the
medicalstudent The voice of London’s Medical Students
May 2012
Are women the superior sex? Page 8
London - more than the Olympic city Page 10
Something on your mind Page 9
Medicine from the Midlands Purvi Patel
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riday 13th April saw medical students from all corners of the United Kingdom make their way to the University of Nottingham for the BMA Medical Students’ Conference. The day started off with the expected bad luck, as an Imperial delegate managed to lose his ticket in the five minute walk from the collection point to the platform. Promising to meet him at the other end, the rest of the London delegation continued on an uneventful journey to the dreary landscapes of the North. After checking in and enjoying a complementary finger buffet, delegates heard opening speeches from the Conference chair, Nick Deacon, and the BMA MSC Co-Chairs, Marion Matheson and Elly Pilavachi. Following this, delegates at-
tended one of five workshops. The keynote speaker, Dr Clare Gerada, Chair of Council of Royal College of General Practitioners, emphasised the importance of a good doctor-patient relationship. She reminded everyone present to be kind to their patients - and encouraged them to be GPs. A brief accountability session allowed delegates to follow up motions passed as policy last year, and hold the MSC Co-chairs to account for their year’s work. Several delegates expressed their dissatisfaction with the work done on their policies, and the principal reason for this seemed to be the lack of time the MSC CoChairs were able to devote to these. And then the motions began. Each university could submit up to six motions, three of which can be submitted as priority motions. At least one motion from each university would be discussed in the first part of the
agenda, and of the rest, five motions would be selected for discussion in the second part of the agenda. Although the majority of these motions passed smoothly, others were met with a surprising amount of resistance. One motion, submitted by Queen’s University Belfast, deplored the decision under the new Foundation Program Application Scheme to give credit to graduates from the Universities of Nottingham and Southampton for BMedSci degrees obtained during the normal course of study. This was met with considerable opposition from the respective institutions, who insisted that their additional degrees were the result of longer hours and a more difficult curriculum. Unfortunately, this argument did nothing to convince the rest of conference, and the motion was carried, much to the despair of the delegates from Southampton and Nottingham. After lengthy discussion of
nine motions, and the promise of at least 25 more on Saturday, it was time for the day to come to a close. The theme of the night’s entertainment was ‘black tie with a hint of Bollywood’ which, as the title suggests, led to a variety of interesting outfits. Delegates were treated to a three course Indian meal, followed by a Bollywood dancing lesson. Understandably, there was a direct correlation between the volume of alcohol consumed and the willingness to take part in the evening’s activities. While the night officially ended there, some of Nottingham’s finest clubs may have been bombarded with students later on. The late start of 9.30am on Saturday was deemed far too early by those who most enjoyed the previous evening’s festivities, but they turned up regardless, to celebrate Dr Hamish Meldrum’s birthday. (cont’d on page 2)
Brains - mind is matter Page 10
Hypochondria - an illness of the mind Page 21
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May 2012
News
News Editor: Ken Wu news@medical-student.co.uk
Editor-in-Chief
M Alexander Shimmings GKT Medsoc President Exams are the main topic of conversation at GKT as the first, second and intercalating year students sweat over their end of year exams, and the final years boldly take on their finals (for which we all wish them the very best of luck). Even the fourth years have some exam stress as everyone seems to say it’s harder than their year. We shall soon find out. Only the fifth years are enjoying themselves at the moment having just finished their in course OSCEs and are currently 'attending' the Pathology Therapeutics Block by going to Borough's excellent selection of pubs. MedSoc have just held their committee elections, and it is my pleasure to congratulate my successor, Dheeraj Khiatani, to the role of MedSoc President for 2012-2013. In other news, everyone survived Ski Tour, the subcommittee elections are coming up, and everyone
Purvi Patel on exams, elections and editors
is keenly awaiting the Summer Ball. Having been stung in the last paper by our perverted editor, I have chosen to be mature this time and not write about anyone on these pages. Except Nana and George, who never write anything remotely interesting, and Suzie, because I am obliged by age old rivalries and she disagrees with my keen sense of fashion. If Jeeves Wijesuriya has mentioned me in his column again, then I am going to file for a restraining order, and sue for libel
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George Ryan BL President The contractors working on the GriffInn have been keeping to their deadlines as well as a patient in atrial fibrillation keeps a regular heart rate but I can assure you that it is coming along very nicely. With the new opening date set for the week of the 11th June, the new bar will be completely unrecognisable in comparison to what we left behind in October. Prepare yourselves for brightly coloured walls, comfortable furniture and a fully functioning kitchen that has the potential to serve anything from a grilled burger to roast dinner. Did I mention we’ll be serving Starbucks Coffee as well? On a more serious note, the hot topic at BLSA this term has been ‘should BLSA remain a-political and a-religious’ and therefore continue to not allow religious and political societies to affiliate? The students union is different for every student. For some it’s a drinking hole, some a way of rais-
And here we are: the final Medical Student of this academic year. May has been relatively quiet, with everyone working hard for exams and such. Of course, some of us have been working hard for other reasons, including fighting both for the life of this newspaper, as well as the ongoing battle with BUCS. One would think that after last month’s debacle, the Presidents of the London medical schools (and MedSoc) would have learnt their lessons, but this is clearly not the case. At least this time they are taking shots at each other, although our unfortunate Mr Wijesuriya is still having trouble with his spelling. Despite this, they have managed to find a common ground – this time the target is not as innocent as the Editorin-Chief of the Medical Student, but the
more real threat of BUCS. The students of London continue to oppose the proposed merger, despite being misrepresented at every opportunity, and instead of throwing a tantrum about how unfair life is Medgroup has been surprisingly efficient at confronting the issue. Some SU elections have already taken place and others are imminent so, jokes aside, I would like to take this opportunity to congratulate the presidents on a great year, and wish their successors all the best for the one to come. On that note, the Medical Student team is losing some of its most valued staff. We say goodbye to our capricious News editor, our ever-prepared Features editor, and our most faithful Comment editor. We are, as ever, lacking a treasurer and a Sports
editor. Of course, this means there is more room for you! For information about any of these roles, or to apply, email editor@medical-student.co.uk Have a great summer, see you in September!
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ing money for charity and others a way to develop ones CV. The principle we must stand by is that the Students Association is flexible enough to be whatever its current body of students need it to be. It is vital in this day and age that we accept and engage with those that unite as part of a religion or political opinion. Those students are equally as proud of being a part of BLSA as any of us are. The debate went very well and I’m proud to say we removed the entire clause from our constitution. I hope this is a step towards engaging all of our students under the umbrella of BLSA
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Nana Adu SGUL President The world of George’s is starting to wind down towards exams. Congratulations to all of our finalists who have battled for five long years and are now free to enjoy their electives. To everyone else, good luck and if possible purchase a rock, then place yourself under it. In the SU world, both elections and awards evening are on the horizon. Elections are basically where most of the exec team and I breathe a massive sigh of relief - because the SU is still standing for another year, and retire from our roles. This follows the democratic process of campaigns, voting and a very very long count - or in Shimmings case, late nights spent stuffing the ballot boxes and crying because no one would vote for him. We are incred-
medicalstudent
ibly excited to see the fresh and fantastic ideas the candidates have for next year. Banter aside, I personally had the pleasure of representing SGUL at this year’s NUS conference in Sheffield, especially because we are a real students’ union (sorry, couldn’t help myself). Some impressive debates raged on, and we yet again represented our students and fought over the issues that matter to you. Don’t forget, despite everything going on, we are still preparing for this year’s bigger and better Summer Ball
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The night’s activities were called into question by Sheffield’s motion concerning the large volumes of alcohol consumed by medical students. It called for the MSC to: support a realistic minimum pricing on alcohol, increase awareness among medical students of the harmful effects of binge drinking, oppose the active advertisement of reduced alcohol prices used by medical societies, and to work alongside medical societies to reduce their focus on excessive alcohol consumption and cater for the needs of those students who do not wish to engage in binge drinking. This motion was the most controversial of the conference, with many delegates speaking both for and against this motion. It sparked great debate amongst students, with the chair having to call for a vote despite numerous delegates’ wish for more discussion. Conference was divided on this issue, as was the London delegation, but the majority voted in favour and the motion was passed as policy for next year. London was, as always, well rep-
the
resented – with the exception of St George’s, who expressed their disinterest in student politics by sending a single representative, and submitting no motions. Imperial’s primary motion was asking for an NHS database anonymising patient information for use in research, whereas GKT’s motion was concerned with addressing the stigma attached to students who fail medical school finals on the first attempt. One particularly boisterous Oxford student decided to speak in Latin, against this motion, for which he was duly heckled by the London delegation. Barts took the BUCS issue to conference, asking the BMA MSC to join the campaign against the proposal merging medic and non-medic sports teams. UCL had a more altruistic approach, and were concerned with reducing health inequalities – the motion that MSC Co-chair Elly Pilavachi declared as her favourite. The topics covered by the motions spanned a huge variety, showing the passion students can have for politi-
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cal issues. The motions brought to conference also show the priorities of different institutions. As a member of the London delegation, and prominent member of UH MedGroup remarked, ‘Manchester brings issues such as sexual assault and global health, whereas London is all about FPAS, exams, and sport – we’d never touch a global health issue’. This, while not completely true - as shown by the motion submitted by UCL - is a fairly accurate description of the London medical schools. It may be due to having so many medical schools in such close proximity, but from day one of medical school, students are aware of the immense competition they face, and this is reflected on a national level. Either way, the weekend was a great success: the MSC policy for the next year has been formed, and the new team elected. The coming year will be crucial in deciding the future of this country and as Dr Hamish Meldrum said, ‘we must never stop thinking we can fight every battle.’
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Contact us by emailing editor@medical-student.co.uk or visit our website at www.medical-student.co.uk
Editor-in-chief: Purvi Patel News editor: Ken Wu Features editor: Bibek Das Comment editor: Rhys Davies Culture editor: Kiranjeet Gill Doctors’ Mess editor: Rob Cleaver Image editor: Chetan Khatri Social Media editor: James Turbett Sub-editors: Alex Isted, Keerthini Muthuswamy, Ashik Amlani Distribution officer: Sanchit Kapoor Consultant editor: John Hardie
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May 2012
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News The Battle with BUCS Rhys Davies Comment Editor For any student involved in sport at medical school, BUCS has become a bad word.At their AGM last summer, BUCS tabled for discussion the ‘historical anomaly’ of medical school sports teams, separate and distinct from those of their parent universities. It seemed ludicrous that the same university should have to compete against themselves in the same league. However, this fails to take into account the independent nature and origins of many medical schools in the UK today. As such, many medical students, including MedGroup, were outraged that their beloved sports teams might face dissolution. In many universities, the medical teams play in a higher league than their parent university equivalents. This honour and prestige, for the medical schools and their universities, would be lost in the disbandment. The suggestion that the most able medical sportsmen and women can simply join the main university team fails to take into account the differences in schedules and commitments
between medical and non-medical students. Many university sports teams train and practice on days and times that medical students, due to course commitments, simply cannot make. MedGroup wrote an open letter to BUCS, detailing their objections to the proposals, as well to the London medical school student unions and sports committees. This developed into a petition signed by more than 2500 students. BUCS responded by saying they would enter into a consultation period, considering the best way to resolve the issue. During this period, Medgroup and others have redoubled their efforts, restating their complaints. However, the London representatives to BUCS, opposed to the medical teams’ continued autonomy and participation, have attempted to downplay the opposition’s existence or relevance. Some medical schools, meanwhile, have attempted to find their own solutions. Both Imperial and RUMS have proposed that medical and non- medical teams share administrative titles only and remain ideologically separate. However, this is still not without its problems. BUCS has remained silent on the issue and have yet to hold
Neil Chowdhury RUMS President
a meeting open to all parties involved. In the face of BUCS’ continuing silence, MedGroup have been gathering support from larger institutions. Cardiff University School of Medicine, also potentially affected by the BUCS proposals, have pledged their support, as have ULU president Vraj Domalip and UH staff president Professor Sir Nick Wright. Recently, they have gained the support of the Rugby Football Union. They have also recently gained the unanimous support of the BMA Medical Students Committee and have the personal backing of BMA Council Chair Dr Hamish Meldrum and Dr Steve Hajioff, Chair of the BMA’s representative body. Now MedGroup are demanding a meeting with BUCS where the affected parties can gather and have their questions answered. The volume of support that they have gathered within the space of nine months is testament to the strength of feeling against these proposals. Hopefully, BUCS will listen to their criticisms and alter or drop their plans against the medical sports teams. However, with time pressing on, BUCS will need to reach a decision, one way or another, soon
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Here comes the end of my tenure as RUMS President - and RUMS has remained ever better than our less than carbon-copies. RUMS won the UH cup in Rugby this year, annihilating any competition we have, and our Sports Ball has been the most successful to date and even equalling in size to our non-medic counterpart’s Sports Ball. This is a true testament of how important our teams are to RUMS, and indeed medical students. We have also taken our kit off for charity and made our signature naked playing cards, which are selling very successfully. RUMS could be the only one ever to set the trend for other medical schools, not follow them. We are also about to have our first Sports Tour coming to London. Brighton and Sussex Medical School wanted to hold a tour and naturally went for the most gifted, clever,
and fun teams in the whole of London. Finally, the Finalist Ball preparations are under way, which is held within the Tower of London’s pavilion this year. The finalists will be able to celebrate within the moat of London's most iconic building. I want to say thank you co-presidents of Medgroup – it’s been a good ride this year, and the banter has been epic. I'm sure the power of the five med schools shall live on - until RUMS takes over Barts and I hope it lives on for the rest of our days
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Suzie Rayner ICSM President So we have reached the last Medical Student this year - how very sad. My thanks go to The Medical Student’s newspaper team for their great work this year, and to all at ICSM – especially the ICSMSU Exec, who I have had the pleasure of working closely with. And the other med school presidents have been alright sometimes too. It felt appropriate to give some words of wisdom to the incoming presidents, about who gets given the role and some of the perks. To become president of GKT, you should have an avid interest in sport and gin, as well as preferably having a name that rhymes with a niche sexual practise. Barts Presidents are often the best looking of the bunch, but beware, the year of presidency may enlighten you to the wonder of the intercalated year at Imperial and cause you to leave the
beloved Barts and join our ranks for a year. My advice to St George’s President also rings true for Barts – if you manage to get your predecessors to stop interfering in your current activities, then you have achieved more than this cohort. At RUMS, apparently the only way to become President is to be Gareth Chan. And the perks of being ICSM President? Well, being President makes you a great hit with the ladies
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Jeeves Wijesuriya UH President
Victory will be ours!
You find us at a very exciting time at Medgroup. As we continue in our battle with BUCS we are excited to announce that we now have the support of the RFU and the BMA! We have also been assured of the personal support of Hamish Meldrum and Steve Hajioff, Chairman and Vice-Chairman of BMA council respectively. We are now responding to BUCS once again as the collective force of all five London Medical Schools, Cardiff Medical School and ULU before their AGM with our criticisms of their current proposals and our own solutions. We are also almost able to launch our new website and the Pan - London mental health survey. These are definitely exciting times for Medgroup! In other news, each of the London Presidents have been severely rep-
rimanded by Medical Student Editor Poorvi following our recent comments about her lascivious behaviour and we would like to take this opportunity to apologise for our comments which (though truthful), were made frivolously after a night on the tiles. We promise not to go after Poorvi again, for now. Mark Shimmings, however, remains fair game
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May 2012
medicalstudent
News
Diary of an FY1 Junaid Fukuta shares his pearls of wisdom on his last day as a FY1
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t is my last day as an F1 and I am staring at my replacement in disbelief. Did I really look like that? He has a crease free shirt, slicked back hair and no bags under his eyes. My envy for his fresh looks is soon overtaken by trepidation for him as I remember what it was like being in his shoes 364 days ago. Politicians say a week is a long time in politics - they should try a year as a doctor! My fellow F1s and I have all transformed from wet behind the ears recruits into fully fledged battle hardened veterans. I try to scour my brain for some pearls of wisdom for my fresh faced replacement and being such a jolly nice fellow I am deciding to share them with you now. Number 1: Don’t bullshit. As my SHO said to me, no one minds a shit F1, but everyone hates an F1 who lies (he was not referring to me I hasten to add). If you do not know something just say. You are now an adult and you are no longer trying to blag your way through exams. People will expect you to know nothing and not be able to keep track of everything and they will not begrudge you for that, but if you start bullshitting to cover your back you will be found out and then everyone will double check your work and you will become ‘that guy’. Don’t be ‘that guy’ Number 2: Do not bullshit – no, seriously I mean it. Just don't ever do it. Number. 3: Lists. Picture the scene: busy post take ward round, muggins here holding mountains of notes whilst trying to write in all of them as consultant whizzes through patients, until a helpful nurse points out that we have actually missed out a patient who is sitting right in front of us. Consultant looks at the patient then to me then back to the patient and says ‘but they are not on the list’ in a way to suggest that they do not really exist. It may sound ridiculous but patients who are not on the list do not exist. This word which should be associated with such menial things like grocery shopping takes on a whole new meaning within the hospital.
"Forget doctors, nurses, and even money. These things do not make a hospital work but rather it is these tiny pieces of parchment that hold the key to a patient’s wellbeing." Without them consultants won’t know where to go, people won’t be booked into theatre slots, and
jobs won’t get done. Unfortunately the F1 is responsible for keeping these all up to date. No one will say thank you for keeping the list up to date but they will definitely let you know their displeasure if it is not. Number 4: Play nice, especially to the nurses. On a busy on-call shift, one senior nurse says to me ‘I don’t feel happy about that guy’. All their observations are normal, but 12 hours later, that patient was dead.
"Once I finish recounting my trials to my replacement he stares at me speechless with his mouth slightly ajar like a goldfish as the enormity of what is about to occur hits him" There will be days when you feel that nurses have been placed on this earth for the sole purpose of annoying you but in reality they can make your life so much easier. Just remember they have been in the game much longer than you and are often much more experienced than you. If they are worried about a patient, take it seriously and remember they know how things work. It is their ward you are working on so do things the way they want it done and your life will be more bearable. Number 5: Ask for help. There will be days when you feel as if you have turned into Atlas in quicksand as the weight of the world is on your shoulders and you steadily sink into the depths of the cesspool that is the inner workings of a hospital. However, remember that there are always people to ask for help and you should never feel like you can’t ask for it. If your seniors are annoyed by you for asking for help screw it: that is what they are paid for. Most of them are also really nice and remember what it was like. Worst of all, if you are annoyed by yourself for asking for help, get over it - don’t let a patient’s care be compromised by your ego. Number 6: Enjoy it. There will be times when you cry in toilets during on-call shifts. There will be times that you wake up terrified as you think you have done something wrong. There will be times when you will think why the hell did I sign up to this, but just remember that you truly have the best job in the world. The colleagues you meet and work with will be so full of character it will seem like they should be in mov-
ies and you will share moments with them that range from the truly terrifying to the sublimely ridiculous.
"Politicians say a week is a long time in politics - they should try a year as a doctor!" Never forget that you are in a most privileged position and peo-
ple you have barely met will entrust their lives into your hands, and that is why you signed up to it. Once I finish recounting my trials to my replacement he stares at me speechless with his mouth slightly ajar like a goldfish as the enormity of what is about to occur hits him. Then I am filled with a strange feeling - although it has been tough and gruelling, I am strangely envious of him. Then it dawns on me I am going to miss it. I am
actually going to miss it, warts and all. All I can say before I leave is: good luck, and the same goes to all of you
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Junaid Fukuta has been writing the Diary of an FY1 for the past two years. Junaid graduated from Imperial College School of Medicine in 2010. He went on to work in the Bristol Royal Infirmary and is currently applying for his CT1 job.
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May 2012
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News
the medicalstudent is recruiting Comment Editor Rhys Davies
Features Editor
Bibek Das
Hello. My name is Rhys Davies and I want you to take my job! Of all the sections, Comment has the most freedom in terms of content (apart from Doctors’ Mess). Each month, I am surprised by the diverse topics medical students in London choose to write about. No other section puts shisha, evolution and white coats on the same page. Then there’s the Head-to-Head. You can pitch the big issues of the day to all the medical students in London and hear their arguments come flying back. If you do this job right, people won’t know you’ve done anything at all. There’s a certain pride in that. Comment lets the medical students speak, and you could be the one giving them the soapbox!
Being Features Editor is the best job on the paper - not as stressful as Chief, but with enough time on your hands to carefully plan your section. You need to be organised and have an eye for detail as you scour thousands of words for tiny mistakes, but you should also be able to recognise your writers' strengths and weaknesses and provide encouragement and critical feedback. For the large part, you get to set the agenda each month, which involves suggesting topics that provide analysis and insight into the fascinating issues that affect medical students - ranging from professional development, to relationships/lifestyle and global health.
News Editor Ken Wu
News editor of The Medical Student. Sounds awesome right? It’s actually one of the best jobs you can have on a student publication. The perks include harassing anyone you can, whether if it’s the BBC, Deans of the medical school or the SU president, to get information you need. You also get to be part of an amazing editorial team with their unique take on medical school banter, as well as ordering them to do whatever you need. Let’s face it, after the editor-in-chief, you are the most important person on the editorial team.
For more information email editor.medicalstudent@gmail.com Deadline is May 31st
May 2012
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Features
medicalstudent
Features Editor: Bibek Das features@medical-student.co.uk
Do Women Make Better Doctors? With the majority of medical students now being female, what does this mean for the future of healthcare? Alexander Isted explores the issues surrounding an increasingly female dominated medical profession
Image by Chetan Khatri
W
omen have for centuries, been absent from the pages of medical history in a field so dominated by men. 1874 introduced the first medical school with a female intake, known as the London School of Medicine for Women as part of the Royal Free. It wasn’t until a report in 1943, criticising the low numbers of female doctors that other medical schools followed suit with the aim of reaching levels of 20% female medics. Over the next
sixty years, mind-sets changed and institutional sexism began to fizzle out, with the proportion of both female applicants and acceptances creeping up, even surpassing those of male medics around the millennium. With the trend set to continue, women doctors are due to outnumber men within a decade. It is clear that the typical doctor demographic has changed radically in the last half century. For many years, girls have outperformed boys in GCSEs and A levels, giving them
the tools for a stronger medical application, so weighted on academia. In an interesting shift in social trends, the old image of a typical doctor as white and male is conversely one of the social groups that now underachieves most in secondary education. Despite the fact that women are soon to be dominating in sheer numbers, they are by no means equally represented across all specialities. Surgery, which has always been infamously male dominant, does not have
an increasing female representation nearly as much as such fields as general practice, palliative care and paediatrics. Whether this is a relic of the old era of male only surgeons, soon to be ironed out as the older, more traditional consultants retire, or whether surgery simply appeals less to women, is unclear. Women certainly have more of a burden of having to factor in the time required to have a family, than men do. In a survey of female medical students and junior doctors, 90%
said that they were concerned about the difficulty of balancing the raising of a family with their medical careers. The media has mapped the increase in numbers of female doctors like the trend of a pandemic, but are women better equipped to make a good doctor than men? The measure of what makes a good doctor seems to vary amongst the beholder. Patients value personal attributes as empathy, communication skills and compassion.
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May 2011
“The media has mapped the increase in numbers of female doctors like the trend of a pandemic, but are women better equipped to make a good doctor than men?” Stereotypes certainly suggest that women are better communicators than men, a study in Scandinavia going as far to say that this is true on a biological level. The study concluded that women have an innate ability to subtly mimic the expressions and idiosyncrasies of whoever they are conversing with, through the action of ‘mirroring neurones’, and thereby show a better sense of empathy. Another study concluded that men interpret social interactions with more rational and logical methodology compared with women who can more easily put themselves into the shoes of whoever they are talking to, allowing them to better relate to them. Even the term ‘maternal’ itself conjures more images of what a doctor should be than the term ‘paternal’. Whilst the
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Features father figure guides and can provide instruction and can instil confidence, the mother can communicate and read feelings, allowing you to be vulnerable. Perhaps these stereotypes exist, but do general gender differences actually exist in the medical profession? It has been found that female doctors utilise psychosocial questioning methods and shared decision-making in consultations 10% more than their male counterparts.
“In certain fields, particularly obstetrics and gynaecology, women are favoured by the majority of patients regardless of whether the doctors have stronger or weaker skills in empathy and communication.” In certain fields, particularly obstetrics and gynaecology, women are favoured by the majority of patients regardless of whether the doctors have stronger or weaker skills in empathy and communication. This is understandable
and often applies conversely for male patients undergoing physical exams, preferring male doctors. Many who have strong religious observations also feel more comfortable with a certain gender, and this is unlikely to change. Fellow doctors and medical staff value medical competence and the ability to work in a team with camaraderie. This is solely based on the individual’s traits, as the aptitude of graduating doctors doesn’t have any significant gender difference with the academic girl/boy divide having closed by completion of the medical degree. Paradoxically admissions staff at medical schools, appear to value aptitude in chemistry, which (with the exception of graduate entry applicants) is better performed by female applicants. This highlights a different issue of whether the university admissions process has its priorities right.
“Fellow doctors and medical staff value medical competence and the ability to work in a team with camaraderie.”
In a survey of medical students, the trait they prized most amongst their fellow medics, who they will one day work with, was cheerfulness, a trait which is clearly not gender-specific. It can hardly be argued that the process of medical school is designed to weed out anyone who would become a ‘bad’ doctor on the grounds of their knowledge, clinical aptitude and drive. Beyond that, the factors that can vary between doctors are an individual’s ideosyncrasies and personality that they bring to the team and ultimately to their patients. Being a pleasant, engaging, extrovert may not make you a better doctor in the exam halls but it will on the wards, both for collegues and patients. Critically, gender has no effect on this, so in the eyes of other medical students, at least, women don’t make better doctors, not do they make worse doctors. An interesting question to pose is ‘do women make safer doctors?’ It is widely agreed that women make safer and less reckless drivers. After years of say, surgery, the act of performing a hip replacement may become as frequent and mundane as the drive to work, so will the traits which make men more dangerous on the roads
make them more dangerous in the operating theatre? Proportionally, more medical negligence litigations are made towards men but this is mirrored by the fact that men ocupy more of the roles which are likely to to have negative outcomes such as surgery and anaesthesia. On an individual level, there is no evidence to suggest that women make safer doctors than men.
“Being a pleasant, engaging, extrovert may not make you a better doctor in the exam halls but it will on the wards, both for collegues and patients.” The quality of the patient experience seems, critically, to be based on how comfortable, reassured, involved and informed the they are made to feel. The very terms ‘maternal’ and ‘paternal’ are increasingly outdated and gender traits should be taken out of the equation. Ultimately, these trends must be taken with a pinch of salt, as the quality of a doctor is not pre-determined by their gender, but their individual qualities
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Image by Yuan Cao Xue
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A Midsummer Night's Dream June 2 - Aug 12 Regent's Park Open Air Theatre Set in the leafy environs of Regent's Park, this Shakespearean classic mixes comedy and romance, with some magic added in for good measure. Fairie queens falling for donkeys - anything can happen in this magical, mystical world.
Notting Hill Carnival 2012 Aug 26-27 Notting Hill The most fabulous event of the summer is back and this time it's bigger than ever. This vivid celebration of music, movement and masquerade is buoyed by stalls loaded with delicious Carribean foods such as jerk chicken and fried plantains. If you want to join the party, be aware that Ladbroke Grove station will be closed on both the Sunday and the Monday.
London Mela 2012 Aug 19 Gunnersbury Park
This Sum
This one day festival is celebration of everything London's Asian communities have to offer. Representing both classical and contemporary Asian culture, the event also features art, dance and comedy.
Ask not what you can d
BBC Proms 2012 July 13 - Sept 8 Royal Albert Hall
Wimbledon June 25 - July 8 All England Lawn Tennis Club The oldest and, arguably, the most prestigious tournament in the world, Wimbledon is the only major grand-slam tournament still to be played on grass courts. Get there early for reasonably priced tickets on centre court and watch some of the top names in tennis battle it out. Alternatively, enjoy the view from Henman Hill with the traditional strawberries and cream.
This year's BBC Proms are part of the Cultural Olympiad 2012, a four-year programme of cultural events leading up to the Olympic and Paralympic Games. Reflecting London's momentous year on the global stage, the 2012 BBC Proms programme is packed with world premieres, beloved classics and internationally renowned musicians.
Festival of t
June 1 - Sept 9 Southba
An urban beach with a tw the chance to work with and festival has it all.There wil take part, plus art, music,
medicalstudent
Superhuman July 19 - Oct 16 Wellcome Collection Incorporating a wide range of different perspectives, from the athlete to the fictional superhero, this exhibition will explore how human ability has been enhanced in the past, contemporary approaches to the subject and what those working at the forefront of human enhancement anticipate for the future.
Coldplay June 1-2 Emirates Stadium Galaxy-conquering popsters hit the most mahoosive of enormodomes, playing principally from their latest album, 'Mylo Xyloto', which adds experimental R&B and electronica to their uplifting and grand-scale, well-crafted alterno pop/rock, without sacrificing any of their crowd-pleasing big-heartedness.
mmer in London
do for London, but what London can do for you
London 2012 Olympic Games July 27 - Aug 12 & Aug 29 - Sept 9 The world comes to visit, as the east end of London is turned into a haven of athletics and sports stars. The olypmics kicks off with football, followed by the paralympics two weeks later. If you haven't got tickets for any of the events, and aren't taking part, we suggest you avoid this area like the plague. No, really.
London Literature Festival he World
ank Centre
wist, the largest ever UK poetry festival and d learn from the world’s leading artists – this ll be many opportunities to get stuck in and comedy, markets and free events to enjoy.
July 3-15 Southbank Centre This festival brings together international, world class poets, authors and speakers representing the spectrum of creative disciplines for more than a week of talks and events. The line-up is yet to be announced, but previous highlights have included Iain Sinclair, Alan Hollinghurst, Zaha Hadid and Philip Pullman.
10
May 2012
Comment
medicalstudent
Comment Editor: Rhys Davies comment@medical-student.co.uk
The Matter of Mind Robert Vaughan peels apart the nature of consciousness
L
ast week, I handed in my first year student selected component. At George's, that equates to 1250 words on a hot topic question chosen from a list of options. I chose to answer whether depression is an over-diagnosed modern day disorder. I thought it would be fun taking on a philosophical, historical question over some boring statistical one. And I quickly discovered that 1250 words are by no means enough to answer said question. Depression’s history is one of intense complexity, harrowing instability, and inescapable confusion.
Less is understood about the brain and/ or the mind than anything else in the universe. All the other body systems are limp-wristed side characters compared the real star of the show, conscious thought. After studying the philosophy of the mind, I picked eliminative materialism as my camp. It might be best to divide the school in two to explain it. The first point is that concepts like consciousness, the soul, and the qualitative na-
be reduced, it must be eliminated. In the 1800s, we spoke of illness as the action of evil spirits upon the body. The reason we can't logically apply evil spirits to medicine is because evil spirits do not exist, and as medicine came into play, the idea of witchcraft and phantoms became so obviously incorrect that we banished them entirely from the field of medicine, and I wager that sooner or later the same is to happen for the idea of ideas.
drugs that do not affect mood but do affect serotonin, and drugs that do not affect serotonin but do affect mood. We generate dopamine when we sleep to re-sensitise our neurones, but why does this make us feel more awake? I'm not talking about physiology, I'm talking about the redness of red, and the sadness of sadness. Or am I? The concept of eliminating the idea of the mind is mind-bending. I'm defeating the argument as I write it, aren't
"Less is understood about the brain and/ or the mind than anything else in the universe. All the other body systems are limp-wristed side characters compared the real star of the show, conscious thought. "
Let us be honest here. We have no idea why we sleep. We don't know when the almost instantaneous exchange of potassium for sodium across a myelinated membrane becomes a thought. We don't know why we make pictures in our head that seem to have location even though they don't. And ultimately we have no idea what consciousness is.
"What is a painting? A painting is a beautiful thing. It inspires, it enlightents, it illuminates. Or rather, it is a collection of paint flecks arranged on a piece of canvas that seemingly gives rise to these complicated properties." Opinion, subjectivity, and adjective description dissolve in the sea of neurobiological mechanism. Happiness would no longer exist. It would be replaced with a concentration of dopamine in the frontal cortex in the brain that is raised above normal. Suddenly, our blinders would be taken off, and the mystery of depression would just be waiting to be unlocked by complex neurobiology, not discussion about our non-existent thoughts. Would it really be so surprising if the mind, like every other known thing, bows to the laws of science, and nothing else? The rabbit hole is a scary place to venture down, Alice, but there are no answers back at your garden party left to be found.
One of the points I managed to make was that depression's definition is inevitably manipulated by consumer capitalist pharmaceuticals companies, and how for a brief time, most mental diseases were solely defined as by being made better by Prozac, which was obviously no good thing. But that aside for now, my main argument was that depression, thought, and the mind in general are so complex and misunderstood, that it would be impossible to not correctly encapsulate what it is to be depressed, and this would ultimately lead to many not knowing whether they were depressed or not. After finishing the essay, I am left thinking about what it might take to truly understand what depression is, and so, I find myself back in the fiery, cognitively closed pits of philosophy of the mind.
"We generate dopamine when we sleep to re-sensitise our neurones, but why does this make us feel more awake? I'm not talking about physiology, I'm talking about the redness of red, and the sadness of sadness. Or am I?"
enough to the Mona Lisa to realise it was a painting at all? All your life, you would see it as what it is intended to be seen as, a beautiful woman. And that's what consciousness is, an illusion. It is mentally painful to try and peer around the back of the mirror but I think it's where the mystery of the mind ends. When does a foetus gain a mind? Never. Because 'minds' aren't real things, just like the beauty of the Mona Lisa.
"Would it really be so surprising if the mind, like every other known thing, bows to the laws of science, and nothing else? The rabbit hole is a scary place to venture down, Alice, but there are no answers back at your garden party left to be found." I tried to pin down a single thought, to dissect it with my scalpel, but it escaped me with all the grace of a butterfly. ture of experience will not, and cannot, be reduced by modern science. This is appealing, isn't it? We understand so much about the universe, but so little about our minds. If I were going to be arrogant, I could say, ‘If we still don't understand the mind, there might be something wrong with what we're trying to understand.’ The second concept in eliminative materialism is that as the nature of consciousness cannot
Now obviously, neurobiology is a prominent area of science in the modern age but making connections between conventional biochemistry and people’s thoughts is still shrouded in mystery. Prozac was probably a good start in trying to physiologically define depression. It slows the reuptake of serotonin by the body, and it made you happier. So serotonin is what makes you happy right? No, because there are
I? This arrangement of letters on a page are brought about by the idea of this article in my mind, isn't it? Maybe not? I'll try an analogy to argue the point. What is a painting? A painting is a beautiful thing. It inspires, it enlightents, it illuminates. Or rather, it is a collection of paint flecks arranged on a piece of canvas that seemingly gives rise to these complicated properties. But what if you could never get close
Okay. I'm done trying to persuade you. Shake your head and blink a few times, as I will. Go back to reality. The reality of the beauty of the redness of red. The reality of the thrill and rush of climax. But, with it, the reality of 12% of people seeing every house party as a little less exciting, every sexual experience feeling that little bit more numb and seeing every colour tinted by that unrelenting grey. And the reality where neither you nor your GP could ever understand what depression, or a thought, actually is
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medicalstudent
May 2012
11
Comment Trimming the fat from the NHS David Fisher Staff Writer
How many medical students sigh when their OSCE station is made trickier by having to palpate an obese patient? I imagine quite a few. How many actually wish to punish their patient? I imagine very few. Yet, more than fifty percent of surveyed doctors on the networking site doctors.net.uk expressed support for the notion to essentially punish obese patients and smokers by withholding non-emergency treatment. This is a disturbing statistic. It is true some procedures are less efficient if the patient smokes or is obese and consequently 25 primary care trusts restrict access to procedures including hip replacements and in vitro fertilization. The trusts prefer to allocate money to patients who are deemed to live more appropriate lifestyles. This seems rather arbitrary. Following this line of reasoning, we should also surely restrict access to dental fillings for people who eat sugary foods.
Applying such a penalty does not make sense financially. It is estimated smokers contribute eleven billion pounds into the national economy in the form of tax revenue but smoking related diseases are believed to cost the NHS five billion pounds. The justification for penalising specific groups in society based on this principle is lacking.
"Following this line of reasoning, we should also surely restrict access to dental fillings for people who eat sugary foods." How can it possibly be that doctors are contemplating this action? In light of the duty of care owed by doctors and the universal principle of non-maleficence, knowingly neglecting patient care is wide of the mark. Furthermore, the first principle in the NHS constitution guarantees ‘a comprehensive service, available to all.’ It must surely be an indication of a deeper issue beneath the superficial question of whether
certain patients deserve treatment. Scratching beneath the surface of this vote might reveal that growing numbers of doctors are realising and beginning to grapple with the unsustainable growth in demand for NHS services.
"How can it possibly be that doctors are contemplating this action? In light of the duty of care owed by doctors and the universal principle of non-maleficence, knowingly neglecting patient care is wide of the mark." People are living longer and chronic disease is an increasing financial burden. The health budget is buckling under this excess weight and even starting to falter as evidenced by the rationing of services that has already begun. The government has attempted to address these concerns by proposing long-term changes to service commissioning in the hope that money will be saved as
Farewell... services become more targeted and cost efficient. For a while it seemed people were in denial over the predicament and opposed the proposals. Only recently has the watered-down and battered bill managed to scrape through the House of Lords. The number of doctors who expressed support for withholding treatments from sectors of society is evidence that the wind is blowing in a new direction. It shows that not only is there an acceptance that there is a scarcity of resources within the NHS, but also a new willingness to search for solutions. However, targeting people who pursue a way of life contrary to societal convention and subjecting them to a second-class standard of care is an unacceptable manipulation to tackle financial shortages. It is laudable that these doctors are thinking of how to tackle the longterm future of the NHS, but they must be careful not to stomp on people’s rights in the process, even if it will save money
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The carefully planned art of spontaneity Zara Zeb Guest Writer
Vitamin D rains down from the sunny sky and I sit indoors with my plans for the evening cancelled. Anything to postpone revising for the upcoming test, I do my chores and twiddle my thumbs. When I can take the procrastination no longer, I leave the house. I have no idea where I’m going, or how safe the area is, but I need to be outside breathing the fresh London air. I reach a junction and decide to turn right. I spot a car boot open with Sainsbury’s shopping on display and neither shopper or car owner in sight nor a front door open. People must be very trusting around here, I think, or just pushing their luck. After aimless wandering and noticing weird and ugly things, such as two rather grim and inaccurate bull dogs guarding a front door and Victorian carvings above doors, I realise I’m walking in a massive square shape and will end up back in my room before I know it, so I begin to look for signs for a diversion. The sign I decide to follow is a small, indiscreet sign that I never knew existed. It proclaims a lake and waterside nearby. Following the sign, I come to a neatly tucked away slice of paradise. A big green field lined by an impenetrable black fence. Following
the fence round, I accidently stumble across a community centre, and the most gorgeous lake I have ever set eyes on. I watch swans, geese, ducks and a few other species beyond my limited bird knowledge dance across the lake.
"Anything to postpone revising for the upcoming test, I do my chores and twiddle my thumbs. When I can take the procrastination no longer, I leave the house. I have no idea where I’m going, or how safe the area is, but I need to be outside breathing the fresh London air." As I walk around I witness a woman on the bank with a baby strapped to her front doing Tai Chi. An elderly gentlemen and his middle-aged son are tear-eyed at a memorial bench. In addition to this, our four legged friends are running everywhere. As dog after dog races past me, I thank the heavens that the gene inherited by nearly every Pakisatani bypassed me – that gene responsible for embarrassingly running to the opposite side of the road to any four legged creature. After a good walk, I decide to head back, ready to sit at my laptop procras-
tinating a little longer. After 15 minutes I realise that I may not have actually been walking in a square after all and that I don’t know where I am. Unfortunately for me I left my Oyster card and money back in my room in my hurry to be spontaneous. Shrugging my shoulders, I continue with my adventure knowing that sooner or later I will return to my room, and if I really don’t know where I am, I’ll ask for directions.
When I get back to my room, my whole body is calmer and relaxed, and my brain is ready to take on the complexities of vitamins and minerals. A smile lingers on my face long after the walk, and I want to smirk at the poor souls who need to search Google Maps for everything, schedule every little thing and most boring of them all, put a date in their diary to do something spontaneous.
"I watch swans, geese, ducks and a few other species beyond my limited bird knowledge dance across the lake. As I walk around I witness a woman on the bank with a baby strapped to her front doing Tai Chi. An elderly gentlemen and his middle-aged son are tear-eyed at a memorial bench."
"Thankfully, a little while later, I recognise a street name which takes me back to the shops I pass on a daily basis – the shop with the creepy owners, the kebab shop whose menu I have yet to try, a cake shop that doesn’t seem very appetising, and the charity shop where I bought 16 books for four pounds."
Thankfully, a little while later, I recognise a street name which takes me back to the shops I pass on a daily basis – the shop with the creepy owners, the kebab shop whose menu I have yet to try, a cake shop that doesn’t seem very appetising and the charity shop where I bought 16 books for four pounds.
Next time I’ll be sure to take my Oyster card. Maybe I’ll see where a bus takes me and walk my way back? Who knows? The possibilities for an adventure are endless
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Rhys Davies Comment Editor
This marks the end of the last Comment section with me as its editor, before I am dragged, kicking and screaming, back to jealous embrace of medicine, that divine mistress. Kicking and screaming. My time as editor has been fun, entertaining, at times, exhausting. In the beginning, it was exciting, lying to the editor-in-chief about my prowess in CS5. The middle pages of The Medical Student were my realm, to rule as I saw fit. For some things, I could follow the holy edicts of Saint Sarah of Pape, the most wise of prophets. Other things, I had to make up on the fly. It has certainly been an experience, putting together the biggest student newspaper in London each month. Most of time, my position just sat in the back of mind, the source of a quiet sense of pride. Then, as the monthly deadline loomed, the panic would begin and I would realise that I had no articles to run over four entire pages. More than once, I considered filling a page with just a brace of massive quotation marks. After a hearty slap, the editor-in-chief convinced me to try printing actual words. At this point my monthly salvation would arrive. My writers would send me their musings, from serious medico-political topics to wonderment at London transportation. The Medical Student, especially Comment, could not survive without the contributions of London’s medical students. Working with just a fraction of our potential writers has been one of the most rewarding parts of this job. So I’m off to brave new worlds and final frontiers! Oh, and medicine. But I’ll still be around, writing the odd thing or two. I might even branch out. I was recently published in a blog on the BMJ website (http://blogs.bmj. com/bmj/2012/05/01/rhys-davies-thepatient-will-see-you-now/). That was totally not a plug, I swear. Anyway, I hope you’ve enjoyed reading Comment this year as much as I have enjoyed editing it. Goodbyeee…
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So long and thanks for the fish.
12
May 2012
Culture
medicalstudent
Culture Editor: Kiranjeet Gill culture@medical-student.co.uk
The Doctor Will See You Now... Rhys Davies Comment Editor It's always something different when the doctor puts down the pills and picks up the pen. With Max Pemberton, you have to wonder if he ever puts down the pen. With regular columns in The Daily Telegraph and Readers’ Digest, and now his third book, The Doctor Will See You Now, there can't be much time left for his patients. I very much enjoyed his previous books, Trust Me, I'm a (Junior) Doctor - detailing his life as a first year house officer - and Where Does It Hurt - recounting a year practising medicine on the streets - and was looking forward to this instalment. This book describes his year working on a Care of the Elderly ward, perfecting his skills in general medicine before training as a psychiatrist. Presumably his fourth book will be called Take Two Of These And Call Me In The Morning. In order to skirt around confidentiality issues, Pemberton fictionalises his encounters with patients and staff. Furthermore, the whole book feels novelised as events dovetail nicely
together for pace and narrative. However, that doesn't damage the essential truth of the story that Pemberton is trying to tell. Many of his patients serve as springboards or examples of a wider social issue he wishes to highlight. Michael Foxton did a very similar thing in his darkly humorous Bedside Stories. Pemberton utilised this in his previous books also; homeless people, the mentally ill and the elderly - sometimes all in one patient - are all areas where the failings of the NHS and our wider society are seen more keenly.
"Instead, Kafkaesque and byzantine rules and regulations, personified by the anonymous hospital managers draw Pemberton's ire." However, Pemberton is fiercely supportive of the NHS and, of course, rightly so. Universal healthcare, free at the point of access, is something to be always proud of. Instead, Kafka-esque and byzantine rules and regulations, personified by the anonymous hospital managers draw
Pemberton's ire, as well as 'Big Pharma', private finance initiatives, and nursing homes that medically cosh their residents with anti-psychotics. Pemberton writes in a rather simple style. This gives the book an air of unput-down-ability. Obviously aimed at a lay audience, some medical students may get impatient with this book but the inverse is surely worse. Anything intentionally aimed at medical people runs the risk of being terminally dull. The characters - based on real people, or a composite of real people - are not wholly two-dimensional but could do with more fleshing out. However, this isn't a novel so it is arguable whether that is necessary. It must be said that care is taken to build the patients' stories, to make sure they matter as much as the point they are being used to convey. An endeavour worth while. I won't go as far to say that this should be compulsory reading for medical students because compulsory reading is universally read by no-one. However, it is an enjoyable read, especially if you like reading about medicine outside of the lecture theatre, and it certainly does make for a change of pace from all the textbooks and academic papers
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Vintage Film Review: One Flew Over the Cuckoo's Nest Durria Rubat Guest Writer Once you have seen One Flew Over the Cuckoo's Nest, you don’t forget it. My first viewing was as a child, and an accident. I had snuck into the living room with the aim of watching movies beyond the watershed as my parents slept. I remember being transfixed to the grainy images on-screen, listening to the crisp dialogue, sitting on edge of my seat the whole time. The violence left me breathless. I wasn‘t sure whether to close my eyes and leave the room, or to continue watching this ghastly spectre. Needless to say it was a long time before I repeated the experience and even today, the film is just as gruelling on the senses. That is not to say that it is not a work of art - Jack Nitszche’s score alone deserves every accolade poured in its direction. The film, written by Bo Goldman and directed by Milos Forman, is set within the confines of a psychiatric institution in Salem, Oregon, where the inpatients are involved in rehabilitation programmes overseen by Nurse Ratchet. She is a collected over-matron, under the watchful
eye of whom the institution runs. The mantra and ethos of the place is discipline, rules imposed with iron fists - but these systems collide violently with the introduction of institutionhostile Randle - played by Jack Nicholson - and thus a revolution begins.
"The film reflects the emerging sentiment of the time, where people were beginning to question the role of institutionalisation ... and analysing methodologies applied in many of the asylums. " Driven by a kaleidoscopic moral righteousness, he begins to convince the other patients of their worthiness, trying to re-focus their attention on reintegrating with society at large, rather than being distracted and cowed by their own lack of confidence and fear of rules and regulations. This is how the dye is cast and it is known that things can never really return to the way they were. Much befitting its era, the film reflects the emerging sentiment of the time, where people were beginning to question the role of institutionalisation,
rehabilitation and analysing methodologies applied in many of the asylums. The cast and characters are a bizarre bunch and their odd narratives and awkward, distinguishing looks are well reflected in the casting, all actors portraying a necessary wayward shiftiness. However, they remain stubbornly adorable and intriguing - the subplots drawing in the viewer in and forcing an emotional intimacy that makes the twists, the deaths and the heartbreaks all the more poignant. It is difficult to know when Nurse Ratchet becomes the enemy and what she stands for, but it is without a doubt a movie about underdogs fighting something greater, something oppressive and she makes a convenient poster-girl against which their frustrations are focussed. It is difficult to write about this movie without wanting to discuss what it means. Beyond being a human, tender story about the lives and hurts of a motley bunch it could also be an anti-establishment tale or a warning to society about where medical institutions can go wrong. This is all for the viewer to discern, but it is undoubtedly a well crafted piece of art, deserving of every award, and the merits of which have rarely been repeated by either the literary world or Hollywood
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medicalstudent
May 2012
13
Culture
Brains: The Mind as Matter
Online Revision Ashik Amlani (ICSM)
My Soul (2005), a laser engraving by Katharine Dowson. Credit: Wellcome Library, London
Kiranjeet Gill Culture Editor ‘Brains: The Mind as Matter’ is a major exhibition currently on at the Wellcome Collection. Anyone who’s read my columns before will know that I’m a big fan of the museum, and having been to a fair few of its exhibitions I seem to have developed a mantra: expect the unexpected. I consider myself something of a neuroscience enthusiast, but as my knowledge is stuck firmly at the molecular level, I was really interested to see how the exhibition would deliver its promise of focusing on the brain as a physical object - one that we can slice up and scrutinise, pickle and preserve – rather than on any notion of the brain as a control centre. And so, after watching a promotional video depicting something called a skull plough, having also played an incredibly exciting and reasonably informative axon-themed game and observed a warning about the disturbing nature of some of the exhibits, it was with a slight degree of trepidation that I paid my visit. ‘Brains’ was by far the busiest exhibiton I’ve been to at the Wellcome Collection - a testament to our enduring fascination with what is arguably one of the most complex and mysterious systems in the universe, and a sure sign that once again the Wellcome Collection has come up trumps with its latest offering. The exhibition is split into four parts – Measuring/Classifying, Mapping/Modelling, Cutting/Treating and Giving/Taking. Spanning from a mummified brain from ancient
Egypt to a very modern piece of artwork incorporating a QR code that links you to MRI scans of the artist’s brain, the exhibition is very much about a meeting of art and science. On entering the exhibition, the Measuring/ Classifying section shows how 18th and 19th century scientists and doctors became obsessed with the idea that the appearance of the brain and skull could uncover key personal traits – intelligence, or criminal tendencies, for example. On the relatively harmless end of the spectrum, this incessant classification gave rise to the quack science of phrenology, but much more sinisterly also led to attempts to link brain size or appearance with the evolutionary progress of different populations, including by Sir Francis Galton, the so-called father of eugenics. In the Mapping/Modelling section I felt I was on familiar turf, and was slightly awestruck to see in real life a selection of the beautifully intricate etchings of Santiago Ramón y Cajal. The Cutting/Treating section contained, as one might expect, the usual assortment of curiosities – trephined skulls, bullets lodged in brains and an array of barbaric-looking surgical instruments-cum-torture devices. The ‘skull saw with crank handle’ particularly sticks in my mind, looking, as it did, a bit like a high-tech pizza cutter. Another fascinating exhibit was the futuristic MD20-3D Medical Imaging System which uses composite CT and MRI images to create holograms of the intracranial cavity, brain and vasculature. Whilst the general public is likely to be equally fascinated and disturbed by the sight of pickled brains in jars, as a medical student
I had a slightly smug feeling of ‘been there, done that, got the formaldehyde on my teeshirt’. So for me, where the exhibition really excelled was not in the physical specimens on show but in the Giving/Taking section, dedicated to those who donate their brains to medicine and science. I was really moved by a series of photographs entitled ‘After I’m Gone’, and I now feel more privileged than ever to be able to say that I have held a human brain. The desire of the donors to make a difference in the world is both humbling and inspiring. Another highlight of the exhibition was the artwork that was a common element in all four sections. In addition to anatomical drawings, there were a number of creative pieces. Two pieces, ‘Me, Myself and I’ and ‘Hearing Voices’, are particularly memorable, depicting the terrifying loneliness and inescapability of mental illness. A series of self-portraits by artist William Utermohlen chart his descent into Alzheimer’s Disease, his once colourful and intricately detailed work becoming increasingly simplistic and distorted. His final piece of work, a simple sketch, is barely recognisable as human – a stark and sad reminder of how Alzheimer’s disease cruelly robs its victims of their faculties. With so many amazing things to see, ‘Brains’ is a wonderfully curated and beautifully presented exhibition, and truly cements the Wellcome Collection’s self-created accolade of being a destination for the incurably curious
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Brains: The Mind as Matter is on at the Wellcome Collection until June 17th.
As exam season draws ever closer, we medical students leave no stone unturned when it comes revision. A common concern seems to be the lack of realistic practice questions, in no small part due to the universities' reticence regarding the release of mock questions. How is it, then, medical students can get access to this most holy of revision grails? Well, where there's a will, there's a way. There are a plethora of resources available to the enterprising medical student. Those of you in clinical years will be familiar with the revision EMQ books on the market such as PasTest or Get Ahead!, but perhaps not so aware of similar online offerings by companies such as OnExamination, PassMedicine, and the subject of this review, Exam Consult. The premise is simple - you pay a subscription, and they give you access to thousands of MCQs with answers and feedback. Exam Consult, created by Elsevier, is no different. They promise over 2000 questions (about half that of some other websites) written by an "expert" panel with short rationales from your favourite textbooks, performance analysis, and the ability to customise your own tests. I approached this review well versed in the competition, and I had high hopes for Exam Consult. They cater for all stages of medicine, whether you are doing basic sciences or if you are looking for finals questions. You can choose a length of subscription ranging from one week up to twelve months. A good, but hardly groundbreaking, feature of the website is that it allows you to pick and choose exactly what topics to have in your test that you create for yourself. Then, you have to pick whether you want to do the exam under timed conditions with answers at the end, or as a practice session with answers after each question. Finally, choose how many questions you want and you're off! Deciding to start alphabetically, I picked 30 cardio questions to warm up. Unfortunately, on first glance there seemed little to compliment. The general interface and usability of the website left a lot to be desired, especially when contrasted with the strong offerings from others such as OnExamination. Navigating from question to question and receiving feedback is not intuitive, and could do with polishing. The question content, however, is where Exam Consult shines. Having done questions from many other sources, I found Exam Consult appropriately challenging and varied. An external examiner for two UK medical schools was heavily involved in the creation of these questions, and it really shows. I personally found the questions extremely useful in preparation for my EMQs. The explanations were also taken from such books as Kumar and Clark, ensuring their quality and authenticity. There are, inevitably, some downsides. Whilst the quality of the content cannot be refuted, Exam Consult offers little in the way of extra features such as mobile access, the ability to pick questions of varying difficulty, or access to e-lectures. They do, however, give you free access to some bonus online content on Student Consult. Finally, the issue of cost. With a three month subscription for £30, Exam Consult compares favourably to OnExamination (£36 for 3 months), but not to PassMedicine (£10 for 4 months) and PasTest (£35 for 6 months), especially seeing as the question number is smaller. The ability to buy in small chunks such as one week or month is unique to Exam Consult and means you aren’t tied in, a key advantage in my view. So if you're looking for an online revision tool, you're spoilt for choice. If money is no object and the relative lack of extra features or finesse does not concern you, I would recommend Exam Consult due to the sheer quality of the questions. If, however, you are looking to get the best value for money, then I would also consider
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