposed for
2033. Many people think this is essential to allow more technical exploration. In comparison to robots, humans have a greater mental flexibility and are able to make real time decisions. The journey will take nine months each way, and it is envisaged that the astronauts will spend about a year exploring, investigating and conducting research on the red planet. The broad themes of research are climate, geological, solar and also astrobiology. This will be the longest amount of time that mankind has spent away from the life supporting environment of the Earth. The mission will face new challenges to individual crew members, especially medical implications for the human body, overall crew composition and design of the supporting space craft environment. Having survived the rigors of being launched into orbit the crew are immediately affected by the lack of gravity. This includes space motion sickness which affects 75% of crews resulting in dizziness, nausea
► Victoria in front of the main shuttle workhouse, Florida
trauma
nasa 13
national medics rugby 7s report 30th April, Nottingham – The National Medics Rugby 7s tournament descended upon Nottingham, for what was a fun-filled weekend sponsored by the MPS, the Royal Navy and Medical Sickness.
► Victoria with UK born astronaut Michael Foale.
and vomiting lasting typically for the first week in space. Neurovestibular disturbances result in proprioceptive illusions described by astronauts as jelly walls and trampoline floors. Orientation illusions are also described, as “up and down” no longer have meaning in an environment in which you can do 360 º rolls any where you want. Astronauts also experience a shift in their body fluids termed the cephalad shift. On Earth our veins are used to pushing blood from our peripheral limbs back to the heart. However in zero g a fluid shift occurs resulting in a relative increase in fluid in the head and upper body so that the astronauts have puffy faces with bulging eyes and skinny legs. The physiological mechanisms for controlling fluid volume signal that too much fluid is on board, so the kidneys increase urine production. The reduction in mechanical stress on the bones alters calcium metabolism, which coupled with the increased urine excretion of released calcium can result in bone density loss of between 0.5-2 % per month, and the formation of kidney stones. Cardiovascular system deconditioning occurs, muscles atrophy, the immune system is depressed, and the long duration of living in very cramped quarters with a maximum of six other people may affect the psychiatric condition of the crew. All these aspects are being investigated in the hope that the mechanism by which they occur can be understood, and a solution found. This may also provide new insight into “terrestrial illnesses” that will provide a novel therapeu-
tic strategy. One of the highlights was spending an afternoon with the UK born US astronaut Michael Foale who had recently returned from a five month mission with a Russian Cosmonaut, to the International Space Station. It was fascinating learning about the work he was doing up there, as a substantial amount was medically related. For example one investigation was examining the arm and hand muscle movements made in zero g to see how they changed. This was achieved by wearing a long glove filled with sensors whih had been designed by an Italian orthopaedic surgeon. Michael Foale explained how important it was to exercise and counteract the effects of zero g to reduce muscle atrophy. A three-hour a day program had been established and included 300 squats in a special harness, and an hour on the exercise bike. He mentioned that they would position the bike over the window looking down at earth and would “cycle” from Paris to Beijing in under twenty minutes! In order to relax and keep himself occupied he developed a passion for geography and digital photography and had some breathtaking images of sunrises, and the Earth. I would highly recommend this elective. For more information, and the application form for the KSC internship you should check out the following website: www.case.ucl.ac.uk/elective2.
Twenty medical school teams took part at the weekend event, which started when all teams arrived for a huge social on the Friday night. On the field Nottingham 1st VII beat Peninsula Medical School in the final of the Cup Competition to retain the trophy they won in 2004. Strong tackling and solid finishing earned the hosts a 38-5 victory over the strong Westcountry outfit. Celebrations reached fever pitch when straight after, Nottingham 2nd VII ran out 33-10 winners over an experienced and very well-supported Hull and York medical school team, to take the Plate Competition. This is the first year that one school has had a clean sweep winning both the Cup and the Plate! The Royal Navy’s Medical Director General, Surgeon Rear Admiral Mike Farquharson-Roberts, presented both winning teams with their prizes. Over 800 medical students, doctors and supporters enjoyed the rugby in the glorious hot weather on the May Bank Holiday with an all day bar, barbeque and disco, which over-spilled into an amazing pub crawl around Nottingham city centre for all the teams on Saturday night!! There was a huge raffle which raised over £800 for the Kenyan Orphan Project, a Nottingham medical school charity, which helps purchase medical equipment in Kenya. It’s just a shame we have to wait a whole year to do this all again! See you all in Nottingham in April 2006. Thomas Kurien President of the National Medics 7s Tournament 2005
From top to bottom: • The losing plate finalists Hull York with their runners up medals • Losing finalists of the Cup Competition Peninsula Medical School • Nottingham 2nd VII team • Nottingham 1st VII with their medals You can find a full match review along with photos online @ traumaroom.com
14 be a phd student
trauma
“i’m NOT that kind of doctor!” Out of all the sentences I said as PhD student, that was the most common. My name is Sinem Ayman, and I’ve completed a PhD in Pharmacology. Embarking onto a PhD course is a big thing. It’s a popular career move for those already doing a BSc and is a necessity if you want to make your mark in scientific research. Here’s my advice on why taking a PhD is often a great career choice and how it can help you. I can give two important pieces of advice to anyone thinking of doing a PhD, firstly, pick a subject matter which interests you and secondly, assess the qualities of your potential supervisor and the environment in which you will be working carefully. A PhD is a long and often frustrating road so it’s wise to consider these things carefully before committing to one. I did my PhD at King’s College London and had a good experience. My supervisors were on hand, helpful and easy to work with. They had a logical, practical and realistic approach to research along with a good publication record. I also knew exactly what I was letting myself in for, as I had not only done a voluntary summer placement (recommend highly), but also my final year BSc project with this group.
experiments will sometimes not work for months on end, which can be very demoralising
If it weren’t for these positives, some aspects of my research could have been very difficult to cope with. The experiments will some-
times not work for months on end, which can be very demoralising indeed. This sort of problem is part of every PhD placement and is a hundred times worse if you have a supervisor that is unhelpful, absent or discouraging (or at worst all three)—let alone if you also have a negative working environment. Doing a PhD is demanding, you are assessed throughout with yearly transfer reports and/or vivas (depending on the university) and are expected to put in very long hours in the lab. You are also expected to work increasingly independently and in an analytical manner, as you are being trained to become a scientist in your own right. However, the working hours are flexible and you can organise your time as you please. As long as you don’t become complacent and do the necessary work, no one really bats an eyelid. Recently, four year PhD courses have become available in which you do four different placements in the first year (normally within the same university) and you pick the one you’d like to carry on with as your PhD project. I think this is great idea as it allows you to fully understand the programme before you commit to a project.
Being a PhD student, your place in university life can be a left in limbo. You aren’t really a student and you aren’t staff either, so the support systems that these two groups receive from the university usually aren’t available to you. Some universities have a well organised post-graduate society and even walk-in centres where people are on hand to discuss any issues you may have. Unfortunately, however, others don’t have anything like this and the needs of the post-graduate are poorly met by student support system designed purely for undergraduates. If it’s available, I recommend getting involved with the postgraduate society as you get to meet lots of people which can improve your social life enormously (especially if the group you end up working with is small and maybe unsociable). You’ll also automatically gain the support of people who can empathise with what you are going through. At the end of the day a PhD has ups and downs, much like anything degree, but it’s worth achieving if it’s appropriate to your career path. You get to be called ‘Dr’ at the end—just try not be too annoyed when people presume you are the ‘wrong’ kind of one!
excerpts of a PhD life The best way to find out what life’s like during a PhD is to ask existing students. Here’s what our panel had to say: really enjoyable “Fascinating, I hope to continue research in future posts and am considering an academic career. Really enjoyed the flexible lifestyle and being a student again. The advantages of doing a research degree after qualifying versus during medical school are 1) better pay and 2) a better idea of where your interests lie.” Gavin – Qualified medic in the final year of a PhD in Physiology at King’s College London. demoralising “I’m sure it will all be worth it in the end but at times it can be quite a demoralising experi-
trauma ence especially when experiments do not work and it seems like you never get any data.” Alan – Final year student of a PhD in Physiology at King’s College London.
confidence as a scientist. I think having supportive people around me, especially my partner who had been through a PhD before me so could understand what I was going through, was invaluable to me in getting through the hard times”. Patricia – Post-doctoral reups and downs “Overall, I have enjoyed my PhD searcher who did a PhD in Zoolbut if you had asked me about nine ogy at Birkbeck. months ago when nothing was working I doubt I’d have been so problematic positive! I have a good supervisor “It’s not what I expected at all and an interesting project and man- doing my PhD, I thought it would aged to get through it but I am glad be more focused and less problemI don’t have to worry about the ups atic, but I suppose these things are and downs of lab work now that never gained easily.” I’m writing up!” David – First year student of a James – Final year student of a PhD in Physiology at King’s ColPhD in Neuroendocrinology at lege London. King’s College London. independent working supervisor stresses “A PhD can be a good experience “My PhD would have been a lot if you have good supervisors and easier if I had had only one pri- are motivated in what you are mary supervisor, having two first doing. I found that I was left to supervisors with conflicting inter- work very much independently ests and completely different disci- with casual supervision. This was plines was very difficult indeed. I good with respect to building up felt they held back progress in lab confidence, but it was also bad in work and would seriously have the sense that at times keeping up preferred to guide my research motivation was really difficult. It’s project completely independently so important to remain motivated as I feel this would have given me especially if things like lab work a much better quality PhD and it aren’t going your way.” would have been far less stress- Sarah – Final year student of a ful.” PhD in Molecular Biology at Charlie – Currently a post- King’s College London. doctoral researcher who did a PhD in Molecular Medicine at intellectually stimulating Manchester University. “Despite all the problems, it’s still an intellectually stimulating, chalmore confident lenging and worthwhile experi“I found I had little guidance from ence.” my supervisors so became inde- Sarah – Second year student of a pendent very quickly, although at PhD in Pharmacology at King’s times this was very difficult. I’m College London. glad I did it, as I now have a lot of
be a phd student 15
You’ve probably realised by now that doctors can have weirdest names. Here’s the world’s most appropriate (and inappropriate!). They’re all real, you can check them for yourself on Medline … cardiology Dr Truluck, Dr Love, Dr Hart, Dr Valentine, Dr Everhart dermatology Dr Spot; Dr Rash, Dr Frye (burn specialist), Dr Tanner, Dr Skinner, Dr Whitehead ear, nose and throat Dr Klotz (Clots); Dr Wax general Practice Dr Kwak; Dr Killer, Dr Yau ("yeow"); Dr Blood, Dr Coffin, Dr Patient, Dr Payne, Dr Slaughter, Dr B. Sick, Dr Stasick (pronounced stay sick); Dr A. Sickman, Dr Deadman, Dr Pulse; Dr.Ill, Dr Uhren, Dr Doctor, Dr Howard Hertz (pronounced HOW-it HERtZ) gastroenterology Dr Grunt, Dr Puppala (pronounced Poop-a-la), Dr Butt hand surgeons Dr Hand; Dr Palmer, Dr Nalebuff, Dr Watchmaker neurology Dr Johnathan Treat Paine; Dr Megahead; Dr Brain, Dr Head obstetrics and gynaecology Dr Wiwi, Dr Ono, Dr Risk, Dr Fear, Dr Yell, Dr Dibble, Dr Fillerup, Dr Hyman, Dr Love, Dr B. Savage, Dr Pillow, Dr Storck, Dr Semen, Dr Hatch, Dr Born, Dr Hatcher, optometry Dr Peek; Dr Glass, Dr See, Dr Seymour Landa pain management Dr Neupane, Dr Pain, Dr Ow paediatrics Dr Donald Duckles, Dr B. Softness; Dr Childs, Dr Jelley; Dr Bunny, Dr Tickles, Dr Elfman, Dr Toy, Dr Kidd psychiatry Dr Alter, Dr Reckless, Dr Brain, Dr Strange, Dr Wisdom; Dr Dippy, Dr Moodie, Dr Nutter, Dr Nutt; Dr Bummer, Dr Looney, Dr Dement, Dr Weiner
doctor who?
16 10 big debate
trauma
magic mushrooms
THE BIG DEBATE Each issue we ask two experts to give us their side on a topical issue. You can have your say on our continuing discussion online.
- the end of the high? This summer ‘magic mushrooms’ were controversially reclassified as a Class A drug. It follows a longstanding review of recreational drugs and their side effects on physical and mental health. We’ve brought together Michael Bashall from the Entheogen Defence Fund and Petra Maxwell from the drugs information body DrugScope, to discuss the change in the law. Should ‘magic mushrooms’ psilocybin) that was classified, not the mushroom itself. As usage inhave been banned?
BASHALL: Magic Mushrooms are not harmful. Since 1987 there have been no deaths attributed to their use. They give relief to people with cluster headaches. People use them to aid meditation, and some churches use them in their rites. Unlike alcohol, they do not incite people to violence and rowdiness. People have been using mushrooms since Neolithic times and before; it is an infringement of their human rights to ban them. Shops had a code of conduct under which they were not sold to minors and customers were warned not to buy them if they had mental health problems. Under the Vienna Convention the mushrooms themselves were not banned as they contain only a small dose of psilocybin [the psycho-active substance], and this was ratified in Holland in April 2005 as bearing no threat to health. Indeed in Holland 12 year olds can buy them. MAXWELL: For many years the law regarding the classification of magic mushrooms under the Misuse of Drugs Act has been something of an anomaly. In their natural state mushrooms were legal, but as soon as they were prepared for use, they became Class A drugs. This is because it was the active ingredient (the psilocin or
creased in recent years and shops began to sell mushrooms openly (believing they were doing so legally), the government became increasingly concerned about defining this ‘grey area’. Therefore, under the Drugs Act 2005 all magic mushrooms (not just the active ingredient) became Class A drugs. DrugScope does not disagree that mushrooms should be classified, but we do not feel that a … we do not feel that a Class A classification is proportionate the harm that mushrooms cause, particularly when considering other drugs in the Class A category. Class A classification is proportionate to the harm that mushrooms cause, particularly when considering other drugs in the Class A category such as crack cocaine and heroin. We would have preferred for the matter to be referred to the Advisory Council on the Misuse of Drugs (the expert body that oversees the classification of illegal drugs in the UK) for an independent, in depth analysis of the evidence to date on the relative harms posed by magic mush-
rooms, and for the government to psycho-active drug can exacerbate act on their recommendations. these conditions. However, it is true that there is no evidence to The effects of psilocin are suggest that mushrooms themselves particularly dangerous in cause long-term health problems. persons with mental health These are the kinds of issues that problems; surely this is the ACMD would have taken into account whilst examining the grounds enough for a ban? available evidence to suggest a recommended classification for BASHALL: Not enough psilocy- mushrooms. bin is contained in the average dose to do any harm. If you try to Proponents of the ban argue eat too many mushrooms you will that we have a duty of care be sick. They also do not taste very nice, which is nature’s way of towards children and the limiting consumption. Retailers mentally vulnerable, an astold customers that they should not pect of which is reinforced ingest these if they had mental through closing this loophole problems, but are they going to ban in the law; what do you say nuts because a few people have nut to those branding you irreallergies? It’s like we have been sponsible for opposing the taken over by a nanny Gestapo. ban? They are certainly not as harmful as alcohol. Mushrooms are not BASHALL: Look at alcohol and addictive, do not incite violence; what anti-depressants like prozac they just make people giggly and do. Many people suffering from happy. cluster headaches claim that magic mushrooms are the only real antiMAXWELL: As Mike says, at dote. If people with SAD were low doses most people just get prescribed them, it would ease giggly and feel increased confi- their suffering. Children can get dence. At higher doses people can hold of alcohol far more easily experience bad trips (feeling anxi- than they could magic mushrooms. ety and paranoia) and later suffer Indeed, in Margate last year some flashbacks, and there is the risk of who were denied mushrooms by a accidents while users are disorien- retailer went out and picked their tated. But of course the greatest own and ended up in hospital danger is posed to those who suffer through picking the wrong ones. or who have a history of mental Again the only death connected to health problems in that using any
trauma mushrooms was in 1987 when the victim mistakenly ate a poisonous variety; commercially produced magic mushrooms are not poisonous, nor are they addictive. MAXWELL: What Mike says is true, that the majority of places selling magic mushrooms until recently did seem to be operating a form of self-regulation in terms of not selling to minors and giving out information with the mushrooms such as the dangers of mixing mushrooms and alcohol. However, I would reiterate: it is not for sellers to say what the law on mushrooms should be; it is not for DrugScope to say what the law on mushrooms should be. This is why we need an independent, expert study into the matter and what the cumulative evidence on the subject says and to act on those recommendations. Do you intend to carry on selling mushrooms in spite of the change in the law?
Many put this down to a revived interest in psychedelic drugs in general, both natural and designer, linked to the growing popularity of psychedelic music. The former editor of MixMag Viv Craske was quoted in Druglink magazine (Mar/Apr 2004) as saying; “This summer looks like a big one for psychedelic trance music and psychedelic drugs. Psytrance will move away from mainstream clubs to free parties and club nights. Clubbers have reached the point where they are bored of taking loads of ecstasy and GHB and now they want 2C-I and mushrooms.” How difficult will it be to obtain mushrooms post-ban? Will the underground trade burgeon or will sellers be deterred by the new law?
BASHALL: Criminals will sell dried mushrooms, because they are easier to handle than fresh ones. Some will pick wild liberty caps. These are easily mistaken for more deadly varieties if you are uninitiated. Dealers will push ecstasy and LSD, which have gone out of fashion to a certain extent, compared to the rise in popularity of magic mushrooms. They will probably smuggle dried mushrooms into the country from Holland; this is a bad thing because people will try to make extracts.
BASHALL: Facing a 14 year prison sentence? I don’t think so. Having said that, two shops were raided in Edinburgh on Monday [18th July] and charged with selling mushrooms not knowing the ban had come into force! We want to change the law, not break it. We intend to challenge the law with a judicial review which we are preparing with our legal team right MAXWELL: It is difficult to say now. whether the popularity of mushrooms will continue in spite of the Why has the UK developed change in the law. Mushrooms are such a love of magic mush- not currently dealt with on the rooms in the past few years? black market to any great extent, but this could change as shops and BASHALL: They are a safe al- other outlets stop selling them ternative to street drugs. They were openly. As Mike says, one of the legal and appealed to a wide range biggest dangers concerning magic of people from all walks of life mushrooms is if people who don’t from professionals to alcoholics know exactly what they are looking who took mushrooms because it for go out and pick poisonous vastopped them needing so much rieties by mistake. alcohol. They are safe and nonaddictive and were a reliable, stabilised and natural anti-depressant. People liked them because they There’s more discussion and links could be purchased from a reliable to further information on our websource and respectable people do site at: not like dealing with pushers. www.traumaroom.com/discuss MAXWELL: Magic mushrooms have seen a big rise in popularity recently. The latest British Crime Survey found that usage had gone up 44% from 2002/3 to 2003/4.
big debate 17
- the factsheet
What are magic mushrooms?? They’re a naturally occurring, non-poisonous fungi that contain varying amounts of the conscious altering chemicals psilocybin and psilocin. Are they found in the UK? There’s over 70 recorded species in the world. The most common species in the UK is psilocybe semilanceata, more widely known as the ‘Liberty Cap’ mushroom. They grow anywhere but typically are more prevalent in forested areas. How are they used? They can be taken raw but are most commonly dried and stored for later use. They can be cooked in food or drunk as a tea. How much do they sell for? At the moment it’s difficult to establish. Before the ban a bag of about 20 mushrooms, enough for five to six hours of effects, cost about 5 pounds. What effects do they cause by taking them? The positive effects include intensifying current mood, euphoria, visual hallucinations and distortion of reality. Negative effects include nausea, paranoia, poor co-ordination, anxiety and shivering. Long term they have also been reported to cause depression, anxiety and paranoid delusions. How do they work? Psilocybin and psilocin, the active ingredients in the mushrooms, bear a close resemblance to the neurotransmitter serotonin. It is believed that they disrupt the normal effects of serotonin within the brain. Scientists report it works in a similar way to the drug LSD which has the same effects—though more intense. Are they a common drug? Recent surveys of drug use among teens aged 16-18 showed that approximately one in six had tried magic mushrooms. Are they illegal in the UK? Prepared mushrooms (eg. dried) have been illegal in the UK as the chemical was deemed a Class A drug. The change in the law has re-classified the drug as the mushroom itself so even collecting them these days is an offence.
trauma
18 clinical skills
clinical
Essential Revision Notes in Medicine for Students
Especially written for medical students facing their final year exams. Fifteen chapters provide c o m p l e t e coverage of all the key topics assessed in medical finals. Key points are presented clearly in diagrams, illustrations, lists, tables and mnemonics to aid learning. Includes invaluable revision checklists to enable you to identify your weaker areas. ISBN - 190462720X £29.95
History Taking in Medicine and Surgery
C on s o li d a t e your skills with this practical, symptomsbased guide, designed to help you improve upon and get the most out of your history-taking. It includes suggested prompt questions to ensure you’re never lost for words and a unique section on broaching difficult subjects enables you to gather the information you need. Practice scenarios mean you can improve your skills with a friend. ISBN - 190462765X £14.95
The Practical Guide to Medical Ethics and Law
T h i s a u t h or i t a t i v e guide to current practice in medical ethics and law forms essential reference throughout your career. It explains the main principles and theories of medical ethics and medical law. Featuring real case studies, it includes tips based on real life incidents. ISBN - 1904627315 £19.95
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in association with
Venous cannulation is an important route for administering fluids and medication. This issue, in association with PasTest, we bring you a guide to this essential skill. A venous cannula may be inserted into just about any vein, although, conventional insertion sites include the forearm and dorsum of the hand. There are a range of cannula sizes available. For routine purposes in an adult patient, a 20-guage cannula will suffice. However the size of the cannula influences the speed with which fluids can be administered. Therefore, in emergency situations the largest cannula available should be inserted if possible. In a number of patients, peripheral cannulation may be unachievable—especially in those with multiple previous admissions, intravenous drug abusers and those receiving regular cytotoxic medications. In these circumstances two main options are available: external jugular vein cannulation or central line insertion. Both should be undertaken only by experienced practitioners. The procedure for external jugular cannulation can be found in the ‘Clinical Skills for Medical Students’ Book. Indications
IV fluids IV medications Blood products Inotropic agents* Parenteral feeds* (*central access only)
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www.pastest.co.uk tel - 01565 752000
skills
Patients with chronic renal failure may require the formation of a fistula in the future. In these patients, cannulae should only usu-
ally be inserted into the dorsum of the hand. Under no circumstances should a cannula be inserted into a fistula. Equipment
5ml of 0.9% saline (for a flush) Antiseptic wipes Cannulae Cotton-wool balls Dressing (to fix cannula in place) Gloves Tourniquet ICE Introduce yourself Consent the patient for the proce-
dure Expose the necessary parts of the body and position the patient. Roll up the patient’s sleeve to well above the elbow. For external jugular vein cannulation, tilt the bed to 10-15o head-down. Vein Cannulation
• Wash your hands. • Apply a tourniquet around the arm, above the elbow. Alternatively a blood pressure cuff may be used. The cuff should be inflated to exert a pressure somewhat between the diastolic and systolic blood pressure. This will allow the veins to distend by engorgement. • Assess the forearm for suitably engorged veins for cannulation. • The best veins to cannulate are those that you can both see and feel. • Gloves should be worn for venepuncture; however, you may wish to feel the veins initially
without gloves, especially with the more difficult cannulations. • Clean the chosen area for cannulation with an antiseptic wipe. A site just proximal to the union of the two veins is often a secure spot. Inform the patient of a ‘small scratch’. If the patient is likely to move the arm, request assistance from the nursing staff to fix the arm. • Make a clean, assertive pass at a shallow angle with the cannula. • When the cannula enters the vein, there will be a flashback of blood. • At this point, advance the cannula while simultaneously withdrawing the needle. • When it is fully inserted, release the tourniquet. • Apply pressure at the proximal end of the cannula to prevent leakage of blood and apply the cap to the distal end. • Fix the cannula in place with a dressing. • Check the patency of the cannula by flushing it with 5ml of 0.9% saline. A properly inserted cannula will not leak, and flushing it will not cause any pain. • Dispose of all sharps carefully in a suitable container. • Wash your hands. Clinical Skills for Medical Students
ISBN 1904627439 £14.95
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Keeping out of trouble on the wards by Annmarie McTigue – Writer, MPS
Whether you’re starting your first or final year of medical school, the chances are you’ll have some contact with patients. Some students begin working with patients from virtually the start of their courses, while for others it may be as late as their fourth year. At MPS, our medical school representatives and medico-legal advisers answer queries from students who are nervous about how to handle tricky situations involving patients. Here’s a quick guide to keeping out of trouble on the wards. Be prepared The general consensus is that you’ll get plenty of support from your school – so take advantage of it. Read your guidebook for advice on what to wear, how to approach and communicate with doctors, nurses and other hospital employees, and how to examine and take histories from patients. Make the meetings Make sure you go to any introductory lectures and inductions; these meetings will probably address many of your concerns, but also offer an opportunity to ask any other questions and find out who you should contact if you experience a problem. Take notes Keep a notebook to hand – there’ll be a lot to take in and remember. Ask for help Speak to your supervisor or ward-based teacher if you have any concerns or are unsure about any task assigned to you.
Intimate examinations and chaperones Most patients feel embarrassed or unsettled by the lack of dignity an intimate examination involves, and they might not understand why it’s necessary to examine a particular part of their body when their symptoms are in a different area. Someone feeling vulnerable can easily misinterpret another’s actions as threatening or intrusive, so try your best to put them at ease. By explaining the reasons for examining that part of their body, warning of any discomfort or sensations they might feel, and giving them a chance to ask questions, you can avoid any potential misunderstandings that could lead to a complaint. It is unlikely that you would be asked to do an intimate examination on your own, but if you find yourself in this position you must offer to find a chaperone and ensure the patient understands fully what you are proposing to do and why. For advice on why and when to use chaperones, see Casebook, May 2004, pages 13-14 at www.mps.org.uk.
Confidentiality You have a duty to ensure that information about a patient’s health and their healthcare is only available to those involved in their care. Do not leave medical records/notes lying around. Do not be indiscreet with patient details on ward rounds or on breaks.
Consent Consent is not an isolated event or a form; it is a process to be gone through with a patient. It involves explaining clearly and honestly what will happen and all the uncertainties, then ensuring that the patient understands and has the time to ask questions. If you have no knowledge of a procedure and are not capable of undertaking it, then you should not obtain consent from a patient for that procedure. Your NHS trust will have a consent policy and you will be shown how to take consent properly. See the MPS factsheet Consent – an Essential Guide for Students (www.mps.org.uk/essentials or e-mail student@mps.org.uk)
Tips from current medical students ‘Be confident, speak clearly and smile; a smile goes a long way to making patients feel more relaxed, especially when faced with a ‘hot off the press’ med student.’ ‘Introduce yourself as a medical student and if they ask you difficult questions repeat this, reassuring the patient that their doctor should be able to answer any questions they may have.’ ‘Get down to the patient’s level; it’s not pleasant when someone towers over you, especially if you’re worried about your health. Ask them if you can sit on the side of the bed or pull up a chair – this is often a useful ice-breaker.’ ‘If you encounter a question or situation that you cannot deal with, don’t try and blag it – stress that you are a student and don’t be shy to ask for help.’
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