MS_Nov_12

the

medicalstudent The voice of London’s Medical Students

November 2012

BUCS Controversy Continues Life as a Max-Facs Surgeon Page 6

Phobia of Success Page 8

Extended Consultation Period Ends Katherine Bettany

This month the extended consultation period on the British Universities and Colleges Sports’ (BUCS) Medical School proposal came to an end, amongst fierce debate between BUCS representatives and union representatives from several London universities, most from notably King's College London Student Union (KCLSU).

Under the current rules, sports teams can compete under different departments, e.g. medical schools, but originate from the same institution.

Described as ‘higher education anomalies’, in July 2011, students were made aware that at the BUCS AGM, a proposal was made to try to merge such sports teams to ensure all teams are treated ‘fairly and equitably’. This caused inevitable tension and unrest within the medical school unions and students affected, leading to BUCS removing the proposal from the agenda of the AGM. The official consultation period began during the summer of 2011, and was nearing its end earlier this year.

‘In this process, BUCS made members aware that the situation of medical schools was felt to be inequitable against that of other members. [...] Individual students should not be able to pick and choose who they play for. This is not allowed for any other member’s students, and is not fair in a membership organisation to treat some members more favorably than others’. BUCS indicated to those affected that it felt this should be addressed and asked institutions to tell them what they thought. ‘This was taken at the time as BUCS imposing a decision onto the schools that they must be eliminated as members, which BUCS has never said it wanted.’

‘BUCS does not have a view about which decision any institution should take on this. We absolutely recognise that the heritage of some of the nation’s oldest sports clubs is powerful and evocative, and we think the solutions offered mean that the identity of the medical schools

teams should be preservable within either of the options we have offered.’

In January, UH Medgroup sent a letter to the BUCS London Regional Meeting, resulting in the consultation being extended to the end of October.

In the letter, the consultation process was described as inadequate, ‘especially with regards to the involvement of the student representatives from each medical school as well as all of the medical students within each institution.’ The extension, aimed to give institutions time to consult the student body and ‘put forward new information [that might] impact upon the decision reached’, however, has not brought peace or clarity - student representatives remain confused and dissatisfied over proceedings. After the written submission deadline on the 2nd of November, the proposal will be turned over to the BUCS Advisory Group (AG) discussion on the 4th of December, where a final decision will be made.

The proposal, described by a KCL representative as ‘deplorable in the wake of the Olympic and Paralympic games’, outlines two options, one of which states that medical school teams should be removed entirely from BUCS and merge with their parent institution teams. 'Some further anomalies remain – BUCS is aware that some institutions currently permit some schools or departments to compete as individual members despite actually being a formally recognised part of the University - this applies mostly to former medical schools.

BUCS will work with those institutions affected by this to remove this anomaly in the coming year with a view to all such arrangements ceasing from 2012. Any institutions which wish to make this change immediately are welcome to do so.'

It was reported earlier this year that Imperial had counter-proposed a method whereby Sport Imperial would (cont’d on page 2)

Doctors, Dissection and Ressurection Men Page 13

The Hospital Bed Page 14

Darts Darts Darts...

Back page

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November 2012

News

News Editor: Katherine Bettany news@medical-student.co.uk

Editor-in-Chief

David Smith & Luke Turner ULU Medgroup Chairs Well hello again! We are feeling particularly smug over here at Medgroup following on from the most successful 999 in history, our first ever sellout event. Although ICSM managed to sell the most tickets, they did so using controversial tactics, so St George's were handed the ‘best turnout’ crown.

The event was enjoyed by all, most notably ICSMSU President Shiv 'do you know who I am' Vohra who spent the majority of the evening downing jäger bombs with freshers and generally avoiding doing any work.

Medgroup continues to work hard for all of its students, rallying together in a last ditch attempt to hold off BUCS’ attempts to merge our sports teams with those of our parent institutions. Whatever the outcome, we will work tirelessly to ensure that all of our medical

Purvi Patel on the November issue

students continue to have the opportunity to participate at the highest level while also being able to enjoy themselves. We are also extremely excited about the upcoming UH Sports Night, hosted by Right To Play, on Wednesday 28th November at the Clapham Grand.

We hope to see many of you there!

Please remember that we value your input into all issues and welcome anyone to our meetings and socials, so please feel free to get in touch by emailingchair@uhmedgroup.co.uk

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Andrew Smith BLSA President First things first, a thanks to the UH chairs for organising this year’s 999. I think a fantastic night was had by all!

It is scary how long ago 999 seems and that we’re halfway through the first term. So much done, but yet so much more to do! No doubt it’ll be July before we even realise it.

One of the major things to happen on BL shores is that on the weekend of the 27th-28th October, BLSA hosted the International MedSoc Conference at St Bart’s hospital. This welcomed Medical Societies from around the country (plus some international students) to discuss the theme of Leadership and Management in Medicine. There were also plenty of networking opportunities to share best practice and make new friends.

I hope that all those who attended

from the UH schools had a great time.

We also had a successful William Harvey Day, an annual event celebrating the research of the university followed by an academic procession, a service in one of the churches associated with the hospital and a formal dinner in the evening - always a special day.

BL has also been graced with a production of The Importance of Being Earnest as the Freshers’ Play, as well as the Fresher Music Concert. Both fantastic performances and evidence we have a bunch of talented freshers!

Until next time

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Mathew Owen SGUL President As the dust begins to settle on, what seems to be, the already distant memories of Fresher’s 2012, it’s back to business as usual for the London Medical schools.

Imperial were back to their old cheating ways at the recent 999 event at the Ministry of Sound. In their desperation to break the age old stigma of Imperial students being more anti-social than a TB-ridden badger hiding from the cull, they kept their ticket sales open way beyond the closing time.

This additional time for sales somehow enabled them to knock George’s off top spot in the ticket sale tables.

But there is no doubt that on the night George’s showed exactly why they are number one! I think we will all agree that the night was a massive success and think we all owe Luke and Dave a massive thank you for all the hard

medicalstudent

work they put in organising the event.

Away from the ministry dance floor, November signals the start of ‘show season’ at George’s. The distant beat of drums, frenzied sketch writing and the first four bars of songs on repeat can constantly be heard from all corners of the university at the moment as the casts of the Fashion Show, Diwali Show and the Revue put themselves through their paces.

Meanwhile the rest of the university eagerly hold for breath for the big performances at the end of the month

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F

irstly, hats off to Medgroup for giving us all such a fantastic night out at 999. In case you happened to miss it, the highlights are covered across the page. I am eagerly anticipating their next campaign, especially after the most illuminating evening a few weeks previously. Composed largely of ‘men’, my presence as a female was disregarded, and I was privy to such secrets, tallies and even pick-up lines that you would never think could be successful.

These last four weeks – has it really been that long? – have felt like a war (what is it good for?), with me fighting a differ-

ent battle every day. But here we are in November, my favourite month of the year, despite the cold November rain. Others may prefer summer or spring months, but November makes me appreciate nature.

While I run the risk of sounding like a member of ‘Friends of the Earth’, I stand by that statement. November is full of warm colours, crisp morning air – all the leaves are brown, and the sky is grey – and there is nothing better than hearing the crunch of leaves underfoot. November even brings us bonfire night, and the fireworks light up the sky – ignite the light and let it shine...

Not only this, but November is the

(cont'd from front page) ‘rank Imperial and ICSM teams according to their position in the BUCS league and form an internal ranking only known to the club and team captains, Sport Imperial and BUCS’. This proposal is still in consideration, and hasn’t been formally agreed by Imperial, ICSM or BUCS; and has drawn a lot of criticism over the threat of decreased participation (there are limits to the number of teams any institution can enter into BUCS). Other London Student Unions, including RUMS have proposed similar solutions, whilst Queen Mary’s, the parent institution of Barts and the London, would rather see a merger (a proposal rejected at the BLSA Students President’s Council.)

Kings College London Student Union held a referendum last year, posing the question ‘should KCLSU continue to support KCL and KCLMS sports clubs/teams?’: the answer being overwhelmingly yes (2504 votes to 147 ‘no’ votes, with 14 abstentions.)

In a series of emails between Union representatives from KCL and BUCS CEO Karen Rothery, questions with regards to the validity of the proposal, in terms of the constitution, have been raised. It was alleged that the proposals would essentially result in BUCS members being ‘expelled’ from BUCS, a move that according to the BUCS Articles, requires AGM approval.

The proposal will now not be going to AGM, and a decision will instead by reached by the Advisory Group in December. Rothery hit back, stating that

‘AG is not a decision making body, but is key for use in BUCS.’ The Advisory Group is designed to facilitate discussion and debate concerning issues of importance to its membership, and for BUCS to understand and take into account members views. ‘BUCS never discounts or ignores the views of AG, whose very clear role is as our key route to member consultation. It is the democratic route for members to tell BUCS what they think and every member has access to the consultation conducted through membership of and engagement with their Regional Executive, as long as the region is working effectively’. It was also claimed that the changes would not require a change to Articles, therefore an AGM would not be required. However, in the spirit of good relations, the proposal was submitted to AGM in 2011 for its information and to signal its agreement. In fact, according to BUCS ‘the proposal we put together based on the discussions we had had with the medical schools and their parent institutions was put to Advisory Group in advance of AGM, and agreed without comment. So all members have in fact been consulted on this through the formal channels for that purpose.’

Amidst all this controversy and confusion, what is clear is the politics of this issue are very intricate, and require careful navigation. So far, only one member suggestion has been made, but BUCS remains ‘open to new information from members and to consider the views members wish to

the

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month of remembrance, where we pay our respects to the brave people who have served, and are still serving their countries with pride. Poppies galore!

That was my attempt at being reflective, do me let know what you think.

If, like others, all you see is incompetence, well, we’re always open to ideas: editor.medicalstudent@gmail.com

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present to us’. However, Rothery added that ‘there is no guarantee that any amendment to the proposal that BUCS puts to Advisory Group on behalf of the medical schools would necessarily be accepted by it – if it preserves the current advantages enjoyed by medical school members, then the group could quite easily say it does not agree.’ Students await the decision in December to learn the fate of their sports teams

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What are the Options?

Option One: The medical school teams will merge with their parent instituation. This could: - limit the number of individual entries an institution can make in certain sports - limit the number of teams an institution could have in any given league by hald the number currently allowed.

Option Two: All students currently eligible to play for the medical school can play only for the medical school, and all others can play only for the parent institution (i.e. medical schools will become full BUCS members).

Single clubs would need to split in order to compete.

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: Katherine Bettany Features editor: Alex Isted Comment editor: Robert Vaughan Culture editor: Kiranjeet Gill Doctors’ Mess editor: Rob Cleaver Image editors: Chetan Khatri Sub-editors: Keerthini Muthuswamy Treasurer: Jen Mae Low

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November 2012

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News 999: Imperial Cheats Again Scrubs-clad freshers from the five London medical schools descended upon Ministry of Sound on the 15th October for the biggest night of the year, 999. In the traditional battle to see which medical school is best, universities competed to sell most tickets to their newest recruits.

Imperial won the battle this year, selling a total of 210 tickets. However as they took it upon themselves to extend the online sales deadline without informing the other medical schools, as usual, they were stripped of this title. St

George's were declared the official winners, selling 181 tickets, with Barts and the London following close behind with 177. Students from RUMS, surprisingly, managed to show awareness for life outside of north London, and turned up to an event south of the river – outnumbering their studious GKT counterparts, who decided to have a quiet night in, ready for lectures the next day. DJs from all of the medical schools had slots on the night, keeping the students of London dancing the night away.

999 has been held annually for ten

years, designed to unite London medical students as well as instil a sense of healthy competition. Currently under the direction of UH Medgroup, the event is as successful as ever, now being held every October, followed up by an equally entertaining evening in January, Adrenaline.

The night is notoriously messy, with this year being no exception and those who chose not to scrub up quickly learned their lesson. Here are some of our favourite pictures from the night

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Gareth Chan RUMS Senior President What a whirlwind month it’s been since my last article. We’ve elected two new Vice-Presidents (Education) to the RUMS Exec team and I am delighted to welcome Alice Harper and Ravi Mistry to the team.

RUMS has sided with Barts in the on going battle against BUCS and the never-ending debacle that has been the debate on independent medical school teams, credit has to be handed to my VP (Sports & Societies) both this year and last year for their continued efforts on this crucial issue; Jack and Anya.

RUMS had one of the biggest turnouts in years at Medgroups’ 999

event at the Ministry of Sound. Word on the street has it that our freshers led the way on the dance floor whilst our studious counterparts at Imperial, fearful of missing their first lecture decided to adhere to a self-imposed curfew. For those medics out there looking for a proper Winter Ball with all the trimmings – you are welcome to join us at the RUMS Winter Ball held at the Rainforest Café!

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Shiv Vohra ICSM President So it’s a Friday night. I’m in Walkabout Shepherd’s Bush dressed as Steve Irwin. Slightly inappropriate you might think? Absolutely not – tonight’s the ‘Dead Famous’ Halloween Bop. And it’s finally a chance for ICSMSU to enjoy life after the wrath of ICSM Freshers’ Fortnight (which was a fantastic success by the way)!

To add the cherry on the cake, we also topped 999 ticket sales, beating all the other riff-raff, including GKT as usual. Thanks to Medgroup for organising such a brilliant night that was well enjoyed by everyone!

Our ICSM Halfway Dinner was held on 22nd October at the very classy Royal Garden Hotel on High Street Kensington, and I’m told it was a great success – it would have been my second time, but sadly, I succumbed to (a highly virulent strain of) the freshers’ flu. You’d think I’d be immune after 4 years of this…

We kicked off our year of RAG with the Halloween Collect that, de-

spite clashing with a Ministry neon rave or some such malarkey, managed to raise over £5000 – so a massive well done to everyone at ICSM that took part and persuaded/frightened the public into emptying their pockets!

ICSMSU had a 10-strong army that attended the International MedSoc Conference at Barts over the weekend of 27-28th October, which culminated in ICSM winning the bid to host next year’s conference, so best of luck to next year’s organising committee!

Finally, our graduation ceremony was held on October 24th at the Royal Albert Hall, and I’d like to congratulate all of our newly qualified doctors and BSc graduates (even the ones that came from GKT to intercalate)!

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Faheem Ahmed & Dheeraj Khiatani KCLMSA Presidents

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Although we’ve all calmed down a bit since freshers’ fortnight there’s still plenty going on at GKT. We've spread the GKT message across the country with recent netball, football and the upcoming hockey tours – as far as we know everyone returned with all limbs intact (though the same can’t be said for their dignity). RAG have raised another shedload of money with their Pub Golf, and are gearing up for Jingle RAG in December.

This month saw a number of MSA events dedicated to providing our final year students with the best advice and support in their foundation programme applications ranging from portfolio workshops to mock SJT sessions.

We’re also proud to have launched our brand new Peer Welfare Scheme, with a team of 20 medics from years 1-4 being trained up to offer confidential

one-to-one advice to fellow students.

Our student advisors will have been fully trained by March come next year.

With a focus on promoting harmfree care across King's Health Partners, the Safety Connections Conference was a successful inaugural event which set the scene for our upcoming Student Medical Leadership Association (SMLA) events of the month. We were delighted to begin our four-part leadership and management lecture series on October 15th.

Professor Martin Marshall, former National Director General and Deputy Chief Medical Officer sparked off the series with an insight into patient safety and quality improvement

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News ICSM Halfway Dinner Katherine Bettany News Editor On the 22nd of October, Imperial College School of Medicine held its annual halfway dinner for the current fourth year students (class of 2015), to commemorate their reaching of the halfway point of medical school, at the Royal Garden Hotel, Kensington. Speakers included medical school favourite (and possibly very drunk) Professor John Laycock, who regaled us with meandering, hilarious anecdotes and student representative, the universally loved Sybghat Rahim.

Steven Tran, ICSM Welfare Officer and fellow fourth year summarised the thoughts of the year brilliantly. 'Loved it. It was a chance to reminisce the last three years of medical school that flew by. It was great to how 3 years of lectures, PBL, dissection, firms, clubs & societies had brought our year together. As Syb highlighted in his speech, we had shown ourselves to be a year that really gets involved and stuck in.

Research in brief BL: Scientists are working on a new material that could be used to make ‘smart’ T-shirts that could, for example, measure heart rate, report any abnormalities to a doctor, and even administer drugs. Light, flexible, transparent and electrically conductive; nanotechnology would be used to create a material that could essentially retain the same power as a television, but also be flexible such that it could be worn.

And I am proud to be part of the Class of 2015'.

As a ICSM fourth year myself, the night was a poignant one for me.

Looking back on my first day at medical school, the years ahead seemed endless and daunting: I knew I had so much to learn and so much growing up to do. And whilst all those things are still true, it resonates with me how far my year has come already. We have all changed almost beyond recognition in these three short years: it is scary that in the same amount of time again we will be doctors. But the thing that struck everyone that night was the wonderful sense of family and community that ICSM has cultivated in us (I’m sure the same is true across all the medical schools in London.) The support we all receive from our colleagues is irreplaceable, and, when looking around the room, I didn’t see competitors, but people I know I’ll be friends with far longer than medical school.

On behalf of my year, I would like to thank the committee, led by Chair Charlotte Boardman, for organising such a special night

GKT: A new study has revealed that, within ten years, everyday drugs such as those used to treat hypertension, diabetes and skin conditions, could be used for the treatment of Alzheimer’s disease.

The identified drugs have been shown to have additional actions that could help to combat the changes that occur in the brain in Alzheimer’s. This contributes to a body of research aiming to accelerate the search for a cure for dementia.

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Conferences are like buses...

Cheng Zhang and Mihir Sanghvi Guest Writers The International MedSoc Conference 2012 was hosted by Barts and The London over the final weekend of October. For those unfamiliar with the term 'MedSoc', it is a contraction of 'medical societies' and is a catch-all term for the unions, associations or societies responsible for the representation and activities of medical students.

The International MedSoc Conference (IMC) has been running for four years now, and having beaten off stiff opposition from Imperial College in the bidding process at last year’s conference hosted by Birmingham, the 27th and 28th October saw 150 delegates from across the nation (Swansea to Edinburgh) and the globe (AusImage by Charvi Wadwha

tralia to Pakistan) come to London for the 2012 edition; hosted by Barts and The London Students’ Association at St.Bartholomew’s Hospital.

The Conference centred around the theme of 'Leadership and Management in Medicine' and brought together some of the most pre-eminent names in their respective fields: Niall Dickson, CEO of the GMC – a man and an organisation whom we are all beholden to. Colonel Kevin Beaton, formally Commander of 3 Medical Regiment, responsible for medical operations in Sierra Leone, Afghanistan and Iraq and now Commanding Officer at the Royal Centre of Defence Medicine at Queen Elizabeth Hospital in Birmingham, responsible for the care of our wounded servicemen and women.

Dr Swee Chai Ang, a trauma surgeon who has been on the very front line of war, operating in Palestine. As well as individuals held in the highest esteem such as Lord Hameed of Hampstead and Professor Parveen Kumar. Serving British Army Officers also ran workshops on the second day of the Conference, replicating 'command tasks' used in officer training, giving our delegates a taste of what training in the forces is like. The talks were witty, informative and at times sobering and gave our delegates a rare insight into how important leadership is irrespective of the power you wield or the seniority you possess – it is something that we all must learn, whether by design or accident.

IMC 2012 also gave the opportunity

for those holding positions in MedSocs around the country to come together and exchange ideas. London is a rare example of where different medical schools come together in order to discuss issues (UH Medgroup) and it quickly became clear that the representatives from 18 other UK medical schools were extremely grateful for the chance to bring back a clearer idea of some of the good practice that occurs in other MedSocs.

Throwing in the black-tie dinner at a five star hotel in Holborn and the disregard that our delegates held for London prices at the afterparty, it was, all in all, a successful Conference which left people with ideas fermenting regarding how best to position themselves and their respective MedSocs in the future. It took a lot of hard work by the organising committee but it was a job well done and we wish Imperial College all the very best for the 2013 edition.

This month also saw a host of conferences held across ICSM. The inaugural conference of MedApplications, run by medical students from Imperial and Oxbridge was held between the 27th and 28th October at Kings College London (Guy's Campus).

The conference was aimed at school children thinking about a career in medicine, and featured speakers such as Admissions Tutor for ICSM Prof.

Laycock and Dr Andy Steval, FY2 and star of BBC3 documentary series Junior Doctors.

Around 100 students were in at-

tendance, mostly GCSE and lower sixth students from London schools, with group sessions teaching practical skills being led by a small team Imperial medical students. The conference, sponsored by Kaplan, was very successful, and inspired many of the young students to think more seriously about applying for a career that may have otherwise seemed daunting and out of reach.

Last weekend, students were given the opportunity to learn more about emergency care in an international conference on trauma medicine hosted at Imperial College London.

Around 200 delegates from around the world attended to listen to 17 expert speakers talk about trauma management, cutting-edge research and interesting life experiences.

Delicious home baked goodies were provided by a committee member’s mother - who’s pretty good at the whole cooking thing - and delegates were given the unique opportunity for some hands on experience in various practical stations. These ranged from inserting a chest drain into a sheep carcass to rolling your friends around on the floor after you’ve fitted a collar around their neck. The event also showcased some novel ideas from student-led research.

From getting burnt, stabbed, shot and run over by a bus to finding yourself in a cage with an angry gorilla... we were left fully equipped to handle any drunken injuries which might arise on a Friday night

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ICSM: Researchers have developed a prototype ultra-sensitive sensor, allowing doctors to detect the early stages of diseases and viruses with the naked eye. The sensor works by analysing serum samples derived from blood, for markers such as PSA and p24.

Based on nanotechnology, positive results generate irregular clumps of nanoparticles with a bluish hue in the serum, and ball-like shapes with a reddish hue appear for negative results. Whilst being ten times more sensitive than current technology, it is also cheaper and will hopefully lead to more widespread use of diagnostic testing.

RUMS: A study has suggested that breast cancer screening, whilst instrumental to reducing risk of death from breast cancer, is also leading to overdiagnosis.

Cancers that otherwise would have gone unnoticed for the rest of a woman’s life without causing any problems, are now being treated unnecessarily. Although more research needs to be carried out in this area, scientists say that up to 4000 women a year are overdiagnosed, whilst around 1300 deaths are said to be prevented.

SGUL: Diabetics with foot ulcers are at a higher risk of death, heart attack and stroke than those without. This is largest analysis of the relationship between the two that has ever been conducted, with 17 830 diabetics being studied.

These patients generally displayed higher cardiovascular risk factors, and researchers say the findings indicate a need to improve the detection and treatment of those with diabetes and foot ulcers.

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November 2012

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News

Diary of an FY1 Anju Phoolchund on medical students in clinical firms

W

here has time gone? It’s now only three weeks to the end of my first job, and I finally feel like I have (some) control on what’s going to happen on a daily basis. The timing could not have been better, as last week was possibly the most challenging week of all: *DRUM ROLL* the onslaught of medical students on the ward.

Now to some that might seem far less stressful than the time we lost two patients in a single morning, but no one should underestimate how intimidating a large group of fourth year medical students can be to an overworked house officer! I had assumed that the email from the consultant explaining that we were going to receive “36 medical students on Monday” was a typo.

However it turned out that she meant it. Being on the other side of the fence is a very strange experience.

“Unfortunately sometimes there is absolutely no way as a surgical house officer you can give teaching and keep on top of the ward jobs at the same time (and apologies now if you were one of my students!

Perhaps because I was on firms till May of this year, I remember far too clearly what firms can be like e.g. some firms where we (students) would be completely ignored by the team, but felt obliged to come in every day for three weeks, and I’d always promised myself I would never let that happen.

Yet I was (and still am) so anxious to offer these students a positive experience of hospitals, and particularly of surgery.

Unfortunately sometimes there is

absolutely no way as a surgical house officer you can give teaching and keep on top of the ward jobs at the same time (and apologies now if you were one of my students!). My grand plans to watch them examine interesting patients in pairs and apply the “sandwich method” of feedback (turns out I did learn something in ICSM’s teaching skills course!) were over before the Monday ward round even started when I realised we had so many new admissions that I could no longer recognise patient names. This is when “opportunistic learning” suddenly became the only real way I could teach. I decided to offer them every form of teaching possible from the front of a computer screen, meaning I could get them to present scans, or just present their clerking, while I ordered investigations and wrote discharge summaries at the same time. I can only hope they learnt something from my one-man shows waving scans and ECGs at them and talking a hundred miles an hour about someone’s aorta!

Another way opportunistic teaching worked was when the occasional (very keen!) student would ask to shadow me for a couple of hours, and learn by doing “routine” tasks such as reboarding drug charts or writing a fax letter for me. While this might appear to be a waste of time to some, it does mean that (a) he or she saves me time that I can then spend doing formal teaching when I spot an interesting patient, or (b) simply learns by reviewing sick patients with me and following my thought process as I attempt to manage them in a logical way (i.e. as per previous article, don’t panic, follow ABC and if necessary crack open the trusty Pocket Prescriber to work out what antibiotic/antihypertensive to give next).

The final breed of student that I faced recently is my little group of “tu-

tees” that my fellow FY1 and I teach on a Thursday evening after hours.

Despite promising ourselves we will be more organised each week, invariably its 5.15 pm and we are calling FY1s from other teams to get hold of interesting patients before the students appear. This is actually the scariest type of teaching because we have no time to read up (I barely have time to check my emails during the week), but there is a certain expectation that we have all the answers.

Instead we find ourselves retrieving information we haven’t used since finals and hoping it’s correct.

In the end, ward based teaching (in my opinion) is more about the experience than about being taught the theory behind a clinical diagnosis in a very didactic fashion. Any-

one can read about non viable limbs and the need for amputation in a textbook, but talking to the patient who lost his leg to acute ischaemia, how it happened and how he’s coping now means you will never forget that man and how his life turned around suddenly one morning.

“Being on the wards hopefully not only helps you pass exams, but also understand the thought process behind what happened to each of those patients, because before you know it, that’s going to be you.”

It makes the whole of medicine and surgery come alive, because when as a student, you present that history and it’s just another signature in your clinical log book, that person is never going to have his foot back, and the decision for that to happen was taken by someone who was once an enthusiastic medical student twenty years ago.

Similarly, one day each of you will be making decisions that will have huge impacts on people’s lives, based on the things you are seeing and learning today. Being on the wards hopefully not only helps you pass exams, but also understand the thought process behind what happened to each of those patients, because before you know it, that’s going to be you. So listen to your FY1 and bring them chocolates to say thank you

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Required: Editor-in-Chief 2013 Apply by 6th December

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Calendar of Events

BL

GKT

ICSM

Student Staff Conference

To Intercalate or Not?

Medsin Global Health Course

SHAG week

Student Role in Patient Safety

RAG Centurion

13th November

26th-30th November

12th November

13th November

19th November

14th November

7th December

28th-30th November

15th Noveer

8th December

7th December

28th November

BL does Strictly Come Dancing Clubs&Socs Xmas Dinners

Christmas Comedy Revue Jingle RAG

Big Chill

Right to Play

Positively Red Week

26th November - 1st December

RUMS Nothing

Forever

SGUL University Challenge Tryouts

12th November Fashion Show

29th November

Fashion Show and Afterparty

30th November Divali Show

22nd and 23rd November

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November 2012

Features

medicalstudent

Features Editor:Alexander Isted features@medical-student.co.uk

Life as an Oral and Maxillofacial Clinical Fellow A personal perspective from Dr Shilen Patel: Dental student by day, Oral and Maxillofacial Senior Clinical Fellow by night

Image courtesy of Nadia Chaudhry

H

aving just finished a day of dental clinics at University, most students are looking forward to going home and putting their feet up.

I on the other hand, am planning my week ahead and looking forward to the challenges of my oncall tonight. I have a quick shower, grab a coffee and make my way to work. In a few hours, I will be back in a lecture theatre with other students at Dental School.

As I arrive at 7pm, the day Senior House Officer greets me with a look of relief as he promptly hands over the bleep and updates me on the patients and their developments. During the hand-over my bleeps goes off multiple times. I realise then that most of my night will be spent in A&E.

"As I arrive at 7pm, the day Senior House Officer greets me with a look of relief as he promptly hands over the bleep" So what does my night working within the Maxillofacial team involve? As with many surgical specialties, the pathologies treated in Oral and Maxillofacial Sur-

gery (OMFS) are diverse and this is clearly reflected in my patient list.

Through the night, patients of all ages present with broad pathologies, including mandibular and midface fractures from midnight brawls and tragic road traffic accidents, abscesses in the neglected dental patients and lacerations in the overzealous child who has fallen from his bike.

"Mandibular and midface fractures from midnight brawls and tragic road traffic accidents, abscesses in the neglected dental patients and lacerations in the overzealous child who has fallen from his bike" OMFS is an exciting surgical specialty, originating during the First World War, during which the technological advances of warfare and automobiles led to catastrophes and the challenge of complex facial injuries unmanageable by dentists alone.

OMFS developed to specifically diagnose and manage pathologies affecting the mouth, jaws, face and neck. In this modern day, the need for OMFS has per-

sisted, through injuries sustained from road traffic accidents and assaults, as well as the late diagnosis and difficult management of head and neck cancers.

"In the UK, Accident and Emergency departments deal with half a million facial injuries per year and we by no means do this alone" In the UK, Accident and Emergency departments deal with half a million facial injuries per year and we by no means do this alone. Maxillofacial surgeons work closely within a multi-disciplinary team with other specialists including Oncologists, Ear, Nose and Throat surgeons (ENT), Plastic surgeons, Dentists, Orthodontists, Prosthodontists, Dieticians, Radiologists, Speech and Language therapists and Macmillan specialist nurses to name a few.

It is a challenging but rewarding surgical specialty often giving instant results and relief of symptoms. It lends itself well to a range of acute and chronic pathologies and offers job satisfaction via a hands-on practical approach involving a multi-disciplinary team.

OFMS Sub-specialities • Head and neck cancer • Head and neck reconstruction • Facial trauma • Facial aesthetic surgery • Craniofacial surgery • Salivary gland surgery • Implants and pre-prosthetic surgery • Pediatric Maxillofacial surgery • Cleft Surgery • Maxillofacial regeneration

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October 2012

7

Features ahead?

As with other surgically inclined specialties, it is vital to develop surgical skills, as well as the ability to manage patients. Senior medical students can undertake courses via the RCS, such as ‘Basic Surgical Skills’ and ‘Future Surgeons: Key Skills’.

RCS also run an annual ‘Guidance for the Aspiring Surgeon’ training day, which covers a variety of topics, ranging from information on surgical interviews to preparation for the Membership of the Royal of Surgeons (MRCS). Most medical schools have a surgical society and some have an OMFS society where students can learn and share material, whilst keeping up to date with current changes in the specialty.

"As with other surgically inclined specialties, it is vital to develop surgical skills, as well as the ability to manage patients"

OMFS is a one of nine surgical specialties recognised by the Royal College of Surgeons (RCS). Being the youngest, it is a fast growing field with both consultant and trainee numbers available. This is reflected in application competition ratios, which are more desirable than other surgical specialties. This is however, not without challenges along the way.

"In spite of the longer training pathway, the timescale to become a consultant is in line with other specialties" In the UK, trainees must be ‘dual qualified’ in Medicine and Dentistry to enter the specialist register. In spite of the longer training pathway,

Image courtesy of Nadia Chaudhry

Making a decision to pursue a career in surgery can be a difficult one, especially with limited exposure to the different specialties during junior years.

Experience in OMFS is therefore recommended prior to committing to University a second time around and, given changes in university tuition fees and NHS pensions, is as important as ever.

Experience in OMFS can be sought at all levels; as an undergraduate you may approach individual OMFS departments for shadowing experience or an observership. OMFS SHO and Dental Foundation 2 (DF2) jobs are popular and a perfect opportunity to gain experience and insight as a postgraduate.

Currently, the GDC and their European counterparts are reviewing the European Directive, which states that all dentists should spend a minimum of 5 years in undergraduate training. The result, which is anticipated this year, will influence prospective applicants and Universities of accelerated courses across Europe.

the timescale to become a consultant is in line with other specialties, with the average age of a surgical registrar and OMFS registrar being 36 and 38 respectively. This has been primarily due to shortened second-degree courses and the option of reduced duration for foundation and core surgical training for OMFS trainees. Traditionally, OMFS trainees had been in pursuit of a medical degree, having held a primary BDS qualification. This trend is changing, with more medics pursuing a career in OMFS. Around 20% of places on medical and dental degrees are reserved for postgraduate students, predominantly entailing 4 and 5-year courses. Potential trainees may undertake either medicine or dentistry first, leading to the two separate training pathways shown on the right.

So what can students now do to get

When applying for your second degree it is worthwhile checking if the institution requires any formalised aptitude test such as Biomedical Admissions Test (BMAT), Graduate Medical School Admissions Test (GAMSAT) or UK Clinical Aptitude Test (UKCAT); this information can be found in the UCAS book.

Academic training opportunities have consistently been growing and Academic Clinical Lectureships and Research Fellowships are available within OMFS post foundation training

Dentistry primary qualification pathway: • Undergraduate Dental training (BDS or equivalent 5 years) • Vocational training with or without Dental foundation training in OMFS (1-2 years) • Membership of the Joint Dental Faculties or Membership of the Royal College of Surgeons • Core Surgical training competencies (1-2 years) • 6-12 months of OMFS experience • Undergraduate Medical training (MBBS or equivalent 4-5 years) • Competency based specialty training ST1ST6 (Average 6 years) • Consultant

Medicine primary qualification pathway:

• Undergraduate Medical training (MBBS or equivalent 5 years) • Foundation training competencies (2 years) • Core Surgical training competencies (1-2 years) • Membership of the Royal College of Surgeons • Undergraduate Dental training (BDS or "Making a decision equivalent 5 years) to pursue a career in surgery can be a dif- • 6-12 months of OMFS experience ficult one, especially with limited exposure • Competency based specialty training to the different specialties during junior ST1-ST6 (Average 6 years) years" • Consultant

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Sources of extra information • British Association of Oral and Maxillofacial

Surgeons: National Training Day • Royal college of Surgeons KSS • BOAMS • IAOMS • www.medicalcareers.nhs.uk • www.mmc.nhs.uk • www.gmc-uk.org • Postgraduate Medical Education and Training

Board

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November 2012

Comment

medicalstudent

Comment Editor: Robby Vaughan comment@medical-student.co.uk

The Phobia Of Success Robby Vaughan Comment Editor

When I was at college I studied A – level maths. Whilst I think that almost none of it was easy, one of the most problematic areas for me personally was those little systemic slip-ups that I couldn’t seem to stop making. I didn’t find all the concepts as easy as each other, but after some time thinking about them I usually got on with them okay.

"However, I got an A* in math’s, and it was my highest percentage score across my results.

How did I overcome the exams? I practiced them. I practiced, and I practiced again."

When it came to exams however, nervousness seemed to get the better of me. I’d transcribe my formulae wrong, make logical errors, or even just take too long. However, I got an A* in maths, and it was my highest percentage score across my results.

How did I overcome the exams? I practised them. I practised, and I practised again. My college, instead of handing out a long list of ‘learning objectives’ for us to make notes on, just gave us a pack of 15 past papers and mark schemes and sent us on our mer-

ry way. Am I a good mathematician?

Well, St. George's right now would be forced to say that I am not at all.

I should contextualize. During an exam briefing for the second year medic cohort which I belong to at SGUL, students quickly brought up the issue of the prevision of past papers – I should note that there are no such papers provided at the moment.

Not a single SAQ. We were repeatedly given different reasons for why they wouldn’t be helpful, why they would be impossible to prepare, owing to the difficulty that goes into crafting them – which is clearly not true as plenty of other institutions manage it - and why we would be better off focusing on studying content or buying our own handbooks to practise with.

Tired of hearing what I then realized, were frankly, excuses, I asked simply ‘[Do you think] we are not paying enough to have [exam questions] provided?’ You probably won’t be surprised to hear that we were told that we are apparently not - even more so a ridiculous thing to hear for our international compadres, I think.

I’m going to make a generalization now: Students, in my year at least, feel we are not prepared enough for the exams. The content teaching is there, and I truly believe it is of a good-tofrequently-excellent standard, but the discipline of the exam itself is completely ignored. I’m aware that medicine is not mathematics, but I maintain that practice does indeed make perfect.

We, like many medical schools,

utilize a single best answer system for testing our understanding of basic clinical science.

Obviously we cannot know the amount of questions devoted to a single topic, or how much detail the question will demand of us, but without any past papers or questions, we cannot even guess. We are the donkeys running after the dangling carrot. The real joke is that we, at present, are stumbling around blindfolded, unable to see where we're meant to be biting. Even more argument can be given to our short answer question variety, which is used to test understanding of some BCS, but mostly PPD topics. These questions involve short essay type answers, which certainly - and when I say certainly, I mean ‘don’t you dare tell me different’ - have a knack to them.

"We are the donkeys running after the dangling carrot. The real joke is that we, at present, are stumbling around blindfolded, unable to see where were meant to be biting."

I challenge any medical student, at any school, to know the entire content of their course off by heart. All revision plans are ultimately designed to secure ‘enough’ knowledge, and whilst this may vary with how competitively the student wants to score, I think it’s obvious to say that we all want to pass.

Without knowing where the ‘enough’ is, therefore, leaves us in the proverbial academic wilderness. Alone.

Oxford handbooks, and other such revision material online, soothe this Darwinian fear of the unknown. However, ultimately, these tools cannot match our syllabus perfectly, are expensive, and can leave a second year (me) feeling worried that they don’t know things that they won’t really need until their fourth year.

Another point raised to me is the idea that including teaching sessions in preparation for students has no benefit for the individual. If everyone becomes better, then no one does. The flaw in this point is that universities owe it to their students to be utilitarian – to make us all better, after all, we are all paying customers – which I remind everyone, is un-debatable - A cohort which is taught about the exam will allow the test to better approximate how much the cohort knows. A cohort which average 65% are a more satisfied (think national student survey, Georges) than a cohort which average 55%. Simple. The use that people would get out of a question bank or past papers would predictably vary un usefulness, from extremely to not much, but I cannot possibly conceive as to how it would be a detriment to anyone.

Furthermore, arguments against prevision of past questions can, and have, come from the philosophy of self directed learning – or ‘f**k off and find out’ culture. It is obviously a student’s role to prepare themselves

for exams by studying and understanding the content of their course, but I’m reminded that until tests involve scanning our brains of our true knowledge and understanding, preparing for an exam will actually involve knowing what the exam is going to be like.

"A cohort who are taught about the exam will allow the test to better approximate how much the cohort knows. A cohort whom average 65% are a more satisfied" Whilst self-directed learning (or directed-self learning, I can never remember) is an important philosophy taught at all universities, it is too often taken advantage of and used as an excuse by lecture's whom are unwilling or unable to help. Whether they are genuinely too overworked, or just not bothered, is a variable. But you St. George's – and I address you as an institution now - are a fine and mighty school, but I don’t believe it would be difficult for lecturers to include sample questions with answers to SBAs and model answers for SAQ’s as part of their lectures.

I think that this article probably won’t be enough to make SGUL, and the wider university sector, take notice. I’m not even certain what to do next, but this culture is something that I think clearly needs to evolve for the greater student good

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November 2012

medicalstudent

Comment Everything That’s Wrong with Society Rhys Davies Consultant Editor

I do so love the Daily Mail. I marvel at how it can publish such a balanced, fair and accurate newspaper everyday to further the general enlightenment of the population. What’s more, its online wing, ingeniously titled Mail Online, brings a touch of class to the Internet that would otherwise be degraded by the guttersnipes that sniff around Twitter and 4chan.

Apologies. Until The Medical Student starts printing such prose in a special font, you may have missed the sarcasm that lightly dusted the previous paragraph.

I have always considered the Daily Mail to be a fountain of twisted and poisonous invective, filled with thinly veiled close-minded bigotry. Occasionally, if I happen to come across a copy (I refuse to buy the rag), I experimentally peruse the pages to see if my hypotheses about its bilious nature remain true. They unerringly do.

"I have always considered the Daily Mail to be a fountain of twisted and poisonous invective, filled with thinly veiled close-minded bigotry."

For some reason, the Daily Mail has a particular grudge against the medical profession. With a roughly predictable periodicity, they will trot out a flat-pack manufactured ‘outrage’ against the amoral and overpaid doctoring class.

The scars left after its savage attack on the drinking culture at my own beloved ICSM are only now beginning to fade.

Back in June, it lambasted the industrial action led by the BMA after stagnation of negotiations on NHS pensions. It was quick to paint a picture (in broad strokes, going outside the lines) of avaricious doctors putting Mammon before patients, on top of their already bloated salaries. The Daily Mail is a newspaper that will not let the truth stand in the way of a good story, or at least a good rant.

Interestingly, they’re not against medicine itself. Though nowhere near as regular as the Daily Express, they routinely feature stories of up-andcoming wonder-drugs and the new miraculous properties of super-statins.

At times like these, I am reminded of Davies’ law of novel pharmacology: any given drug on the horizon is, more likely than not, a mirage.

The latest target to draw its Sauron-like ire is the Liverpool Care Pathway. This is a protocol that

strives to ensure terminal patients achieve in their final hours that holy grail of clinical excellence, quality of life (and, dare I say it, dignity). Lines are removed, invasive and unpleasant medications and investigations are called off and in their place, pain, nausea and fear are attended to. It is not the withdrawal of care but the shifting of its goal from cure to comfort.

In typical Daily Mail style, the Liverpool Care Pathway has been demonised as widespread euthanasia of the elderly. Once again, doctors play the bad guys, aping Shipman in choosing the fate of their geriatric patients.

In a marvellous coup de grace, they have highlighted the fact that NHS Trusts receive financial incentives for the numbers of terminal patients on the pathway and painted as payment to clear beds with extreme prejudice.

Money-graibbing and playing God, a two-for-one! Horror story anecdotes are being trotted out under such titles as ‘I Survived The Death Pathway!’

Other newspapers like The Daily Telegraph have jumped on the lynch-mob bandwagon but I blame the Daily Mail as the instigator. In fairness, if doctors are putting patients on the Liverpool Care Pathway prematurely or unilaterally, then, yes, that is a minor outrage. However, the reality is very likely the opposite.

"For some reason, the Daily Mail has a particular grudge against the medical profession. With a roughly predictable periodicity, they will trot out a flat-pack manufactured ‘outrage’ against the amoral and overpaid doctoring class. The scars left after its savage attack on the drinking culture at my own beloved ICSM are only now beginning to fade."

With the exception of those in palliative care and oncologists, doctors don’t like death. That’s understandable. In the glory days, heroic doctors could outwit death with effective antibiotics or ground-breaking surgery to save the acutely ill patient. If the patient died, that was a failure on the doctor’s part. Unfortunately, while we are still running around hospitals pretending to be Dirk Bogarde’s Dr Sparrow, the reality of medicine has moved on.

In the developed world, chronic disease in one form or another makes up most of the ‘business’. Old age too, and all its attendant derailments, forms the basis of many a ward round these days.

The compassion of holding hands. Note Daily Mail: the doctor's hands are not in the wallet With this clientele, we shouldn’t be surprised that our patients die. Furthermore, we shouldn’t see it as a medical failure. Instead, it is a medical reality.

"In typical Daily Mail style, the Liverpool Care Pathway has been demonised as widespread euthanasia of the elderly.

Once again, doctors play the bad guys, aping Shipman in choosing the fate of their geriatric patients."

But it’s wrong to think that just doctors working on ward of wishful thinking.

We are part of a society that refuses to acknowledge death. Part of this is to do with the over-estimation of what medical science is capable of. If doctors, who (should) know their limitations, see themselves as failures in the face of death, what can we expect from a public whose only exposure to medicine is Casualty and House? it's the

A larger issue is the super-immediate ‘now-ness’ of modern society. In an age of fast food and fast cars, we can have the latest model of anything the moment the whim takes us (personal finance willing, of course). If it breaks or gets lost, get a new one, bigger and shinier than before! The next paradigm-

"We are part of a society that refuses to acknowledge death.

Part of this is to do with the over-estimation of what medical science is capable of. If doctors, who (should) know their limitations, see themselves as failures in the face of death, what can we expect from a public whose only exposure to medicine is Casualty and House?" shifting gewgaw will be out in three months but you’ll be long bored before then. Nothing need last. Films are pacier and books are snappier than ever.

And don’t even get me started on the Internet, which has thrown the process into warp drive.

Take, for example, Twitter, which I adore – constant immediacy.

The point of this quickly unravelling rant is that our long term planning has become increasingly myopic. From childhood, we are aware we will die, at some unspecified day in the distant future. But instead of planning and meditating on how we should like to die – the Ars Moriendi of an era past – we ignore it and buy the new iPad instead.

The consequence of this is that we ignore death and it becomes a pitiful and frightening experience in a hospital bed. We ignore the ogres, which lead us there, chronic disease and old age. Thus, as doctors and as a society, all three are taken as a surprise. The Liverpool Care Pathway is a sensible and sensitive alternative to fumbling around at the end. It allows both patients and doctors a chance at dignity in the last hours of their care.

With such a noble goal, no wonder the Daily Mail is furious

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medicalstudent

November 2012

11

Comment For Medicine to evolve, we need PPD Ishaan Bhide Staff Writer Being a second year, I’ve already undergone my fair share of ‘Personal and Professional Development’ – or PPD for short. It is, for all intents and purposes seen, as just another hoop to jump through, a box to tick, an animal to eat, a banana to swallow; whatever.

Learn, regurgitate and forget - that’s its mantra, I feel. There really isn’t much room for the long-term retention of poor little PPD left in the world. At the same time I realised that as a medical student my actions will have consequences no matter how much I want to stick my head in the sand and imagine one of my many ideal worlds, specifically the one where I’m walking through a land of marshmallows with giving me a massage whilst I read only the things I care about in a newspaper and giving me lots of money.

I think part of the reason why it took me this long to come to this conclusion is probably because of the ex-

amples I have seen. The media, journalistic exaggeration at this point, only cares about the viewership rating, and not the aforementioned retention of history and skepticism. They’re constantly switching, focus on to the next big topic. Again and again.

"There really isn’t much room for the long-term retention of poor little PPD left in the world."

Things like the fiasco of Victoria Climbié lie forgotten, out of the public’s eye. ‘Oh it happened a long time ago, it couldn’t possibly happen in this day and age.’ Hence people forget and they forgive. Naturally they then go on to make the same mistake again as witnessed with Baby Peter. It’s only human nature. Hell, I do it every time I go to see my dentist. The last time I went there, he told me I might get a cavity if I’m not too careful with my all-chocolate diet. I mean I even own one of those SoniCare toothbrushes that remove plaque and stuff but appar-

ently you have to use it instead of just leaving it in its box. Who knew? Obviously, I curse the dentist every time and vow never to go back. Yet, here we are.

I’m not advocating that we learn more PPD, or even that we do an SSC. Even though the GMC believes it helps us learn ‘life long skills.’ Yes it does.

You’re quite right GMC. I now know exactly how to read around a topic by using nothing but Google and Wikipedia. Note that it used to be just Wikipedia whilst I was in school. I apologize, I know I’m a bit behind the learning curve but I’m working on it. I just feel that it is important that these concepts remain in the public attention a bit longer or at least stay in the minds of health care professionals longer than they do at the moment.

PPD may well be thrown out of the GMC’s wardrobe like that sweater that doesn’t fit in the years to come. I don’t think it’s educationally progressive to keep making the same mistakes, and that is why it is important to reflect. It’s perfectly okay to make new ones but another thing to keep repeating them. My stance on most things is quite hypocriti-

cal and mostly laissez-faire. I tend to sit on the fence, so much so that I’m surprised when I hop off it like I am now.

"I just feel that it is important that these concepts remain in the public attention a bit longer or at least stay in the minds of health care professionals longer than they do at the moment."

A few years ago on the plane back from Canada, I was sitting next to a rather amiably inspiring man; lets call him Toronto for the sake of a name. Toronto had just graduated and showed me this ring he was wearing. It was called a steel ring, not only because it was made of steel but also because that’s the name given to the ring - which is worn on the little finger for variety’s sake. It symbolises the moment when a man becomes an engineer and honours those who died when the Quebec Bridge collapsed on two separate consecutive

occasions. The initial rings apparently used to be made from the metal from the bridge to act as a constant reminder of the power that engineers wield over the rest of the public and what happens when one decides to forget this responsibility. Incredibly thoughtful, Ja? Now medical students don’t need the equivalent for remembering Midstaff, or Baby Peter, but I can’t help but feel it would help reduce the mistakes we make if the GMC made it policy to look over its shoulder, and just doubt itself every once in a while.

Don’t go personally racking yourself with self-doubt though. For me, the knowledge that anything I may do as a doctor in the future has an irrevocable effect on a patient’s life will be enough to make me examine the most trivial of my actions over and over under a microscope. Don’t do that. The trick is to be slightly wary about everything. Dead hero or live coward I hear you ask? Embody PPD. Live coward, live sceptic of yourself.

Live coward a thousand times over.

Any day. Cowards R Us. It’s a thing

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12

November 2012

Culture

medicalstudent

Culture Editor: Kiranjeet Gill culture@medical-student.co.uk

SKYFALL Rhys Davies Consultant Editor

I’m a bit of a geek about Bond. Well, I’m a bit of a geek about a lot of things. Growing up as a slightly awkward, slightly uncool child will do that to you. Anyway, despite doubts after MGM’s demise, James Bond has returned!

Skyfall is the 23rd film to feature James Bond of Her Majesty’s Secret Service. It opens in Istanbul where Bond (Daniel Craig) is trying to track down a recently stolen hard drive. He chases the thief, a man named Patrice, across the city on motorbikes first, before the action moves to a fight sequence atop a moving train. Trailing all this is a second agent played by Naomie Harris. With the train getting away from her, and hastened

by M (Judi Dench) back in London, she takes a shot at Patrice. She misses and hits Bond, who is knocked off the train into a river far below.

The end.

Or rather, that’s when the title sequence, with Adele’s theme song, comes in and the film begins in earnest. The hard drive that was stolen contained the names of all NATO agents currently infiltrating terrorist and criminal groups.

Losing it, then, was a bad thing. M is under increasing pressure from Mallory (Ralph Fiennes), chair of the Intelligence and Security Committee, to step down. She declines and stubbornly vows to get the hard drive back. However, on her way back to MI6, she learns that the missing hard drive is currently being hacked from her office computer, shortly before the office blows up.

Bond, meanwhile, is not dead. Not that anyone thought he was. Instead, he was enjoying a holiday of sun, sex and…scorpions. News of the MI6 blast prompts him to return. He is caught up to speed while undergoing fitness-to-operate tests in the underground bunkers of MI6 (since Vauxhall Cross was somewhat compromised).

Shrapnel from one of Patrice’s shots in the opening (which Bond only decides to excise now) reveal his identity*. Bond is sent to Shanghai to await him – but not before meeting with Q (Ben Whishaw) to receive a new gun and an emergency radio - 'what did you expect? An exploding pen?'

In Shanghai, Bond trails Patrice to an assassination. Once the job is done, they fight and Bond grabs Patrice before he can fall out of the window. However, before he can extract any in

© MGM and Sony Pictures Entertainment formation, Patrice falls. No worry, as he left behind a gambling chip for a Macau gambling den.

He collects a case of four million euros, Patrice’s payment, and meets with Sévérine, a femme fatale who he saw at the scene of Patrice’s assassination. She agrees to take Bond to her boss, the man with the hard drive – but only if he defeats her bodyguards, who are going to kill him…

That’s enough plot for now but I will say there were Komodo dragons after that point.

Skyfall's a rather strange film. On the one hand, it’s faithfully checking off the list of Bond tropes; national security at stake, exotic locales, exciting action chases, femme fatales, badderthan-bad bad guys. But on the other, it’s tread

ing some very unfamiliar ground. Political pressure on the Secret Service (between this and The Thick of It, I think everyone wants an inquiry in their stuff now), strong characterisation of the main characters, M and MI6 vulnerable, on the backfoot. Virgin territory - apart from the opening to The World is Not Enough. It’s good to see alongside dependable familiarities new life being breathed into the franchise. Furthermore, it’s even better to see this new life in the form of genuinely superior storytelling, instead of, say, an invisible car - Die Another Day, you know who you are.

There are times when this doesn’t even feel like a Bond film. It's a very good film but nothing we can compare to any of the previous 22

installations. But then Daniel Craig jumps in an Aston Martin DB5 and all is right with the world.

When I saw that, I genuinely pissed rainbows.

The acting delivers on the script, top class.

Daniel Craig is very easily a brilliant Bond, despite being so very blond. Small tells and physical movements betray volumes about his very stoical characters. Then contrast that with all his action sequences, which are highly entertaining. Judi Dench gives the performance of her Bond career, especially so since so much of the plot focuses on her. Like Craig’s Bond, she comes across as someone aged and vulnerable, but still determined to finish the job. Javier Bardem plays the baddie, Raoul Silva. A ridiculously bleached and camp villain, second only to Mr Wint from Diamonds Are Forever, he is that brand of psychopath that having worked a dirty job for so long - an MI6 agent in Hong Kong, under M’s direction - that he becomes a monster. Aside from having a rather weak motive, something vague about revenge, he is a superior villain, a cold-blooded killer and severely emotionally unhinged. I am certain that his first scene, a long slow, monologing walk to a chairbound Bond will go down in cinematic history.

Ben Whishaw, Ralph Fiennes and Naomie Harris et al all provide strong supporting performances.

This film marks 50 years of James Bond in cinema. As such, nostalgia permeates this film. However, it doesn’t get so lost in in-jokes that it neglects the current story. This is homage done right. It's doubly pleasing when an instalment pays proper tribute to the giants whose shoulders it finds itself on. Nods are made to some of Q’s most famous gadgets (see above) and the DB5 makes a glorious return. The final scene is startlingly familiar to something between 1962 and 1985 (Connery to Moore).

This is an exceptional film and it is an exceptional Bond film. Geek or no geek, you will enjoy this film. You have a license to be thrilled. (Oh God. Author hangs his head in shame). But I sincerely doubt anyone’s decision to watch this film or not will be based on my humble review. The film speaks for itself. * – The shrapnel is revealed to be made of depleted uranium. Niche ammunition, pinning it down to Patrice but props to Bond as well. Not only is it still radioactive, weakly, but it’s also fairly toxic. Also, as you’d expect from Element 92, it’s really dense so it’s impressive that it didn’t blow Bond’s shoulder off. This last point is nodded to in the film

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Man + Doctor: Painting a Picture of Practitioners Rob Cleaver Doctors' Mess Editor Nick Wadley is an artist but also a patient.

In his book, Man + Doctor, he confronts his seven year experience of medicine through drawings and in doing so, manages to capture so many familiar situations in which we have been on the other side of - across a clipboard, behind a consultant, head tucked into a word document on exiting an MDT meeting.

The book is stuffed with a mixture of comic realism and evocative surrealism. His drawing of

the scanner, cloaked in a shield absorbing the best jabs from hammers and bells, cogs and mallets is a particular favourite of mine. The time spent inside is most suited to the exploration of an imagination and to capture an oft described interpretation of the sounds is strangely, quite a comfort.

The sparseness of colour that is used only lends itself to the empty space on the page and is most easily interpreted as a deliberate move by the artist to document the nature of time on the ward; empty, lifeless and loosely framed by sleepless nights.

To someone flicking through the book, the most grabbing of his drawings is the last. Drawn after five days in a coma, it is haphazard and unintelligi-

ble much like the state in which Wadley must have found himself during his most recent admission.

"The sparseness of colour that is used only lends itself to the empty space on the page and is most easily interpreted as a deliberate move by the artist to document the nature of time on the ward" In a recent interview with The Guardian, in which he details the stories and feelings be-

hind his art, he talks about shedding his identity and becoming nothing more than a patient, a trance like entity, visited often but seldom listened to. This is something that we all become quite happy to accept; 'I performed a respiratory exam on this patient on this ward,' and 'I talked to this other patient the other day'. They have no names and are defined only by their conditions.

I think that what Wadley provides here is not just charmingly, resonant pictorial evidence of the world in which we function, but also gives us feedback on how everything we do feels for a patient.

Here is a gift for the doctors from man and a note on how one is not a pretty picture without the other

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medicalstudent

November 2012

13

Culture Doctors, Dissection and Resurrection Men Zwe Htoo explores a new exhibition on surgery that will appeal to just about 'any body'

B

y 1820 London was home to no fewer than 17 private anatomy schools as well as four hospitals offering anatomy classes. Surgery was a brutal business, carried out rapidly due to a lack of anaesthetics, and without any real knowledge of the importance of aseptic technique, the risk of death from blood loss or infection was high.

Surgeons needed bodies to hone their skills in order to save lives, but the legal supply of cadavers was scarce and all too often surgeons turned to body snatchers, known as the resurrection men. Whilst this was obviously something of a covert practise, it was well-known enough to draw the abhorrence of the public - '...the bodies of the deceased patients of the hospitals of this metropolis are BOUGHT and SOLD like those of sheep and oxen', said Ann Millard, in 1825.

These resurrection men often stole from wakes, mortuaries and graves to supply the London schools, but some did not stop there. As the demand for bodies increased, so did their value, and some even turned to murder.

The new exhibition, Doctors, Dissection and Resurrection Men, at the Museum of London, takes you on a

The Anatomist Overtaken by the Watch, by William Austin, 1773 © Museum of London walk through this often troublesome history of surgery. The exhibition was inspired by the 2006 uncovering by archaeologists of a burial ground beneath the Royal London Hospital in Whitechapel. The site contained 262 burials, each showing evidence of extensive dissection, and providing

further evidence for the widespread trade in dead bodies during the 1800s.

From the famous ‘Italian Boy Murders’ of Nova Scotia Gardens to the controversial passing of the Anatomy Act in 1832, the exhibition sheds light on the dilemmas faced by sur geons of days gone by. Their deal

ings with the so-called resurrection men tainted the reputation of surgeons, but they often had little choice as the religious beliefs of many meant that they were reluctant to give up their bodies in the name of science.

Alternative means of teaching anatomy are also explored. Several exhib-

its show strangely life-like detailed wax models of the past, whilst another shows 3D renderings of the human body asking whether one day we may be able to teach anatomy in a virtual world, perhaps one day eliminating the need for anatomical specimens.

In modern day Britain, the Human Tissue Act of 2004 heavily regulates the removal, storage, use and disposal of human tissue from both the deceased and the living, yet it is still a controversial topic. To address this issue, the exhibition ends with a short film considering many of the religious views, superstitions and opinions of those living in today's society.

From the supporters offering up their own bodies for medical teaching or research, to organ donation, to concerned youngsters afraid of what will happen in the future, it leaves you wondering: who really owns your body?

The exhibition is very obviously a worthwhile experience for anybody interested in Anatomy or Surgery, but through interactive displays and a variety of exquisitely displayed artifacts it hopes to appeal to just about anybody

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On at the Museum of London until 14th April 2013.

Korean Film Festival - The Thieves Samuel Kim Guest Writer The Seventh London Korean Film Festival kicked off with one of the biggest Korean films in the last ten years, ‘The Thieves’. Much likened to ‘Ocean’s Eleven’ with its cool and smooth-talking criminals, ‘The Thieves’ turned out to be just that.

Although not a premiere, it was organised like one, complete with red carpet and flashing cameras, cinemagoers were in for a glamorous night.

After a long repeat of the latest KPop, obviously including ‘Gangnam Style’, on the big screen, the host welcomed us and warmly introduced the actor Kim Yoon-Suk and director Choi Dong-Hoon, who introduced the movie and took part in a Q&A.The impressive line up of actors from both Hong Kong and Korea included Kim YoonSuk (‘Yellow Sea’), Kim Hye-Soo (‘The Red Shoes’), Lee Jung-Jae (‘The Housemaid’), Simon Yam (‘Election 1 and 2’) and Derek Tsang (‘The Eye 2’).

The actors, as well as director Choi who has dozens of critically acclaimed films to his name such as ‘Woochi the Demon Slayer’ and ‘Tazza: The

High Rollers’ - has made a gripping and fluid film that has become one of the highest grossing in Korea.

For those who have not seen it yet, I offer a cautious spoiler alert. Macau Park, the protagonist of the movie is depicted early on as a deceptive and cheating criminal, offering five of Korea’s most successful and ambitious thieves a job to complete, along with an equally competent crew from Hong Kong. The job involves a classic heist of a $20million diamond located in a casino with each member assigned a particular part of the theft.

The Hong Kong group of four includes a veteran gang leader ready for a final score (Chen), two gunmen, Johnny and Andrew, and Julie, a codecracker secretly working for the police.

However, the real focal point of the movie, apart from the smooth con work of the criminals, is the complex history of relationships within the Korean faction and how the film incorporates past events into the present to change viewers’ opinion of the different characters.

The mixture of the two different cultures and how they interact and eventually co-operate is parodied in an amusing but harmless way with a suitable level of stereo-

typing that allowed for the audience to recognise the funny intentions.

As the film goes on, the way the characters develop and the relationships they are able to form provides more depth to what might originally seem a shallow action movie, with criminals such as Andrew, a designated clown that is Korean but in the Hong Kong group, becoming more integrated with the Korean group.

I will shamelessly depict the film in its favour as I thoroughly enjoyed the whole evening and the two hours spent watching this film flew by as the action, plot and actors made for an incredibly good showing.

However it should be noted that those not of Korean or oriental origin may not find ‘The Thieves’ as thrilling or as suave as ‘Ocean’s Eleven’ and it is true that it lacks the elegance and sophistication of the latter. But the charm of the story lies in the characters and how they develop through the story and the classic banter which they have.

Overall, highly recommended

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For more information about the Korean Film Festival and future events, visit www.koreanfilm. co.uk

Image by Wei Ren Lau

medicalstudent

Sport

Darts, anyone?

Last ones standing. Image courtesy of Tom Brunt

Tom Brunt Guest Writer A monumental night was had at the Horseshoe Inn last week. Our intrepid group of lads rocked up to London Bridge, teeth bared having been top of the league for the last two weeks (a first for ICSM Darts Club).

First order of business: head to the bar. With beers in hand we met the ferocious team known as the ORCS, featuring the one and only Duncan, organizer of the entire South Kensington Academic Darts League.

There was a serious challenge ahead of us and we all knew it.

After having a brief chat about not having paid affiliation fees yet, we set about constructing our roster for the evening.

We were somewhat lacking in players, as we tend to find ourselves with at away games. This all changed when none other than Harriet “The Power” Folland stepped through the door with three other fresher girls in tow.

Jaws dropped to the floor, men fainted, and there were utterances from the crowd that they had seen nothing like this before at a darts match since the sport ever began. In an emer-

gency captaincy move I called for a team meeting over in the corner by the potted plants to discuss tactics.

Harriet had appeared at our last UCL away match and earned her title for defeating three of their finest men after having 'never played darts before'. We were counting on a repeat performance.

Judging by the aberrant hopelessness on the other girls’ faces I could tell they could perform just as well.

I threw three of the girls in straight away for a triples match. Facing off against ORCS’ angriest 30-year-old bankers, the girls faired valiantly and one even scored an enormous 120.

Despite our best efforts, we were losing matches rapidly. Matt “Briefcase Wanker” Hutchins (former ICSMDC Captain) and I were three pints down and were almost considering actually playing a game of darts to even the score.

The match ended with a disappointing 10-1 defeat. We retreated back to the potted plants to have a team debrief.

Emotions flowed as the girls expressed their disappointment but had discovered a new found passion that they had never known.

As a consolation, our main scorer and UK National Parkour Champion three-times running, Greg “The Joker” Hatfield, received a coveted trophy

for having scored a 180 last season.

It was a unanimous vote to continue the festivities in the nearby GKT bar next to a McDonalds.

We began our apologies circle, apologizing for the terrible things we had done that week and smashing our shots for scoring less than ten.

As I was seeing away my double straight Malibu, it was announced that it was time for the weekly parlour challenge. This week Louisa “Spitroast” Byrne was the contender. With a weak performance of attempting to do the yoga position known as “downward dog”, Greg thwarted his opponent with a masterful walking handstand.

On our way home we encountered a potential transfer candidate in the form of “Cone-y 2012”. This intrepid darts player was practising his checking out next to the skips and we felt obligated to free him from his GKT captors and allow him to play darts with us for the rest of the season. He now has his own darts tie and headband to look the part.

This was a sad defeat that has led us back to our usual form although we are optimistic for the rest of the season.

With such a large fresher turn out, the club can only get stronger and we can only have more tours

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Cone-y, the newest member of ISCMDC