the
medicalstudent The voice of London’s Medical Students
November 2011
GMC respite - student registration halted Page 4
Why medical students should avoid Facebook Page 8
Graduating to unemployment. Image by SE 10
Oversubscription Hits UKFPO Sanjeev Ramachandran
The  UKFPO  has  confirmed  that,  once  again,  this  year’s  national  recruit- ment  process  for  the  Foundation  Pro- gramme  has  been  oversubscribed.  An  overhaul  of  the  Foundation  Pro- gramme  Application  System  (FPAS)  is  expected  to  be  phased  in  for  the  2012-Â13  cycle.  With  such  high  levels  of  competition  for  places,  it  is  hoped  that  the  new  application  process  will  help  alleviate  the  UKFPO’s  burdens. With  this  year’s  batch  of  Founda- tion  Programme  applications  sent  off,  finalists  have  done  what  they  can  to  secure  a  job  for  next  August.  Professor  Derek  Gallen,  UKFPO  National  Direc- tor,  said:  ‘I  am  confident  that  despite  the  programme  being  oversubscribed  once  again,  all  eligible  applicants  will  be  placed  in  jobs  by  the  start  of  the  Foundation  Programme  in  2012’.  Wor- ryingly,  however,  one  London  founda- tion  school  in  particular  has  received Â
a  significant  increase  in  applications  this  year.  A  contingency  plan  has  been  implemented  by  the  UKFPO  to  allow  them  to  be  processed  in  time,  whereby  the  surplus  of  applicants  will  be  ran- domly  allocated  to  another  founda- tion  school  for  scoring.  The  UKFPO  assures  students  that  this  will  not  af- fect  the  outcome  of  their  applications.  ‘Strict  quality  management  controls,  with  schools  blind  scoring  the  same  quality  control  applications,  have  dem- onstrated  that  there  is  a  strong  corre- lation  between  scores  across  the  UK’.  Despite  the  UKFPO’s  statements,  this  year’s  FPAS  has  provoked  discontent  amongst  the  applicants,  with  one  final  year  saying  that  ‘it  seems  like  more  of  a  lottery  than  ever’.  With  competition  for  places  unlikely  to  dampen  in  the  coming  years,  these  events  do  beg  a  deeper  question  -  is  FPAS  really  ready  to  deal  with  a  consistently  high  number  of  candidates  in  as  fair  a  way  possible? FPAS  2012  is,  in  fact,  the  last  of  its  kind.  For  the  past  few  years,  applica-Â
tions  have  been  scored  largely  based  on  responses  to  ‘white  space’  questions.  They  are  designed  to  assess  the  skills  and  competencies  needed  for  the  Foun- dation  Programme  and  have  t urned  into  a  yet  another  hoop  generations  of  final  years  have  had  to  jump  through.  The  current  process  has  attracted  a  great  deal  of  criticism,  not  least  from  medi- cal  students  themselves,  who  often  felt  it  was  an  exercise  in  creative  writing  rather  than  a  valid  way  of  selecting  the  best  doctors.  The  most  relevant  criti- cism,  however,  is  that  this  system  is  highly  resource-Âintensive,  requiring  a  large  number  of  markers.  This,  in  turn,  leads  to  an  element  of  subjectivity  in  the  marking.  The  competition  is  such  that  even  a  couple  of  points  either  way  can  decide  whether  applicants  get  into  their  first  choice  foundation  school  or  not.  Given  the  years  of  difficult  train- ing  final  years  have  had  to  endure,  they  are  well  within  reason  to  expect  only  the  fairest  of  application  processes.  So  what  is  the  answer?  Over  the  past Â
two  years,  the  Improving  Selection  to  the  Foundation  Programme  (ISFP)  project  has  been  in  the  process  of  de- signing  and  a  trialling  a  brand  new  ap- plication  system.  This  year  they  ran  a  full  scale  trial  of  the  new  process  at  17  UK  medical  schools  alongside  the  cur- rent  system  and  the  outcome  of  the  t rial  has  in  fact  decided  the  fate  of  FPAS.  Starting  from  next  year,  the  ‘white  space’  questions  will  be  scrapped,  to  be  replaced  by  a  system  that  is  de- signed  to  be  more  objective  and  less  resource-Âintensive.  FPAS  2013  will  consist  of  two  elements  -  the  Educa- tional  Performance  Measure  (EPM)  and  a  Situation  Judgement  Test  (SJT).  The  EPM  essentially  measures  one’s  academic  and  clinical  performance  at  medical  school.  It  takes  into  account  the  students’  ranking  at  medical  school  exams  (based  on  which  decile  they  are  placed  in),  any  extra  degrees  they  may  have  done  and  their  prizes,  publica- tions  and  national  poster  presentations.  (cont’d  on  page  2)
Are white coats a thing of the past? Page 14
Bodysnatchers 4DJ ĂŽ BOE NFEJDJOF Page 19
Secret diary of an oncall girl Page 23
2
November 2011
News
medicalstudent
News Editor: Ken Wu news@medical-student.co.uk Mark A Shimmings GKT Medsoc President I write this article while recovering from one of the best weekends of the year - Tournament In The South or ‘T.I.T.S’, a mixed hockey tournament hosted by Southampton medics. GKT did quite well, getting to the semi-finals of the cup. George’s and RUMS were also in attendance, and as was to be ex- pected by the end of the weekend the non-London students were in awe of our magnificence both on and off the pitch. Things at GKT have been going swimmingly post-freshers. ‘999’ was a hit. Medsoc have since hosted a Hal- loween party, and put the wheels in motion for this years Beaujolais Nou- veau and Christmas Party. The new MedSoc Sponsorship Scheme is un- derway - KCLSU sports clubs and so- cieties with a good enough reason can now apply for up to £300 of sponsor-
Editor-in-Chief John Hardie on a medical winter of discontent
T ship. Politically, we are now working with KCLSU through student council to increase medical and health school representation from three allocated seats out of 50 to something a bit more representative of the 52% of the stu- dent population that the health schools (GKT) comprise. I think most humans who like democracy would agree our current lack of representation is slightly ridiculous. Watch this space
.
George Ryan BL President In case anyone ‘forgets’ to mention who out sold everyone else in tick- et sales for 999 (and by default is the best medical school) I thought I’d dive straight in and spill the beans: in first place, for the second year in a row was the MIGHTY Barts and The Lon- don! All banter aside it was a cracking night and hopefully a good introduc- tion for the freshies to the old medical school rivalries that we still fester over. In the last month BLSA has de- fended its place on QMSUs student council;; heard Sir Bruce Keough talk about ‘Where the NHS will be in 10 Years’;; voiced its students issues at the Student Staff Conference follow- ing ‘The Big BL Survey’ of over 500 students;; hosted a brilliant Halloween party;; hosted a not so brilliant Mo- vember party and seen the closure of
dropped marginally. Some schools are even reporting early estimates of a rise in the number of applicants, despite the £54,000 tuition fee price tag. This is in contrast to the 15% fall in appli- cants to all English University courses. The good news is that Medicine still has suitable value attached to it to attract countless top-quality can- didates, although the demographic is likely to have changed. Far from the explosive nature of Guy Fawkes’ night, FPAS has been more of a slow burn- ing process. Once again, there are too many medical graduates for founda- tion training places. Those school- leavers applying to medical school with the hope of an assured job when graduating will have to think again. UKFPO claim that they will eventu- ally find places for the surplus of medi-
cal graduates, but this will be a long waiting game for final-year students. So for those of you waiting, sit tight, and grab yourself a nice glass of port. Oh, and just in case you run out of firewood due to student pov- erty, we’ve tracked down some wor- thy establishments in which to keep yourself warm – they’re on page 20
.
Find us on Facebook and Twitter medicalstudent newspaper
the GriffInn for its £1,000,000 refur- bishment…ahhhhh we are so good. The number of applications to Barts has risen 27% this year. This puzzled me at first;; it doesn’t make any sense, why would we have more applicants in a year where fees are tripling? Then it came to me, 8th in the National Student Survey, 2nd in the country for FPAS results, it all adds up, Barts is quite sim- ply the best medical school in the land
.
Nana Adu SGUL President Right now St George’s freshers fort- night is a distant memory as students are swamped with lectures. Despite the lack of enjoyed sunlight, many Georgians are still very active. Peo- ple have been incredibly active in raising money for charity week and their selected charities. The bidding war to raise money was fierce. How- ever, I came, I saw, I conquered and I am left with a wall mountable picture. Continuing on with the theme of charity, fashion show and the Diwali show have moved from planning to practicing. It’s mind blowing to just ap- preciate the hours that are put in, the centimetres of space that is utilised for dances, the beautiful voices and tunes echoing from the music room and the collectiveness of Georgians. People say that the George’s spirit is dead, it’s not! In terms of the George’s life, we
he Anglo-Saxons called No- vember ‘wind month’, be- cause the cold winds started to blow. So, it’s time to fin- ish your preparations for the winter months. Have you ordered your cattle to be slaughtered and salted, and for your kitchens to prepare the preserves for the winter months? Have you suitably topped up your vitamin-D levels over the summer? You haven’t? Well, it’s too late now – you’ll need U VB radiation in the range of 290 - 315nm, and we don’t get that in the UK after October. Sorry. Medical students and prospective medical students have been prepar- ing for the future in the form of UCAS medical school applications and FPAS foundation training applications. Ear- ly indications are that applications to most medical schools have only
are looking forward to: interfaith week, casino at the bar, space disco, fashion show, Diwali show, the revue and my pathetic attempt at growing facial hair for Movember (I blame genetics). The exec team have been grafting hard as usual and are very u nderstanding seeing as I failed to submit my report on time. This particular week has seen us as a union push to get year reps for the first years via elections. It’s a long task
.
(cont’d from front page) It forms ex- actly 50% of the final application score, with the other 50% calculated from their performance in the SJT. The SJT is the most obvious and radical change to the current system. The question many have been asking in bewilderment - what exactly is the SJT? The short, but unfortunate, answer is that it is yet another exam medical stu- dents will have to sit. It will be an in- vigilated, machine-markable 2 hour 20 minute paper, to be sat nationally on set days. Applicants will be given descrip- tions of hypothetical scenarios foun- dation doctors are likely to encounter and are then asked to select the most appropriate action to take. Rather than being a test of clinical knowledge it is designed to assess a number of attrib- utes required in the role of a FY1, such as team working and professionalism. Although the SJT may seem like an unknown entity, the medical profession in this country are certainly no stran- gers to it. It is currently being used in
the
the selection for the GP training pro- gramme and is being piloted for other specialties. According to the ISFP - ‘Research evidence suggests that SJTs are able to predict performance in the role, as well as showing higher validity over other methods’. Once one pushes past the unpleasant prospect of having yet another exam to get through, the ad- vantages of the new application system are clear. Each component of the pro- cess has objective, clearly defined and consistent criteria by which to assess an applicant, removing any room for in- terpretation and subjectivity. Further- more, as the SJT is machine-marked the new system is markedly less re- source-intensive, allowing the system to deal with significant increases in applications. It also removes the issues of plagiarism and coaching that ex- isted with the ‘white space’ questions, along with the problem of developing new, original questions every year. Nevertheless, the new system is not without its flaws. For example, it
medicalstudent
@msnewspaper does not allow applicants to demon- strate their individual skills and com- petencies. By failing to reward extra- curricular achievements, there are concerns that this system might lose out on well-rounded doctors who will have unique skills to bring to the pro- fession. A third year told the Medi- cal Student - ‘It is outrageous that our talents outside of exams won’t even be looked at. They are going to pretty much judge our competency as fu- ture doctors based on a one-off test’. As a final note, no process is ever going to be perfect. Given the strain on resources in the NHS, the applica- tion process is always going to be a bal- ance between rigour and validity ver- sus practicality and cost. As with most things, the t rue f laws of the new system might only be exposed once it goes ‘live’ next year. For now, however, some faith will have to be placed on the promising results from the ISFP pilots. It might, one hopes, bring the UKFPO one step closer to curing its FPAS headaches
.
Contact us by emailing editor@medical-student.co.uk or visit our website at www.medical-student.co.uk
Editor-in-chief: John Hardie Assisstant editor: Amrutha Sridhar News editor: Ken Wu Features editor: Bibek Das Comment editor: Rhys Davies Culture editor: Robyn Jacobs Doctors’ Mess editor: Rob Cleaver Treasurer: Alexander Cowan-Sanluis Sub-editors: Alex Isted, Kiranjeet Gill, Image editors: Chetan Khatri, Purvi Patel Distributing officer: Sevgi Kozakli
medicalstudent
November 2011
3
News Gareth Chan RUMS Senior President
Barts to the rescue at 999
With the continuing success of ‘Vod- pop’ at Piccadilly Institute, the launch of the RUMS Winter Masquerade Ball and our sports teams’ ongoing success- es on the pitch, we’ve started the year as we mean to continue! With a strong RUMS presence at 999, our freshers certainly showed you how to party, and party hard! We’ve quashed all rumours from my counterpart down at Strand Polytechnic from the last edition and have one altruistic suggestion for our neighbours;; pick on someone your own size – Georges might be a good match! Here on the home front, we’ve se- cured the long-term use of Lewis’ for RUMS Sports nights. The fight for more social space for medics within
John Hardie Editor-in-Chief Medical students from around London gathered at Ministry of Sound on 17th October to take part in one of medical school’s greatest traditions – 999. Stu- dents from BL, SGUL, RUMS, ICSM and GKT celebrated in a demonstra- tion of London’s medical prowess. Medical schools were given the chance to compete for the status of London’s most socially adept medi- cal school. Barts and the London tri- umphed in their show of numbers, with a total of 267 tickets sold. Royal Free, University and Middlesex Hospitals had a disappointing performance, hav- ing sold fewer than half the number of tickets, just 100. Georges came in narrowly second with 248 sales, fol- lowed by ICSM at 161, and GKT at 143. 999 was founded as a regular event nearly a decade ago by the University of London Union Medical Student Of- ficer. It was envisaged that the event would bring together students from the University of London Medical schools, and cement their status as a unified body, lending support to each other, whilst promoting healthy competi- tion between the five medical schools. UH Medgroup assumed respon- sibility for the night after ICSM left the University of London in 2007 to become an independent body. UH Medgroup, comprising the five stu- dent union presidents and BMA rep- resentatives, introduced a second 999 event that takes place each January. Scandal broke out at the conduct of one medical student president. The student union presidents were set to take part in the traditional drinking race, but the competition was abrupt- ly called off when the GKT president, Mark Shimmings, was nowhere to be found. The Medical Student’s investi- gations have revealed that Shimmings’ blood alcohol levels were suitably raised for him to engage in unusual
UCLU, and for our independence as RUMS continues. The annual MDs show fast approaching (24th - 26th Nov) and it’s time again for RUMS to gather for a good tummy-tickling giggle. Fi- nally I would like to congratulate and welcome our two newly elected offic- ers to RUMS Exec: Anya and Neale!
.
Suzie Rayner ICSM President
DJ Dave down in the ‘booth! Image by Yuanchao Xue behaviour, including running a total of four miles around South London before returning . The GKT president was physically unable to compete in the competition, and therefore avoided the cohort with a jaunt around South London, Medgroup President Jeeves Wijesuriya claims. When quizzed, Shimmings pleaded a memory lapse, and claimed no memory of the episode. Residents of Southwark were greeted by a number of assaults on their sensibilities. The unusual sight of male students dressed in over-
ly revealing nurses’ uniforms com- plemented the expected array of scrubbed-up individuals. Eyewitness reports confirm that the individuals concerned had not waxed their legs, provoking outrage from onlookers. The DJ-booth was definitely the highlight of the evening. Inhabited by the double-act of Anil Chopra and David Smith, the ex-ICSM presi- dents played a mind-blowing col- laborative set of ‘Old Skool Ga- rage’. It was a marrying of musical minds that was always meant to be
.
999 Yeah buddy!!! Image by Yuanchao Xue
So the Students’ Union at ICSM breathed a sigh of relief at the end of Freshers’ Fortnight, but we did not rest for long. The social term kicked off again two days later with 999 @ Ministry of Sound. Imperial came third in ticket sales, but considering we live the furthest away, I accept this as a suitable success. Most im- portantly, as normal, we beat GKT. I feel that ICSM can live with the loss to St George’s and Barts consider- ing we beat them in the league tables. We’ve had a flurry of charity ac- tivity since I last wrote, with the first ever Oxjam held at the Reynolds bar, bringing some upcoming music talent to our venue. The first RAG event of the year, the Halloween collect, took place last week. Hundreds of Fresh- ers took to the streets, sporting blood spattered scrubs to cajole and harass
the public into handing over their mon- ey. It was a huge success and it raised £18,142 – a record for this event! Our RAG also appeared on Twitter cour- tesy of the Apprentice’s Tom Pellereau. Graduation was held on October 19th. The prestigious ceremony was held in the Royal Albert Hall, and over 2500 Imperial Students graduated over the course of the day. Congratulations to all the newly qualified doctors and those who have completed their BSc
.
Jeeves Wijesuriya UH President What a fantastic month! Off the back of five tremendous freshers fortnights we had the EPIC 999! Sold out yet again, and with BL narrowly retaining their title as Most Social Med School over a spectacular George’s. We have also been supporting the new London medical school Presidents in helping and advising them in their new roles. We are also in the midst of planning campaigns across London, such as the Mental Health Campaign and Survey, launching an unbiased view of the So- cial Health Care Bill and what it will mean for us, as well as looking at medi- cal school applications and the impact the new tuition fees will have had on the demographics of students applying. Importantly, the UH committee found ourselves in the pub after a meet- ing discussing which of our medical schools represented which house from Harry Potter. After much discussion (and arguing) we concluded that Barts
would get Gryffindor on the basis that their crest is an actual Griffin. George’s is the Hufflepuff of UH, well-liked by and considered non-threatening and fun. JK Rowling clearly based Sly- therin on Imperial, for obvious reasons (many have found Suzie entrenched in Parsel-tongue-esque conversation with Imperial College staff), and GKT do have a Ravenclaw-esque feel. RUMS get no mention having come last in 999 ticket sales (despite selling an all- time high number) and are therefore banished to the Forbidden Forest
.
4
November 2011
News
medicalstudent
GMC holds off medical student registration
Tomorrow’s students or tomorrow’s doctors. Image by Chetan Khatri
Ken Wu News Editor
The GMC has recently announced that it will not register medical stu- dents for the foreseeable future. How- ever, the GMC will issue students their GMC reference numbers at the beginning of their final years in- stead of the current system of issu- ing the GMC reference numbers at the end of the final academic year. By issuing final year students their GMC reference numbers at the start of the academic year, the GMC claims that it will make provisional registra- tion more straightforward. Moreover, it will enable students to have earlier access to certain NHS resources, such as the NHS databases. The GMC chief executive Niall Dickson said that the move, which will begin in the 2013 ac- ademic year, is ‘a sort of reminder that the light is turning to amber, it’s about to go g reen, you’re heading towards se-
rious country’. However, it is important to stress that when a student is issued their GMC reference number, it is not equivalent to a full GMC registration. Although the GMC will not en- force a voluntary or a mandatory registration of all medical students, it will continue to push its efforts at engaging with medical students.
“We don’t think student registration is necessarily the way we will achieve this” This could involve the introduction of GMC membership cards, which the GMC will hope to ‘provide students who take up this option with access to additional resources aimed at develop- ing their knowledge and understand- ing of the role of the GMC and profes- sional values’. Niall Dickson elaborated on this notion further, saying that ‘our main objective is that students under-
stand what the GMC does, and that they understand the obligations on them — the issues in terms of professional and ethical behaviour, and how we can get closer to them and support profession- alism and their transition into practice.’ Furthermore, Mr Dickson said that ‘we don’t think student registration is nec- essarily the way we will achieve this’. The efforts of the GMC to engage with medical students have already been im- plemented, with a Welcome to Medi- cine pack and a memory stick preloaded with guidance on standards and eth- ics given to all new medical students. The issue of whether medical stu- dents should be registered with the GMC has been a long standing debate. In fact, the issue stretches back to the early 20th century, when the GMC used to register all medical students. This was stopped during the Second World War due to economic reasons and after the war, no-one thought it was worthwhile to reintroduce the measure. However, recently, the issue was raised again by the GMC, especially in light
of the negative portrayal of medical students in the media and in 2011, the GMC stated in their Education Strat- egy that ‘in 2011 we will re-examine the case for student registration in the light of the effectiveness of our student engagement programme. This will ex- plore whether the benefits outweigh the disadvantages. The key test will be whether it will contribute positively to the promotion of professional values and to supporting a smoother transi- tion to practice (rather than merely be- ing a mechanism for addressing seri- ous fitness to practise issues amongst a very small minority of students)’. The review in 2011 essentially dis- cussed four possible options regarding the registration of medical students: to take no further action, mandatory reg- istration, voluntary registration, closer engagement with medical students. They agreed that mandatory registra- tion would be difficult to obtain govern- ment approval, especially with the lack of evidence regarding improvements to patient safety. The limited effectiveness
of a voluntary registration also made the option unattractive to implement. In fact, medical schools are far better suited than the GMC to deal with stu- dent cases and medical students are still required to adhere to the GMC’s guide- lines in Tomorrow’s Doctors regard- less of their relationship with the GMC. Furthermore, the enforcement of GMC registration is likely to cause uproar amongst the student popula- tion. Students feel that there will be a scare culture within the medical stu- dent community and therefore restrict- ing the freedoms of a student in fear of the consequences that their actions will have on their careers, especially on pre-clinical courses where there is minimal patient contact in the first three years. Additionally, the BMA medical students committee has al- ways stood in opposition to the regis- tration of medical students. However, the issue is still on-going and Niall Dickson said that the registration of medical students would be kept un- der review and revisited in 2015
.
medicalstudent
November 2011
5
News
ICSM does RAG-style Trick or Treat Lizzy Kostov, Lena von Heimendahl and Angus Turnbull on a record-breaking Halloween collect
O
n the evening of the 25th October, the Freshers were stripped of their RAG vir- ginity in the most pleas- ant yet profitable way. They were equipped with buckets, maps, and killer buzzwords such as ‘teenagers with cancer’ f rom the glorious commit-
tee, and HIT THE TUBES! Not quite knowing what they were faced with, the Freshers followed our instruction to dress up in the most immodest of ways, and not to leave the tubes until they had collected every last penny. As toilet paper mummies, zombies, humungous pumpkins, gorillas and
bananas boarded the tube with their brand-spanking new blue buckets, we wished them well! The ‘silence’ rule on the tube was well and truly broken as an army of collectors did what they had to to get people to delve deep into their pockets. They sang, they begged, they danced, they did many many un-
speakable things (well, a £50 cheque certainly doesn’t come for nothing!), all in the name of the Teenage Can- cer Trust. As we sat, biting our nails, waiting for the walking dead to re- turn and keeping their rewards (beer) cold we could not have anticipated quite how well they did. Not only was
You’re such a pumpkin-head. Image by Shoaib Rizvi
there an incredible energy and buzz, but the buckets were heavier than, to be honest, GKT’s will EVER be.
“As the Zombie grinded the gorilla and the pumpkin became one with the banana, the fruits, along with the rest of the committee were extremely happy” Then feeling deceptively rich and in true medic style, the party was on! The Freshers, after quick rehydration, were blindly led to Embargos’ f lashing dance floor to display their finest moves. As the Zombie grinded the gorilla and the pumpkin became one with the ba- nana, the fruits, along with the rest of the committee were extremely happy! On Saturday morning, as a moun- tain of notes, pounds, pennies, euros and rupees landed in our SU ready for counting, the committee stumbled in, not quite knowing what to expect. Piz- za, brownies and good company saw the 10 hours f ly by and by the end, we man- aged to count a staggering £18,142.34. This broke all the collect records bro- ken and we were pretty chuffed, to say the least. Turns out the Freshers are way more talented than we gave them credit for. We hope they will continue to keep up the good work when the stakes are raised in our RAG week in February and hope to topple the Barts and be- come the RAG champions of 2012. All fun and debauchery aside, the event was an amazing success for the charity. ICSM RAG will be sup- porting the Teenage Cancer Trust, helping them to build a new ward specifically for teenagers suffer- ing from cancer. Remember, teenag- ers shouldn’t have to stop being teen- agers because they have cancer
.
Calendar of Events
BL Foundation of BL Night
23rd November
National Medsoc Conference
26 - 27th November Electives Fair
28th November
GKT Christmas Comedy Revue
30th November - 2nd December
ICSM RAG Centurion
16th November
Trauma Conference
19th - 20th November
Choir, Orchestra Concert
RUMS Naked Calendar Photo-shoot
16th November
RUMS In Your Hands Forum
22nd November
MDs: Back The Suture
19th, 24th November
24th - 26th November
3rd December
23 - 26th November
5th December
8th December
1st December
Clubs and Socs Christmas Curry Christmas Concert
Drama Play: ‘Guards! Guards!’ RAG Christmas Collect
Winter Masquerade Ball
SGUL Diwali show
23rd - 26th November
6
November 2011
News EU threatens graduate entry programmes
Research in brief
Nicholas Lelos explores the uncertain future of graduate medicine
O
nce again, trouble has been brewing over the ho- rizon about medical edu- cation. This has been a recurrent theme ever since the at- tempts to apply the Bologna Process, a pan-European agreement with over 49 signatories for streamlining edu- cation across the continent. The aim of this proposal was to allow degrees confered across its member states to be equivalent and recognised without the usual hurdles that bureaucracy of different countries present one with. Thus, mobility of European workforce would be assured and qualifications from diffent universities would all be of a single standard - BSc, Masters and Doctorates, or their equivalents. A furore was raised about a consul- tation being instigated by the European
commission about the wording of Coun- cil Directive 93/16/EEC from 1993, which sets the requirements for medical training at the undergraduate level. In particular, A rticle 23 Sec 2 ‘A complete period of medical training of this kind shall comprise at least a six-year course or 5500 hours of theoretical and practi- cal instruction given in a university or under the supervision of a university.’ The current consultation is about whether the duration of medical train- ing should be six years, irrespective of the hours. This will probably be weathered by the traditional five year course for the reasons stated above, but can present severe difficulties with the graduate-entry programmes, as well as to people who have already qualified with degrees from them. The British Medical Association has
responded by denying any change to the wording of the directive, defending the current system and arguing that grad- uate-entry programmes, by virtue of their intensive studies and curriculum, are as good value as the t raditional pro- grammes. None of the BMA office hold- ers contacted were able to comment. For many years, various EU mem- bers states and the UK have adhered to the above directive by considering the first year after graduation, the FY1, as under the supervision of the medical school, and hence the fabled ‘sixth year’. In countries such as Sweden, Germany or Portugal that period takes 18 months. In countries such as Greece, Italy, Spain, Netherlands and Belgium, the sixth year is part of the degree, so they can roll-out into work as fully licensed doctors immediately after med school.
A bittersweet graduation.
However, for graduate medical entry programmes, prevalent in the UK since 2000, the solution was the hour limit. The combination of the FY1 pre-registration year along with the study period of the graduate en- try program racked up to 5,500 hours.
“It is a little appreciated fact that a holder of a UK degree can go and work in most places in Europe, as long as they can prove that they can speak the language” The work regime is extremely in- tense, and the pre-requisite of a degree to be eligible aligns it with systems in Australia and the United States. It is a little appreciated fact that a holder of a UK degree can go and work in most places in Europe, as long as they can prove that they can speak the language. We in the UK tend to be more aware of the con- verse, as we are a nexus of employ- ment for qualified doctors from across Europe with an English aptitude test and an interview, usually mopping up the least desirable jobs in the Foun- dation Programme and elsewhere. The outcome of this is still un- known, and ways out of this situa- tion are unclear at this stage. Specu- lation surrounding this issue is rife, rendering the future of our medical graduates even murkier than it al- ready is in these troubled times
.
Policy and politicians: the NHS in 10 years James Newman Guest Writer
On 1st November, Sir Bruce Keogh, the medical director of the NHS as of 2007, and also the Professor of Car- diac Surgery at UCL and Director of Surgery at The Heart Hospital, spoke to a packed audience on the future of the NHS. After a brief introduction, Sir Bruce gave a summary of the vari- ous NHS policies and directives, un- der the current coalition government. He started by looking at the Darzi Report before going on to outline the priorities of the NHS, which are: qual- ity, leadership in moving the NHS for- ward, and personalisation of services. Quality is currently at the centre of the health service, which encom- passes joining up of services into a
coherent unit comprising and combin- ing clinical effectiveness, safety and patient experience. Similarly, leader- ship was explained as being impor- tant, not only in an administrative sense, but also in a clinical setting. By ensuring that there is a clear direc- tion to follow, illustrated by practic- ing clinicians, changes to NHS pol- icy can be implemented effectively. He went on to mention the impor- tance of the personalisation of ser- vices, in terms of pharmacogenetic aspects of healthcare as well as the ba- sic aspects of such as simple manners and a personal approach to patients in clinical practice. This, Sir Bruce commented, is where the NHS so of- ten falls down in international com- parisons. Indeed he relayed a story of how, when working in America, as an employee of a National Health Service he was seen as a cog in an ineffectual
statist machine, where patients queue outside concrete buildings waiting for the same homogenised treatment. The problem is that until recently, it wasn’t exactly an inaccurate picture in many cases. He stressed that whilst qual- ity must come first and foremost, per- sonalisation is surely a close second. Then, in the spirit of the times that we live in, Sir Bruce proceeded promote the benefits of the coalition bills to us. He did a very good job of explaining the well-intentioned hesi- tations of our current leaders, eluci- dating how the plan is to take power away from the politicians in order to create a more consistent set of NHS policies, where they don’t change every time the government does. Sir Bruce also gave an explaination on the challenges facing the health ser- vice of the future. These included the challenges of the current economic
medicalstudent
climate as well as public expectations being outdated. He particularly men- tioned the fact that what the public thought was reasonable 20 years ago sometimes is no longer possible in the current era. There is also the growing influence of technology and the chang- es that it brings, in terms of a faster, and more globalised medicine and the de- velopment of the ‘expert patient’, aid- ed by the growth of internet medicine. Additional challenges also include a demographic consideration of health- care and how there are rapidly shifting traits of diseases, from an aging popu- lation to new and exciting strains of TB created in the East End from the meld- ing of so many immigrant populations. Sir Bruce finally offered a solution to these problems whereby the NHS would need a coherent policy with clear treatment guidelines and free from the interference of politicians
.
ICSM: A patient suffering from choroideraemia, an incurable type of blindness, has been treated using gene therapy. The treatment uses a virus as a delivery vehicle to carry DNA, with the missing gene, to the eye by infecting the pohtoreceptors in the retina. The trial will see a total of 12 patients receiving treatment via surgery on one eye and is mainly used to assess safety, and if effective, will be implemented in both eyes. RUMS: Facebook friends have been linked to the size of brain regions. A correlation has been found in the amount of grey matter in an individual and the number of Facebook friends that they have. In particular, the amygdala, the right superior temporal sulcus, the left middle temporal sulcus and the right entorhinal cortex have larger volumes of grey matter in people with a large network of Facebook friends. BL: Normal bacteria found in mouths of people provide the optimum conditions for gum disease. Researchers introduced the bacteria Porphyromonas gingivalis to mice under normal conditions. The mice with normal oral bacteria exhibited periodontal bone loss but the mice without the normal oral bacteria remained disease-free. The bacteria Porphyromonas gingivalis is thought to have stimulated the growth of the normal oral bacteria thus increasing the overall number of organisms. SGUL: A trial for HIV-associated cryptococcal meningitis has begun in Malawi and Zambia. A team from St George’s will conduct a four-and-a-half year trial on a new treatment which involves a short, one-week course of amphotericin B, and a combination treatment of high-dose fluconazole with another drug called flucytosine. The results will be compared with the current treatment guidelines of amphotericin B for two weeks to assess any medical, economical and practical benefits of the new treatment regime. GKT: A genetic marker has been shown to predict the effectiveness of Cognitive Behavioural Therapy (CBT) on children suffering from anxiety disorders. Children with a shorter version of the Serotonin Transporter Promoter Polymorphism (5HTPP), which has previously been linked to depression under stress, were found to be 20 percent more likely to respond to CBT and thus free of their anxiety six months after the treament had ended.
medicalstudent
November 2011
7
News
Diary of an FY1 Junaid Fukuta on swimming with sharks and sardines
H
aving been in the hospital environ- ment for what would have been, and what will be most of my adult life, I have found that it is really quite a pe- culiar scene. Everyone, including myself, seems to be rushing about all the time, willing their legs to walk, and I stress walk, as fast as possible. It’s bizarre why people don’t run about more often if they are really that busy and pushed for time but I have found that running is often for real emer- gencies, where patients are actually crashing and immediate life saving measures are required. It is much better, when you are inevitably stopped or told off for running in hospital, to reply ‘crash call’ rather than looking sheepish and come up with some valid reason other than ‘I just need to get this bloody TTO done so that I can go home half an hour later than I had planned’. Of course nothing can be more embarrassing than being stopped by your registrar and hastily shouting ‘I really need the toilet’ as you speed past him. When it comes to the pecking order in the hospital staff, it really is quite literally a differ- ent kettle of fish, especially on my surgical ro-
tation. Consultants are often described as the sharks of the hospital and the reality is that they really are that scary, none more so when yours just happen to be tall and massive. Even the sen- ior registrars are, we’ll say respectful, of them.
“Consultants stepping into a ward is like one of those David Attenborough documentaries, where the swarm of sardines suddenly mass-retreat when the shark swims towards them, mouth wide open, ready to catch any fish that just happens to fall into their oral cavities” Now being an F1 means you constantly have to ask for senior consultations and referrals, and on this particular occasion I had a confused pa- tient who didn’t speak much English and whose reasons for coming into hospital are particularly
dubious. As a medical student, you would walk away and go and practice on someone else. How- ever, as an F1, it’s your job and when you can’t do it, you ask for someone more senior. This time, the grovelling was to the on-call registrar, who had kindly agreed to see my patient. However, just as we were about to go up to the ward, the on-call consultant came steaming down the other way, stopped, paused, looked at us and said ‘what are you doing?’ My heart sank – now my grovelling will be revealed. I explained the situation, hoping above all hopes that the consultant would do his couldn’t-care-less-about-the-young-doctors-why- couldn’t-they-be-more-like-me-in-my-days look and walk off. What he actually did was to dis- sect every inch of my grovelling and reveal that a senior referral was completely unnecessary for this occasion and that I should go up there my- self and man-up. My heart sank even further. I’ve found that consultants stepping into a ward is like one of those David Attenborough documentaries, where the swarm of sardines suddenly mass-retreat when the shark swims to- wards them, mouth wide open, ready to catch any
fish that just happens to fall into their oral cavi- ties. There is a clear radius around the person, where if anyone dares to step into it, they will be accosted, dragged, chewed up, digested and excreted in the most inhumane way possible. Be- cause they are the sharks, they can also move and literally step in to any consultation. I was mid- way through clerking that same difficult patient when the same consultant who had just berated me minutes earlier had decided that this was an interesting case and walked in, plonked himself nonchalantly on the patient’s bed and proceeded to interrupt my history taking. Now when you start clinical medicine, you are taught to do a full clerking in a series of well-planned and struc- tured set of steps. This particular consultant pro- ceeded to skip many of those steps and in a flurry of medical bravado, diagnosed the patient, came up with a management plan and the proceeded to discharge the patient and handing me his TTOs to do. By this point I had forgotten all of the his- tory that I had taken ages to extract and I had to start all over again, from the beginning, with the confused patient, who spoke little English.
.
8
November 2011
Features
medicalstudent
Features Editor: Bibek Das features@medical-student.co.uk
What’s not to ‘like’ about social media?
One last book to read. Image by Bob Xu
Alex Isted Sub-Editor The world of social media is becom- ing more and more ingrained in soci- ety, as a tool to communicate, share experiences and keep in touch with family and friends. During the 2011 ‘Arab Spring’ it allowed the images of
a fruit stand owner assaulted by Tuni- sian police to go viral, leading to na- tional protests and revolution. A You- Tube video entitled ‘It Gets Better’, aimed at motivating gay teenagers to persevere through homophobic bully- ing, snowballed into a movement in- spiring thousands. Barack Obama’s 2008 presidential campaign used al- most every form of social media at its
disposal and his Facebook page be- coming the most popular in the world, with obvious political ramifications. There is no greater resource for the sharing of ideas and interacting with others online than social media, and consequently there are more than half a billion Facebook users worldwide and over 50 million tweets are made per day. Other sites like, YouTube, Flickr,
Bebo, LinkedIn and MySpace also have huge popularity. The social media age is certainly a positive development to society, but when people don’t use it cautiously, it can be a platform for un- professionalism and embarrassment. As the GMC put it, ‘social media can blur the boundary between an individu- al’s public and professional lives’ which means that if you are not cautious, your
private life can become public. While everyone is at risk of damaging their reputation by being reckless online, the potential danger of social media blunders is even greater amongst those who rely on the trust of their commu- nities, such as politicians, police offic- ers, teachers and particularly doctors. In 2009 a g roup of seven doctors and nurses were suspended for participat-
medicalstudent
November 2011
ing in the craze by ‘planking’ in their hospital in Swindon, when on duty during their night shift, in various lo- cations including the helipad, the ward floor and on trollies, and posting their pictures on Facebook. As the staff soon found out, the online world is a danger- ous place where the uploading of a pho- tograph or post is often permanent and traceable. It’s clear that evidence of un- professionalism online can be very hard to shake off. When anyone with the ex- pertise to Google your name can see a window into your life, doctors must be very cautious with what is visible. Stories like these make headlines and whilst other fellow healthcare pro- fessionals observing can laugh and con- sider themselves safe from social me- dia related unprofessionalism, it is easy to make a mistake online. In a world where our private lives are increasingly publicised and visible online, the infor- mation we consider to be personal is in danger of being accessed by patients, with potentially damaging conse- quences. The GMC claim that doctors can be held accountable for making ‘in- temperate, disparaging or inappropri- ate remarks’ about patients online even if they are kept anonymous. While the GMC claims not to monitor Facebook, the information uploaded can easily spread and be brought to their attention. The online situation for doctors is by no means dire. As yet, there have been no ‘fitness to practice’ issues re- garding doctors’ behaviour on social media, regardless of how inappropri- ate these blunders may have been. However, in the past year a junior doctor has been suspended for mak- ing ‘scatological’ remarks about the
Director for Health and Work at the DoH, on the website Doctors.net.uk. The GMC may be unlikely to lock up your medical licence and throw away the key, but acting unprofes- sionally online doesn’t do doctors and medical students any favours. It is cer- tainly not uncommon for employers in any profession to do some online browsing when you apply for a job, and patients can so easily do the same, so it is in everyone’s best interests to make a good first online impression.
“In the past year a junior doctor has been suspended for making ‘scatological’ remarks about the Director for Health and Work at the DoH.” The position of the GMC and BMA regarding doctors’ and medical stu- dents’ use of social media has been clear. They acknowledge that most people will use sites like Twitter and Facebook regardless of what they ad- vise but they have made some guide- lines on how to navigate social media as a doctor or medical student safely. Actions to be safe from social net- working unprofessionalism are simple and certainly don’t require online ab- stinence. By being cautious with priva- cy settings on social media pages and conservatively filtering who can and can’t see aspects of your profiles, you can make your private life more secure, visible only to your close friends. How-
9
Features ever, despite this, a comment, status or tweet should be considered the same as shouting through a megaphone: if you don’t want the repercussions for something you say online, don’t say it. You should be sure to be conscious of your online image which is vis- ible to anyone. By appearing unpro- fessional like having drunken antics from rugby tour, or controversial, with an extreme political affiliation or dis- play of intolerance, you are damaging your professional standing to employ- ers and more importantly to patients. The key test is to search for yourself online and see how much information about yourself you can find. Then ask yourself whether what you find is how you would like to be represented pro- fessionally. It would be a good idea to keep an eye out and monitor how your online profiles look, particular- ly with regard to pictures and posts. With the internet and social me- dia set to stay, those in healthcare are responsible to ensure that the online resources are taken advantage of, im- proving medicine for doctors and medical students as well as patients.
“The key test is to search for yourself online and see how much information about yourself you can find.” With the huge success of the so- cial media website for professionals, LinkedIn, there is an increasing num- ber of social media sites designed spe-
The Medical Student’s Top 5 Medical Social Media Sites 1) Doctors.net.uk The UK’s largest online forum for doctors. 2) doc2doc The BMJ’s online network for doctors for blogging, forums and discussion. 3) Medpedia A peer-reviewed version of Wikipedia where only those with a medical degree or PhD can edit pages. 4) Ozmosis A service with the sharing of medical knowledge at its core – discuss clinical cases and medical publications with other doctors. 5) The Student Doctor Network Educational forums for medical students and junior doctors. cifically for doctors. These provide doctors with the opportunity to discuss medical issues, network and main- tain professional relationships online. Blogging amongst doctors has also gained popularity in recent years, par- ticularly through sites like KevinMD. com and with books collating blogs like ‘In Stitches’ by Dr Nick Edwards. As long as doctors conform to their ‘ethical and legal duty to protect [pa- tient] privacy’ in their posts, blogging acts as great way to creatively publish your experiences, opinions and ideas. The key balance to be made is to maximise the effective use of online resources without medicine becoming
robotic and detached from the patient. The web needs to be there to supple- ment the medical support of their doc- tors, neither to hider it nor replace it. When people use the internet for such a vast range of services like news, maps, weather, shopping and com- munication, amongst others, it seems logical that healthcare be supported online. The days are gone where peo- ple go to their doctor with no under- standing of what’s wrong with them. It is now common practice to Google the problem and self-diagnose, but the internet’s support needn’t end there. Interactive forums allow access of in- formation and the sharing of experi- ence to people suffering from poor health, in a way that may even be su- perior to the support a doctor can give.
“Don’t be worried about the ‘Thought Police’ round every corner, just err on the side of caution.”
‘Planking’
The net is teeming with websites offering medical information, which the public often uses to get an over- view of a medical condition and (wor- ryingly) medical students use as a learning resource. Websites like ‘Hel- lo Health’, founded in the US in 2007, allow patients to have greater online communication with their doctors, providing features like video chat, in- stant messaging and the uploading of real time symptoms, all of which improve the patient’s experience. With the explosion of social me- dia looking set to continue, doctors and medical students need to act re- sponsibly online to protect them- selves, their patients and the public image of the health service. Don’t be worried about the ‘Thought Police’ round every corner, just err on the side of caution and where possible be conservative with the nature of what you put or allow to be put online
.
10
November 2011
Features
medicalstudent
Money - that’s what I want Zoya Arain examines the growing use of financial incentives to motivate doctors
S
o, why medicine? - the in- evitable icebreaker we have all faced in our medi- cal school interviews. The perfectly memorised rhetoric prob- ably involved themes of ‘liking sci- ence’ and ‘wanting to help people’.
“At present, medical practitioners are thought to be the second highest earners in the country.” But are these vague sentiments the sole driving force pushing a medi- cal student through the 5 or 6 subse- quent years of medical education and
Medicine - every little helps. Image by Chetan Khatri a lifetime of training in the profession? In 1966, in an attempt to prevent the migration of family doctors from the NHS to private practice, the then prime minister Harold Wilson de- clared that the government would in- crease the pay of doctors and dentists by 30%, following the recommenda- tions of a pay review body. At present, medical practitioners are thought to be the second highest earners in the country according to the Guardian’s survey of best paid jobs 2010, with an annual salary ranging between £34,272 (10th centile) - £141, 662 (90th centile). But how important is finan- cial motivation in a medical career? This is a relevant question to con- sider in light of the pending health reforms, where the private sector
is looking to hold a larger stake in healthcare in the near future. Andrew Lansley’s shake-up of the NHS will necessitate GP consortiums being re- sponsible for £80bn of the NHS funds to commission healthcare in 2013.
in which they, in partnership with GP consortiums, will generate a profit f rom the savings on patient care. The compa- ny aims to treat patients at 95% of the cost of the NHS, saving approximately £40 per patient. It has been projected by Oliver Bernath, founder of IHP, that if 1000 GPs sign up to the scheme to cover “If 1000 GPs sign up a population of 2 million patients, there to the scheme...there is a possible £80 million of profit which is a possible £80 could be generated, leading to a wind- million of profit which fall of £160,000 for each GP partner. could be generated, Lansley’s rationale for delegat- leading to a winding this responsibility to GP consor- fall of £160,000 for tiums is in an effort to save £1 billion each GP partner.” in management costs, and will ‘em- power’ doctors against the ‘frustrat- ing bureaucracy’ that plagues the According to one newspaper, a private health service. Ann Robinson, who company, IHP, has suggested a scheme has worked in the speciality for 20
years, has said that it is unclear as to why GPs would be better at imposing cuts than primary care trusts: ‘The re- sponsibility involved in commission- ing is huge and training non-existent… it is not taught on any medical school curriculum or offered on any course… would anyone want me to be responsi- ble for complex budgetary decisions?’ Financially, the future within this speciality appears increasingly attrac- tive, however this conflicts with some of the current data about job prospects. The number of advertised GP posts has dropped by around 70% in recent years;; the BMA estimate that of the 1000 graduates to enter the special- ity this year, approximately a third will struggle to find work. A major part of the problem is that since GPs
medicalstudent
November 2011
have become private contractors splitting the profits generated in each practice between them, there is less incentive to recruit more partners and reduce their share of the profits.
“While a secure income is essential, financial rewards for meeting goals actually degrades our work.” Moreover, the BMA found in a national sur- vey of GP opinion 2011, that on average GPs were shouldering an increased workload for less money. Of those who participated in the survey, 88% said that their workload had in- creased in intensity over the past 5 years. This, says Lawrence Buckman, Chairman of the BMAs General Practitioners Committee, is due to GPs ‘taking on more of the work tradition- ally done by hospitals’. More than half of those surveyed expected a net decrease in their NHS income between April 2010 and March 2011.
“Financial incentives create or exacerbate doctor’s conflicts of interest which compromise doctor’s loyalty to patients and exercising independent judgement.”
11
Features Lester et al, showed that performance declined when the financial incentive was withdrawn. James R. Demming, a Family Physician and Expert Team advisor for the Mayo Health System, comments that ‘This may appear to argue against the withdrawal of financial in- centive, but I believe this argues against fi- nancial incentives in general…While a se- cure income is essential, financial rewards for meeting goals actually degrades our work’. An article entitled ‘Financial incentives for doctors’ by Marc A Rodwin, explores the det- rimental effects of this phenomenon. Rodwin argues that financial incentives used to change clinical behaviour implies that ‘doctors should consider their own self-interest when mak- ing medical decisions’, however ‘self-interest’ compromises a patient centred ethos which is ‘central to good medical practice’. Rodwin fur- ther discusses that many financial incentives ‘create or exacerbate doctor’s conflicts of inter- est which compromise doctor’s loyalty to pa- tients and exercising independent judgement’.
“Medicine is an individual to individual business: the very concept of a doctor-patient relationship is singular.”
Another angle from which to explore the extent to which financial factors motivate doctors, is considering reasons for leaving the profession. In a survey conducted on the In a healthcare environment that is be- junior doctors who were considering leaving ing increasingly subjected to the phenom- the medical profession in the UK in 2004 by enon of profit and saving, perhaps it is Moss et al, 75% named ‘working conditions’ necessary to consider the effect that fi- as the reason for their decision. ‘Working nancial incentive has on patient care. Conditions’ as defined by the study referred A longitudinal study conducted in 2010, to pay, working hours and job satisfaction. assessing the effect of removing financial in- In Australia, it has been reported that doc- centives from clinical quality indicators by tors have relatively high rates of job satisfac-
tion, which ‘is not surprising’ according to Professor Peter Brooks, director of the Australian Health Work Force at the uni- versity of Melbourne, given that Aus- tralian doctors are ‘probably better paid than many doctors around the world’. Although financial motivation appears to play a role in the career choices made by those in the profession. Richard Hayward, in an article for the BMJ, discusses why doctors enjoy doing what they do, and elu- cidating alternative causes for discontent.
“With the current direction of the NHS reforms...has the individualistic aspect of healthcare become threatened?” He w rites that medicine is an ‘individual to individual business: the very concept of a doctor-patient relationship is singular...this attitude takes priority over the community as a whole, which is not to say that doctors aren’t interested in the NHS, but it is too diffuse to warm their blood’. However with the current direction of the NHS reforms, and the more managerial responsibility del- egated to doctors within specialities such as General Practice, has the individualistic aspect of healthcare become threatened? Money and the provision of healthcare have become intrinsically linked since the establishment of the NHS. The subse- quent focus of health provision has gradu- ally shifted towards the cost-effectiveness of community care. This begs the question to what extent are the simple motives of ‘liking science’ and ‘wanting to help peo- ple’ diluted with the increasing burden of financial responsibility and incentive
.
WALKING THE TIGHTROPE Ashik Amlani gives his personal perspective on financial rewards in medicine Many of you reading this will, at some point, have considered your eventual salary in a medical career. This may be especially true of those still in school and in the early years of university, who have yet to experience the life-saving aspect of the profession for themselves. If you Google ‘doctor salary uk’, you are greeted with a mind-boggling 17,400,000 results. A figure that serves to highlight how vital a consideration remuneration may be to medical students and doctors alike. I find it hard to believe, however, that a student who has never before worked as a care-giver would be more motivated by the intangible reward gained from saving a life than by the prospect of a £100k+ salary once qualified. I used to think being a doctor was about being paid lots of money to cut people up. As I have progressed, though, I find my feelings somewhat different. Being in a hospital full time really does throw into sharp focus the care giving aspect of the job, and strangely this feels more gratifying than the pay check. In fact, studies have shown that financial reward does play a part in motivation, but more so in dentists than in doctors. Doctors place value on other factors, such as an interest in science, a desire to work with people, and the feeling they get after ‘saving a life’. Consider this cynic well and truly humbled. But is money the best motivator, or are abstract feelings really more likely to deliver results? Somewhat counterintuitively, the evidence suggests that money plays a less significant role in determining healthcare quality than other factors. A recent report on the ‘Quality and Outcomes Framework’ (a pay-for-performance scheme for GPs introduced in 2004) states that the scheme ‘has not resulted in improved ill-health prevention or health promotion by general practitioners’. The private sector is potentially very lucrative, and I have personally witnessed doctors discussing and working on private cases on NHS time. Surely the distraction of monetary gain, to the detriment of NHS patient care, is a case of the system gone wrong? Add to this the issues regarding the intrinsic cost of giving out these rewards as well as negative patient selection (in order to avoid penalties) on the part of the doctors, and you have a damning argument against offering financial rewards. With the imminent introduction of the now infamous healthcare reforms, concerns are mounting that these changes will increase the influence of the private sector, and offer more opportunities for a profit driven healthcare system. One of the proposed ideas is for the GP consortia to offer financial incentives deterring GPs from sending patients to hospital. You don’t need me to highlight the potential pitfalls of this system. As seems to be the case with medicine, we walk a tightrope when offering financial rewards. Too little, and the profession will fail to attract new talent: too much leads to distraction and wasting of precious resources. As always, a balance must be struck, and it remains to be seen who will really profit most from this system: the doctors or the patients?
12
November 2011
Comment
medicalstudent
Comment Editor: Rhys Davies comment@medical-student.co.uk
Polishing the glass ceiling Natasha Liow Guest Writer
Feminism is a dirty word. A generation away from the Women’s Movement, all that remains of the ideals and philoso- phy behind feminism is a reluctance to associate with the term. To do so is to invoke images of Amazonian-like women burning their bras. However, at its roots, feminism is about equal- ity and a woman’s right to choose: from jobs to families. Some would have you believe that the fight for equality is over and done. On the contrary we find that disparities still exist between the genders in the workplace, in salary and position, and the medical field is no exception where there is a continued male dominance in certain specialities. At f irst glance some of these disparities are explained by an insidious, persis- tent sexism. However, it becomes clear that sexism is not the full story. Much of the disparity seems to stem from women’s own choices. The question is whether that choice is t ruly f ree, or a re- sult of conditioned reaction to learned gender biases that are still rife within our society. The number of women entering medical school has been steadily ris- ing for the last three decades and cur- rent statistics now show that there are in fact more women than men. In 2009, UCAS reported 55.5% of places offered for medical degrees were women, con- trasting with less than 10% in 1970. Some medical schools in the UK have a female:male ratio now approaching 65:35. However, this rise in female stu- dents and graduates has not translated to an increase in the number of females in the upper echelons of academic and clinical medicine. As of 2009, only 8% of UK consultant surgeons and only 3 of North America’s 125 medical school chairpersons are women. There are also clear differences in the representation of men and women in a range of specialities. Women tend to be underrepresented in the higher- earning specialties, such as surgery but overrepresented in the lower-earning specialities of paediatrics and internal medicine. Unequal numbers are most prevalent in surgical specialties. Whilst many papers will use figures such as 23% of surgical trainees being women in 2009 to trumpet the growth of fe- male representation, on the flip side, a 77:23 male to female ratio is still a huge gap. It is clear that disparities exist be- tween the sexes in medicine and the real question is why these differences exist. The underrepresentation of women in the higher ranks of medicine reflects a pattern seen in many other profes- sions. Known as the ‘glass ceiling’ ef-
fect, positions of power or leadership may be visible to a female g raduate, but not actually attainable for a variety of reasons. Some argue that this effect is due to women being less effective lead- ers and less productive, leading to male counterparts being selected for promo- tion over them. However, studies have demonstrated that women have equal or more effective leadership skills than men and that women, on average, pub- lish more papers. Another stance is the ‘pipeline’ ef- fect, whereby there has simply not been enough time for the higher numbers of female students to translate to consult- ant level. However, the reality is that after 30 years, enough time for a gen- eration to have moved up the ranks, the number of women in positions of pow- er has not had the same magnitude of growth. Furthermore, the pipeline ef- fect should be seen across specialities, however, in some specialities such as Obstetrics and Gynaecology, there are now significantly more women than men at all levels. This contrasts with the continued relatively low numbers of women in surgery, both at trainee and consultant level.
“If they chose to have children and take out significant time from their careers, or stop having careers altogether, they are perceived as weak, as they were not capable of juggling it all.” Sexual discrimination comes in many forms from sexual harassment to omission of women from social situa- tions. In male dominated specialties, male trainees may get to benefit from socialising with their male superiors in activities to which their female coun- terparts are not always invited, such as golf. These extra-work activities may form the basis for job opportunities and networking, thus disadvantaging wom- en in career progression. Discrimina- tion also takes on a more insidious form when the commitment of a woman to her chosen speciality is questioned if and when she decides to have a child. However, though sexual discrimina- tion still has a definite role in causing the disparities, job application numbers also suggest that women themselves create and contribute to the problems. One study found that only 10% of ap- plicants to general surgery were wom- en, showing that women are choosing against certain specialties. Further- more, despite making up only a tenth of the general surgical application pool, women made up a quarter of the hired list. This suggests that the trouble in the numbers is not totally the fault of sexist employers, but rather women themselves.
If only being a women in medicine in real life was this easy. So, where is the glass ceiling? If women are simply deciding against applying to certain roles, surely this is their choice and therefore not problematic. The problem with resting the entire feminist argument on the question of choice is that choices are influenced by a number of factors. As such, although a woman may have made a decision, that decision may not be free of con- founding sexist factors. The reality is that prescriptive gender roles still per- sist in society. These roles are exposed to both sexes from childhood and may innately affect the choices made as adults. So whilst the choices are per- ceived to be f ree of biases, unfortunate- ly biases may be entirely subconscious. Traditionally, women were seen as the carers of children and men as the ‘breadwinners’ of the family unit. Much of the philosophy of early femi- nism centred on questioning this mod- el and to encourage women to believe that, if they so chose, they could have something other than or alongside motherhood. In contemporary terms, this has had unforeseen consequences for the modern woman. If a woman chooses against having a husband and children, they are often perceived as sad, spinster individuals. If they chose to have children and take out significant time from their careers, or stop having careers altogether, they are perceived as weak, as they were not capable of juggling it all. Finally, if a woman chooses to have children but to not participate in the family unit as the primary carer for them, they are per- ceived as bad mothers. Studies by both Salchwater et al (2005) and Sanfey et al (2006) found that whilst both men and women were concerned about the impact of a surgi- cal career on family life, the priority
varied between the genders. Men were concerned that work would cause them to miss family events, whereas women were concerned that family life would interfere with work. This highlights the inherent prioritising of work by men and family life by women. The question is whether these priorities are formed on the basis of perceptions of what so- ciety expects of each gender. This un- derpins an attitude that is pervasive to most of the post-feminist era where, although women have fought to have careers, their responsibility as the key carer for children is no lighter. Women still do more hours of do- mestic tasks (e.g. cooking and clean- ing) and spend more time dealing with childcare per week than men, despite working as many hours. In part, this is due to a continuing expectation of women to be the primary carer of house and family, despite a full-time job. This is also reflected in the sig- nificant disparities that still remain between the amount of leave given to men and women following the birth of a new child. The onus on the woman to put her career on hold and to fulfil the role of stay-at-home mother is rein- forced by the significantly longer leave women are given. This could be an- other factor to explain the lower num- bers of women in consultant positions of certain specialities.
“In the meantime, women in medicine must make a conscious effort to choose specialities based on their abilities - not on their biological clock.” Women are therefore forced, con- sciously or subconsciously, to take into
account their heavy domestic respon- sibilities when selecting their special- ity. A choice, which is no longer based solely on whether the woman has the right skills set or experience for the job in question. The University of Exeter is cur- rently working in collaboration with Women in Surgery of the Royal Col- lege of Surgeons to examine the rea- sons behind women’s career choices and so far have found that women chose careers in which they perceive they are more likely to succeed. The perception of surgery is not a positive one, with women believing that it will hinder their opportunities to have a family, whether through seniors ques- tioning their commitment on deciding to start a family, or through long hours which would conflict with them fulfill- ing a society-imposed role of domestic goddess. Feminism has indeed furthered the cause of women in all workplaces, the medical field included. The high num- bers of women in medical school and in- creasing numbers of women in training positions is testament to this. However, the disparities that still exist in consult- ant positions and in certain specialities demonstrate that feminism is still rel- evant in today’s medical environment. Though some of the disparities are still due to both overt and covert sexism, women themselves are contributing to the wide divide. The choices they make are based on subconscious gender roles which are deeply ingrained within so- ciety. Until these roles can be broken, the disparities in numbers will remain. It may be some time before these roles can be changed in the whole of society;; in the meantime, women in medicine must make a conscious effort to choose specialities based on their abilities - not on their biological clock
.
medicalstudent
November 2011
13
Comment
The dark side of medical banter Dr. Emlyn-Jones speaks up about homophobia in medicine today.
A
long with some friends from my medical school, I attended some weekend re- vision courses in the lead up to finals this year. These types of courses are put on in various cities around the country by various medical organisations, and consist of one or t wo intensive days of interactive lectures covering various aspects of the medi- cal course. While the teaching at these courses was excellent, some of the jokes employed during various comic interludes I found disturbing. Here is one example. During an af- ternoon session on musculoskeletal examinations, a lecturer got a volun- teer from the audience to demonstrate Schober’s test of flexion in the lumbar spine. The volunteer bent over in or- der to flex the spine, and the lecturer simultaneously put up a powerpoint slide showing actors Heath Ledger and Jake Gyllenhaal embracing, in a poster
advertising the film Brokeback Moun- tain, a film about gay cowboys. The implication was obvious, and the whole audience erupted into laughter.
“The volunteer bent over in order to flex the spine, and the lecturer simultaneously put up a powerpoint slide showing actors Heath Ledger and Jake Gyllenhaal embracing, in a poster advertising the film Brokeback Mountain, a film about gay cowboys.” As a gay man, I cringed in my seat. Up until that point the weekend had been fun, but at that moment a chasm opened up between me and the rest of the lecture hall. The message for me
was clear;; you don’t belong here. Sadly, this kind of joke, in various forms, was also cracked at the other courses I at- tended, and when I spoke with a gay GP who’d trained a decade ago, he told me that such jokes were routine back then as well. This was clearly intended to be harmless fun, and when I complained to the lecturer after the course had fin- ished, he gave a fulsome apology to- gether with an assurance that it would never be repeated. Interestingly, it didn’t seem to have occurred to him that in a lecture theatre of several hun- dred students, it was a statistical likeli- hood that some of them would be gay, and might be offended! During my years at medical school, I also witnessed homophobic comments made by consultants. For example, in response to a house officer’s humor- ous imitation of the Trendelenburg gait on the ward round, one consultant told
him that he would ‘attract every homo- sexual in the county’. If he had made a comment which was racist or sexist, all hell would have broken loose
“In response to a house officer’s humorous imitation of the Trendelenburg gait on the ward round, one consultant told him that he would “attract every homosexual in the county”. If he had made a comment which was racist or sexist, all hell would have broken loose.” (assuming his team had had the courage to challenge him), but many in the medical profession still seem to re- gard gay people as fair game.
Whilst many gay doctors and medi- cal students have experienced no prob- lems as a consequence of their sexual orientation, some do face substantial challenges, which can result in intense feelings of loneliness and isolation. Even though laws serve to protect gay people in the workplace, and the exist- ence of Civil Partnerships have gone a long way toward social equality, there is still clearly a problem in the medi- cal profession. The solution is for peo- ple to have the courage to challenge homophobia whenever it occurs, and so change our profession for the better. For gay students and doctors, there are several organisations out there which offer support. The London based Gay and Lesbian Association of Doc- tors and Dentists (GLADD) for exam- ple organises regular social events and educational meetings, and provides opportunities for networking (http:// www.gladd.co.uk/)
.
14
November 2011
Comment Shisha for students Roshni Patel Guest Writer
Sex on the Beach, Tequila Sun- rise, Cosmopolitan – all spell out the same thing to most peo- ple but what do Blue Mist, Star- buzz and Fantasia mean to you? We’re not talking about alcoholic cocktails anymore. Instead, they are types of shisha. This is the name given to the tobacco that is smoked via an (aptly named) shisha pipe. The smoke from a shisha pipe (also known as a hookah) is usually cooled by wa- ter, and smokers inhale the fla- voured air through a mouth piece that is fixed onto a long hose. Shisha is also known as Mu‘assel, meaning ‘honeyed’ in Arabic. The origin of shisha is much debated, with some believ- ing its origins lie within parts of India, whilst others claim that the Middle East is in fact the t rue home of shisha. There is no denying that shisha smoking is a huge phe- nomenon in both South East Asia and the Middle East, and is now spreading to the United States and the United Kingdom. In the UK a 2007 survey by a Birmingham medical stu- dent found that, of the 937 stu- dents questioned, ‘38% had tried shisha. 8% of students were smoking shisha at least monthly (defined by the WHO as cur- rent use), 9% of students were cigarette smokers, and of these, 30% were current shisha smok- ers, so that most shisha smokers smoked shisha as their only form of tobacco’. It is also important to rec- ognise ethnic differences with regards to shisha smoking, as it thought to be more popular and more culturally acceptable amongst certain ethnic minori- ties, such as Indians, Pakistanis, and Middle Eastern populations. The most popular places for students to smoke shisha tend to be shisha lounges, or in the com- fort of their own home. This has been facilitated by the number of ‘shisha cafes’ populating Lon- don, and the vast availability of personalised pipes and flavour- ings. Since the ban on smoking indoors in public, these cafes provide a sheltered space out- side to smoke shisha. There is no doubt that Shisha smoking has become the latest must-try social experience, especially amongst university students. So what is it about shisha smoking that has proved to be such a hit amongst these groups
of people? For one, it is a very different and unique social expe- rience. Many have thought that the pure satisfaction of being able to choose different combi- nations and trying new flavours compares to that of a child in a sweet shop. Amongst medical students it is also worth noting that many prefer social outings to shisha lounges as an alternative to clubs and bars, as it is thought that the health repercussions of a session of shisha smoking are far fewer than that of a night of drinking. Although there is no evidence yet to suggest that this is true, as a general consensus it is agreed that shisha smoking has far fewer health implications than smok- ing cigarettes or drinking alco- hol. But is this true? There are some publications that contradicting this opinion. A study carried out by the World Health Organisation suggested that ‘the volume of smoke in- haled in an hour-long shisha ses- sion is estimated to be the equiv- alent of smoking between 100 and 200 cigarettes.’ When asked whether they thought they could ever be ad- dicted to shisha, medical stu- dents replied, ‘it is more of a social addiction rather than an actual addiction.’ Students also explained how it is possible to get ‘tobacco-free shisha prod- ucts, an option that is u navailable with any other form of smoking.’ It seems that more so than cigarette smoking, shisha is a shared activity, a social activity, where people can get together in an atmosphere that is much more relaxed than that of a bar or club. For some students it is also a matter of availability. For exam- ple, students from universities surrounded by shisha cafes and little else in the form of social ac- tivities are much more likely to spend their time in these places. The popularity of areas such as Edgware Road, which boasts an impressive array of Middle Eastern flavour, Lebanese cui- sine, and an extensive range of shisha cafes, are ever increas- ing. So are the nation’s students really turning towards this new trend in tobacco smoking, or are there facts regarding the health implications that still need to be uncovered? Either way, it seems that shisha smoking is here to stay. With an ever growing palette of flavours to try and new shisha cafes opening on every London street corner, there is no end of things for medical students to do and try!
.
medicalstudent
Head to
In the 21st century, w the histor
YES Rhys Davies Comment Editor
When I was younger, when we used to play doctors and nurses, I would rush to grab the pint-sized white coat. That was how you knew that I was the doc- tor. These days, kids have to scramble for the shirt with the sleeves rolled up. It has been a few years now since the white coat was blacklisted in Brit- ish hospitals. The official line is that they harboured and carried infection. More cynical physicians claimed it was a ploy by NHS managers to disempow- er medical professionals. Many doctors senior enough to remember the change look back fondly on their uniform and dream wistfully of a day when they might come back. This should not happen. Proponents of the white coat will say that it is an essential symbol of medicine, that it easily allows patients to identify their doctor. This isn’t quite true. It allows patients to identify doc- tors, phlebotomists, mortuary workers and lab technicians, among others, but doesn’t help narrow down who is who. The white coat is ubiquitous in practi- cal science and is hardly the reserve of the physician alone. Indeed, doctors weren’t even origi- nal in taking up the white coat in the first place. They began wearing white coats in the 19th century to appear more scientific and hygienic to their patients, borrowing the image that scientists had already cultivated. Just as they replaced the morning suit, so too have they been replaced by the shirt-with-the-sleeves- rolled-up. They were a fashion, a fash- ion whose time has come and gone. Some people say that a white coat
fosters a patient’s trust in their doctor’s abilities. Isn’t this cheating? We should have to earn our patients’ trust through our clinical skill and bedside manner – these are the things that truly make the doctor. I can wear a beret but that doesn’t make me French.
“They were a fashion, a fashion whose time has come and gone.” But as well as appearing compe- tent and knowledgeable, the doctor in a white coat can also appear authorita- tive and elitist. This can be barriers to good patient-centred communication, especially in a time when we are mov- ing towards more equal doctor-patient relationships and shared decision-mak- ing. It is worth noting that specialities where this trend is greatest are not strongly associated with white coats;; psychiatry, paediatrics and general practice. Conversely, a survey in 1991 found that the biggest reason for wear- ing a white coat was the status. The second biggest reason was pockets. I am not saying that medicine should not have its status symbols. Instead, we should invest our identity in a piece of paraphernalia that we actually use. The stethoscope, for example, as a practical use at the bedside and can easily iden- tify the doctor in the room. The same claims of infection risk can be levelled at it but a stethoscope is much easier to clean than a white coat. Also, a lack of storage space is no problem to a suffi- ciently resourceful doctor. Like the beaked plague masks be- fore them, the time of the white coat has now passed. We may remember them fondly but they belong to history now
.
Look at this guy. What a tool! But th
Next month, Co Should Medicine be a
Deadline: 27th November. Send all articles to comment.medica
medicalstudent
November 2011
15
Comment God bless evolution
o Head
Robert Vaughan Guest Writer
white coats belong in ry books.
hat might not be because of the white coat.
NO David Fisher Staff Writer
Picture the scene: an elderly patient approaches a doodling medical stu- dent who is inexpertly wrapping his stethoscope around his neck and says, ‘Excuse me doctor, could you tell me the time please?’ ‘Oh no, I’m not a doctor’, replies the student sheepishly, slapping his pockets searching in vain for his wrist watch he had left behind when rolling his sleeves earlier. This confusion is not uncommon in hospi- tals particularly since 2007 when the Department of Health unveiled a policy that led to banning the t raditional white coat amid fears they provided a route for infections to spread. This was un- fortunate because as an accessory gar- ment they protected underlying clothes and had large pockets which gave them practical value. Perhaps most impor- tantly, the coat made doctors easy to identify.
“Without doubt the medical profession lost its uniform in a moment of overzealous caution.” Some argued that patients do not communicate as freely with a doctor in a white coat as they do with a doctor in plain clothes. In fact, many patients, the elderly in particular, felt a sense of confidence when they saw a doctor in a white coat. Several surveys have re- ported that patients prefer speaking to a doctor in a white coat. The distinguish- ing apparel brought comfort because it represented the highest form of medical care. The loss of the white coat means
doctors are less easily identifiable and on a subconscious level appear no more qualified than any other semi-smartly dressed stranger. The tradition for doctors to wear white coats originated in the late nine- teenth century. It is ironic that they have been removed from the workplace for fears of cleanliness when originally they were introduced to represent pu- rity and cleanliness. Principally white coats departed from hospitals because studies sug- gested they may facilitate microbial infections spreading more easily. Sur- prisingly, the evidence is quite sparse. The original report admits ‘there is no conclusive evidence that uniforms (or work clothes) pose a significant hazard in terms of spreading infection’. The decision was obviously an overreaction as evidenced by other countries such as America examining the data and con- cluding that similar measures were not necessary. At its essence, the cause of contamination was a failure to clean the coats on a regular basis. Washing a gar- ment for a mere ten minutes removes most micro-organisms. The problem of microbes festering at the bottom of sleeves could easily have been over- come by taking measures to ensure daily washing of the garments. These alternative proposals would likely have been similarly effective at tackling in- fections and would not have overturned a cherished tradition. It is distressing that a momentous change in health policy could occur with such nonchalance on the basis of inconsistent evidence. Without doubt the medical profession lost its uniform in a moment of overzealous caution. It is our duty to ensure no more of the traditional foundations of medicine are whittled down at a whim
omment asks; graduate-only course?
alstudent@gmail.com Articles should be 500-1000 words in length
.
The coal miners of Northern England ran out of coal to mine. They mined and mined – get- ting more efficient as they went – until there was nothing left to mine. Saddening? Yes. However on reflection, it must have been obvious from the start that this was going to happen. It is said that one of the main benefits of entering the health- care sector over any other is the job security it seems to of- fer. `People will always be sick,’ they say. However with frequent reports in the news about scien- tific and pharmacological break- throughs, a world in which most diseases have been cured for good seems more than just con- ceivable. Failing that, at least a world where the doctor’s role has been made largely redundant. This makes you wonder: What makes our vocation any more se- cure than the coal miners’ of the 1980s? The answer is evolution. There are more and more re- ports of pathogens that have ex- ploited this magical mechanism to undermine traditional medi- cal treatments. MRSA, C. dif- ficile, and more recently gonor- rhea are all examples of bacteria that are now exhibiting antibi- otic resistance that they had not had before.
“Our medical forefathers, it seems, have already stirred the evolutionary war machine into action with constant overuse of antibiotics, forcing it to inevitably snap back with growing anger and speed.” Evolution is essentially a long game of trial and error. It begins with countless, tiny variations in the structure of a genome, tak- ing place over millions of years. These variations may: prove in- stantly fatal for a life form, not present any change in the phe- notype at all, or, if very lucky, result in a change that will ben- efit the genome in its environ- ment over its original genetic siblings. It then becomes the case that over a large period of time genomes grow and adapt to ‘threats that would normally re- duce their ability to survive’ or ‘selective pressures’ – A process
Charles Darwin famously chris- tened ‘natural selection.’ Science textbooks often talk about evolution as a process that happened millions of years ago, giving examples like how giraffes changed their necks to eat off high up branches in the savannah via natural selection. What is less clear from learn- ing about evolution in this way is that: Firstly, the selective pressures required to stimulate evolution do not have to be as natural as the height of a tree. It could for example, be the treat- ment of a bacterium or virus by a manmade antibiotic or antiviral respectively, and secondly, this process is not just ancient his- tory, in fact it is happening this at this very moment. HIV is another classic exam- ple of this, evolving so fast and unpredictably that no single vac- cination lasts for long enough to have any effect, kind of like a criminal who evades the law by changing his face a thousand times a day. Our medical fore- fathers, it seems, have already stirred the evolutionary war ma- chine into action with constant overuse of antibiotics, forcing it to inevitably snap back with growing anger and speed. It does make sense that we would eventually be able to evolve immunity against such threats independent of medicine, just like we have before. How- ever, ironically, our appetite for living with medicine has already accelerated the change in patho- gens faster than our genome is naturally able to keep up with.
“What will be required to overcome such biological smartarse-ness?” What does this really mean for us as medical students? That in our careers we will face a ris- ing tide of treatment-resistant pathogens growing in complex- ity and intelligence, pinning the desperation back on us. What will be required to overcome such biological smart-arse-ness? It is up to us now as scientists to find the less obvious, more el- egant approaches to sickness if we are to outlast the next genera- tion of flu pandemics or MRSA strains;; areas like gene therapy and immunotherapy are no long- er just a pleasantry for the future of medicine, they are a necessity. Worrying? Yes. Difficult? Yes. But hey, unlike the coal miners, at least we’ll always have work!
.
16
November 2011
Comment
medicalstudent
Nothing beats a good cup of Modafinil Amrutha Sridhar looks at a potential rival to everybody’s favourite poison
I
t’s 2am, your eyelids sneakily droop down every time you zone out, and that Rang, Dale and Rit- ter sitting on your desk shoots reproachful looks at your submission, your exhaustion. Your friend, your companion, and probably the love of your life if you want to continue embark- ing on a medical career, sits steaming in a mug, loyal and welcoming. Coffee. Now your love and devotion has a new rival;; Modafinil. The dependence on coffee is an al- most quintessential part of a medical career. Medics have the reputation of being able to work hard and play hard, and quite naturally, it does have two el- ements to it;; the drive to succeed at a demand career, and the desire to keep up with the stereotypical student life- style. Most people who read medicine, or most people who are somehow asso- ciated with a medical student, are aware that the stresses and demands placed by the medical course are matched by few other undergraduate courses. The con- tent of the course is at a high level, but in addition to this slightly depressing fact, the programme itself is quite in- tensive, and furthermore twice the du- ration of most other university degrees. Thus, medical students have to work arguably harder than their non-medical peers, and definitely for a longer period of time. The other aspect is the reputation
that medical students party hard. The recent, incensed article in a leading newspaper highlighted the rambunc- tious affair that was an Imperial Col- lege bop, but there’s no doubt that such nights occur across the universities of the United Kingdom. One supposes that this popularity of raucous partying is both stress relief from the long and tiring days spent in hospitals or with PubMed, as well as putting mileage on the proverbial ‘Student Lifestyle’ clock with rigorous amounts of partying whenever their schedule permits (for a select few, that constitutes every week- end). Now, skip forward a few years to the point where those medical students are now qualified and practicing doc- tors, with expectations and responsi- bilities resting on their shoulders in a job as intensive as the aforementioned degree. The Oxford Handbook of Clinical Medicine need give no input in deciding whether or not this is a tenable life plan. The black stuff has several benefits in the short term, which include increased alertness, even during sleep depriva- tion and tiredness and perhaps also en- durance. However, caffeine has several long term effects and few of them are particularly desirable, and the effects of overdose are even less appealing. The most obvious of these are probably the physical effects – it might not be partic- ularly inspiring for patients to ask for a
doctor and have an agitated racoon t urn under conditions of sleep deprivation. up and In a study carried out by intro- Imperial College London, duce one group of doctors were itself. treated with Modafinil and Con- the other group with a pla- sent cebo, and the groups’ mo- might tor and cognitive functions be- were as- come sessed. The a slight prelimi- issue nary results at this revealed stage. The bro- that the chure then goes on Modafinil It might not be parto offer anxiety, group had ticularly inspiring palpitations, and increased for patients to ask tremors, which are cognitive for a doctor and an impediment to function in have an agitated medical treatment, compari- racoon turn up and especially surgi- son to the introduce itself. cal. Therefore, the placebo Consent might beuse of caffeine as group, but come a slight issue a performance en- there was at this stage. hancer by medical no signifi- practitioners, espe- cially surgeons, is a valid concern as it has been shown to compromise motor skill finesse. Modafinil does not affect motor skill finesse. Modafinil is often used to suppress the need for sleep and in addition to this it has been shown to improve working memory function
‘You take the blue pill and I’ll show you how deep the rabbit hole goes’ are not words you want to hear at 3am in the Doctors’ Mess. Credit: Heather Welch
cant difference in motor skill capacity between the two groups. Modafinil, like Caffeine, is not without its risks and side-effects. Linked to DRESS and Stevens-Johnson Syndromes (both of which are adverse hypersensitivity reactions to the drug), its less serious side-effects include palpitations, anxi- ety and irritability, as well as a negative interaction with the hormonal contra- ceptives used by many young women. That brings us to the comparison of Modafinil and Caffeine, whether it is better to keep with the devil you love, or to try the drug en vogue. Caffeine is well known and easily available, not to mention ubiquitously consumed, the desire to enhance performance notwithstanding. Modafinil, on the other hand, is a prescription drug in most countries including the United States. With such limited availability, Modafinil becomes a far more demand- ing affair, and due to the general unfa- miliarity with the drug, a potentially more dangerous and possibly even illegal one. Aside from the taboo of self-medicating doctors, there is the factor of the level of care owed to the patients. Caffeine in higher doses (a level purely depend- ent on the patient) is shown to affect motor skill co-ordina- tion, which becomes a serious concern for surgeons. How- ever, Modafinil has been studied less thoroughly than Caffeine, so though there is no proven compromise of mo- tor skills, there is also a lesser under- standing of the general and long-term effects, and this keeps Modafinil in the wild card category for now. Medicine has never been a sport, and therefore the use of performance enhancing drugs becomes a desperate attempt at perseverance rather than a slur on sportsmanship. Still, does this distinction make the practice at all ac- ceptable? A doctor still owes a respon- sibility to the patient, and does effec- tively practicing under the influence of a central nervous system stimulant make said doctor unable to fulfil that obligation of high standard care? If Modafinil should then be banned from usage during medical practice, why should caffeine still be allowed? Modafinil is licensed for use in narcoplepsy and other diseases char- acterised by excessive sleepiness - not including being the FY1 on the night shift. Its mechanism of action isn’t en- tirely understood yet but it seems to increase levels of monoamine neuro- transmitters in the brain. It’s not just doctors who are inter- ested in Modafinil. The MoD have also commissioned research into its mili- tary use
.
Write for us.
Editor@medical-student.co.uk
18
November 2011
medicalstudent
Culture Culture Editor: Robyn Jacobs culture@medical-student.co.uk
REVIEW
Contagion
Ashik Amlani Guest Writer
will discard the science in order to up the ante action wise, but here is that rare beast that delivers both to a satis- fying degree. A film in which science eclipses the stars to be the real hero. The plot revolves around fictional virus MEV-1, lethal to around 20% of its carriers and spreads via fomite transmission (through contact with an inanimate object capable of carrying organisms). We follow its path through the eyes of several protagonists over a few weeks as it causes a pandemic. It all begins with Gwyneth Paltrow, the woman blamed for carrying the virus to America. She is returning from Ma- cau where she contracts the virus from a casino, has an affair in Chicago and thus the relentless spread begins. Other threads involve an everyday family man Matt Damon, struggling to cope with the death of his wife and son within the first few minutes, and rogue journalist Jude Law, seeking to profit from the mass confusion and panic. Whilst the virus infects seven million within two weeks, the Centre for Disease Control
All-star ensemble cast? Check. A-list director? Check. Plot involving im- pending disaster and the end of life as we know it? Check. On the face of it, Contagion has all the elements your av- erage end-of-the-world thriller - grim, tense and full of foreboding, yet with enough substance and depth to make even the most cynical appreciate its value. Delve a little deeper, however, and you find that it is a more compli- cated animal. Instead of relying on emotional attachments or a deus ex machina ending, Soderbergh deliv- ers a taut, thought-provoking and, in his own words, ‘ultra-realistic’ film in which the plight of the innocent vic- tim is starkly rendered. The science is handled with accuracy and surprising detail. How many average moviegoers (or even medics for that matter) would be familiar with such terms as fomites and R0? It is all too often that films
REVIEW
and Prevention (CDC) employees Lau- rence Fishburne - he and his woman on the ground, Kate Winslet, are locked in a race against time to find a cure. Mar- ion Cotillard plays a WHO epidemiolo- gist who is tasked with investigating the source of the initial outbreak, but finds herself tangled in the corruption and lawlessness symptomatic of the hyste- ria so realistically depicted in the film. That's not to say it's perfect. There are some niggles, most pertinently in the film's cohesiveness. The interweav- ing, strand-like narrative can work well (think Crash, Babel or Soderbergh's own Traffic), yet Contagion fails to k nit together all the disparate events and characters. Perhaps it would have been better suited to a TV series. Similarly because there are so many threads, sev- eral actors are denied the time to make an impression and I left the cinema feeling somewhat short-changed. Of course, this may also have something to do with the fact that most of the sus- pense is contained in the f irst hour with the last 40 reserved for tying up loose
The stars were more worried about the reviews than the virus ends, leaving the ending all but certain. As we've come to expect f rom Soder- bergh, Contagion is a slick, suspenseful and sometimes downright sinister por- trayal of worldwide catastrophe that doesn't fall too wide of the mark. The
flaws don't detract from the cinematic experience and it is a film well worth the price of a ticket. At best, it is two hours well spent and at the very worst, at least it will make you acutely aware of the dangers of touching your face
.
Death and the Maiden Kiranjeet Gill Culture Sub-editor
‘Death becomes her’ - Thandie Newton puts on a rather dead performance
First performed 20 years ago, Argen- tine-Chilean playwright Ariel Ko- rfman’s Death and the Maiden sees Thandie Newton make her stage debut as the play returns to the West End. Set in a sparsely-furnished living room in an unnamed Latin-American coun- try, we meet Paulina Salas (Newton), a formerly fearless political revolution- ary, reduced to a shadow of her for- mer self after being kept blindfolded, raped and tortured at the hands of a now fallen military dictatorship. Fif- teen years on, she remains deeply af- fected by her ordeal;; an unfamiliar car outside her home leaves her cowering in a corner, clutching a gun to her chest. Paulina’s husband Gerardo (Tom Goodman-Hill) is a lawyer who has re- cently been appointed to a commission investigating the crimes committed dur- ing the dictatorship. After his car breaks down, he is offered a lift home by one Dr Roberto Miranda (Anthony Calf). As the t wo men chat, Paulina recgonises the doctor’s voice as that of one of her captors and so, when Gerardo convinc- es him to stay the night, she decides to take action. Dragging him out of bed in the small hours, she ties him to a chair and attempts to extract a confession from him at gunpoint. Through several hours of psychological torture, Dr Mi- randa maintains his innocence but even- tually, under pressure from Gerardo, fakes a confession to appease Paulina. Dorfman has w ritten the play in such a way that the audience is often unsure who to side with - I’d assumed before I saw the play that it would be Pauli- na, but on several occasions I found
myself really feeling for Dr Miranda. There is a great deal of tension in the play - Paulina is clearly a woman on the edge, and it’s hard to tell when she might crack. A lot of the time, how- ever, the acting seems to fall flat, and overall I was left unconvinced by any of the characters’ portrayals. This was a shame, particularly given the pro- vocative and emotional nature of the play’s main themes of torture and jus- tice, and the self-perpetuating circle of violence they are associated with. Although it was written two dec- ades ago, the play’s themes remain rel- evant. An important question Dorfman poses is what evidence is sufficient to justify the revenge Paulina dishes out. Can it ever be justified at all? Her ab- solute conviction of Dr Miranda’s guilt shines through, but it is based entirely on his voice and this alone is surely not enough. At what point does Paulina stop being a victim of torture and be- come a perpetrator instead? Can her ‘rights as a victim’ ever justify the way she treats the doctor? And important- ly, does it make a difference whether he is actually guilty: ‘What if he’s in- nocent?’ Gerardo asks. ‘Well then he’s REALLY screwed’, replies Paulina. The play’s return to the stage seems particularly timely given re- cent events in Libya, and also in con- text of the systematic abuse of prison- ers that has taken place in the name of the ‘war on terror’. Dorfman high- lights how, by succumbing to retali- ation in this way we condemn our- selves to a future of cyclical violence and injustice, a message that remains important in our post-9/11 world
Death and the Maiden is on at the Harold Pinter Theatre until January 21st.
.
medicalstudent
November 2011
19
Culture
Invasion of the Body Snatchers: Does science fiction affect the NHS? Robyn Jacobs looks at the genre of science fiction and how it is going to affect our future.
S
cience Fiction is a genre that most do not openly admit to enjoying. Unless you want to be termed a sci-fi geek, it is normally the sort of thing that you shut up about. However, with modern sci-fi books such as ‘The Time Trav- eller’s Wife’ by Audrey Niffenegger and ‘Quicksilver’ by Neal Stephenson being not only read by non sci-fi fans, but also having awards and accolades thrown at them, the whole sci-fi scene seems to have changed. Even if we move away from books and look at films, the strengths of sci-fi does not seem to have abated. Modern classics such as ‘Avatar’ and ‘The Matrix’ have secured sci-fi into the modern consciousness. So, how on earth does this relate to medicine and the delivering of a modern healthcare regime? At a recent ‘Battle of Ideas’ seminar, I attended a lecture entitled ‘Tomorrow never knows? Sci- fi and the future’ with eminent speak- ers including Martin Wright, editor of ‘Green Futures’ magazine and Ken Macleod, author of ‘The Restoration Game’. It gave me an excellent chance to try to understand how this favourite genre of mine (no, I am not ashamed) could relate to my medical course.
“Yes, I did just liken cannibalism with the private sector.” We could look at fiction as purely escapism;; to be able to deal with, let’s be honest, the absolute crap that we go through as medical students;; we need to have some outlet with which we don’t have to constantly think. For some, that is sport, for some it is drink, for me, it has always been reading. However, I believe that we get more out of a story than just an ability to run away to a different world, where there is no death and sickness or where old men do not assume you are a nurse, just because you don’t have a Y chro- mosome. And where better to find all of this extra meaning, than in sci-fi? As reiterated by the chair of the event David Bowden, science fic- tion is normally set in a dystopian fu- ture;; where robots have taken over the world, or humans have turned to canni- balism because the earth can no longer provide enough resources. Hang on a sec, reword that slightly and don’t we have the probable future of the NHS: robots have taken over most medical procedures and patients have turned
Andrew Lansley’s reforms finally hit the NHS to the private sector because the NHS no longer has enough resources? And yes, I did just liken cannibalism to the private sector. By looking at how characters in these books deal with these situations, could we not establish ways for ourselves to deal with them? Away f rom the setting of the stories, we could look at the content instead. As Martin Wright stated, there is of- ten a ‘schizophrenic view of scientific advances’. Take, for example, film ad- aptations of Isaac Asimov’s books such as ‘I, Robot’ and ‘Bicentennial Man’. One sees robots as a threat to the hu- man civilisation whilst the other touch- ingly explores the highly complex is- sues of consciousness in machines. We
“We could look at fiction as purely escapism; to be able to deal with, let’s be honest, the absolute crap that we go through as medical students”
could link this fracturing of an idea to the way in which societies often have confusing views on medical advances, such as the issue of vaccines. Parents are refusing permission for childhood immunisations against deadly diseas- es over safety fears, as well as refus- ing that their daughters are given the potentially lifesaving cervical cancer vaccination in case it encourages them to be promiscuous. At the same time, there are calls for there to be research into vaccines against AIDS and malar- ia. It’s a truly confusing state of affairs. So, rant over. Well, almost. In a time when the future of the NHS is in mas- sive uncertainty or whether you will pass surgery EMQs is in massive un-
certainty, reading the classic science fiction books that underpin so many of our modern technologies and ideas may not be such a bad thing. The next time you are trying to remember which trial worked for the new urological robotic technique, why not put down the medical books and pick up Karel ýDSHN V SOD\ µ5 8 5 ¶ 5RVVXP V 8QL versal Robots)-the first piece of lit- erature to ever use the word ‘Robot’
.
Battle of ideas is part of the range of events held by ‘The Institue of Ideas’. For more information, check out the website: www.instituteofideas.com
20
November 2011
medicalstudent
Culture
The London Medical Museums Medicine is one of those funny subjects that takes over your life. There have been times when visiting some of our capital’s great cultural museums and galleries that I have felt guilty - it was an afternoon ‘wasted’ on an activity centred on something that wasn’t medicine. Luckily, there is a solution! 24 museums in London have a medical aspect to them - they form part of the conglomerate association ‘London Museums of Health and Medicine’. There is a wide range of places to visit, from well-known names such as the Science Museum to less heard of places, nestling in the little corners of London that still seem to have a small amount of magic left in them. Alexander Fleming Laboratory Museum On the site where Alexander Fleming made his famous acci- dental discovery of penicillin. There is a small museum dedi- cated to his memory. St Mary’s Hospital, Praed Street, W2 1NY Times: Mon-Thur 10:00-13:00 £: Entrance is free for all Imperial students, £2 for all other students.
Anaesthesia Heritage Centre A museum dedicated to the history of anaesthesia. A new free exhibition has just opened and will run till Oct 2012. ‘A bless- ing in disguise – Misuse of Anaesthesia’ looks at the use and misuse of the powerful drugs that anaesthetists use every day. It uses modern day examples such as Michael Jackson and Heath Ledger. 21 Portland place, W1B 1PY Times: Mon-Fri (not Wed) 10:00-16:00 £: Free.
Bethlem Royal Hospital Archives & Museum The original site of ‘Bedlam’ the infamous mental health hos- pital, the site now holds an art gallery displaying pictures f rom artists who have suffered from mental illness. The current ex- hibition is entitled ‘Handle me with care’ and runs until the 15th December. Monks Orchard Road, Beckenham, Kent, BR3 3BX Times: Mon-Fri 09:30-16:30 (selected Saturdays) £: Free
BDA Dental Museum With over 20,000 items, this museum is the place to go to find out about teeth! Created in 1919 when the first female dentist donated her old instruments to the BDA. Interesting to both those interested in teeth and women in medicine. 64 Wimpole street, W1G 8YS Times: Tues and Thur 13:00-16:00 £: Free
British Optical Association Museum A specialised museum, dating back to 1901, which explores the history of the human eye and visual aids. Only accessible by prior appointment, so make sure you book in advance! 42 craven Street, WC2N 5NG Times: Appointment only Mon-Fri 09:30-17:00 £: Free
British Red Cross Museum & Archives Dedicated to the history of the British Red Cross since its be- ginning in 1870, this museum has a wealth of artefacts from blood transfusion kits to fundraising material from the First World War. Unfortunately, access is only by appointment, however there are a range of online exhibitions. 44 Moorfields, EC2Y 9AL Times: Appointment only Mon-Fri 10:00-13:00 and 14:00-16:00 £: Free
Chelsea Physic Garden A ‘secret’ garden where you can learn about the medicinal properties of the rare plants on display. A Christmas fair will be available from 26-27th November, where you can stock up on some early gifts. 66 Royal Hospital Road, SW3 4HS Times: Tue-Fri 12:00-17:00, Sunday 12:00-18:00 £: £5 for students and free for friends of the garden
Florence Nightingale Museum A museum celebrating one of the great women in medicine;; highlights include her famous lamp used during the Crimean war. On 24th November, a talk will take place on the life and legacy of Florence Nightingale using audio-visual material from the Wellcome Library. St Thomas’ Hospital, 2 Lambeth Palace Road, SE1 7EW Times: Daily 10:00-17:00 £: £4.80 for students and £7 for the November talk
Foundling Museum Dedicated to children looked after by the hospital between 1739 and 1954, it holds foundling tokens-pinned to the clothes of the children by their mothers before they were left at the hospital. Exhibition ‘Flourish at the Foundling’ r uns until 27th November and showcases art by care-experienced people. 40 Brunswick Square, WC1N 1AZ Times: Tues-Sat 10:00-17:00 Sun 11:00-17:00 £: £5 for students (includes free entry to exhibitions)
Freud Museum
A package at the Red Cross Museum
Tucked away in North London, the home of Freud has been transformed into a museum dedicated to his life and work, as well as that of his daughter A nna Freud. From the 16th Novem- ber, an exhibition on oriental rugs will be on display and will be exhibiting several of Freud’s own rugs. 20 Maresfield gardens, NW3 5SX Times: Wed-Sun 12:00-17:00 £: £3 for students
Museum of the Order of St John
The Great Ormond Street Hospital Museum The famous children’s hospital has a small museum devoted to the long history of the hospital. On site is filled with examples of old medical equipment. The museum and archives are both only open for appointment only, so although it is free to visit, to guarantee entry, make sure to phone in advance to book a place. Museum of Great Ormond Street Hospital, First Floor, 55 Great Ormond Street, WC1 (opp. The hospital) Times: Appointment only Mon-Friday 09:30-16:00 £: Free
Museum of the Order of St John A museum steeped in history, it tells the story of the ancient ‘Order of St John’, the Order’s current role today in the St John Ambulance service and the similarly named St John Eye hos- pital in Jerusalem. Free tours are available on Tuesday, Friday and Saturday at 11:00 and 12:30 (however, a small donation would not go amiss) St John’s gate, St John’s Lane, Clerkenwell, EC1M 4DA Times: Mon-Sat 10:00-17:00 £: Free
medicalstudent
November 2011
21
Culture
Kew Gardens
Royal Botanic Gardens, Kew Definitely worth a day trip, Kew has over 300 acres of gardens to explore, including collections of medicinal plants in ‘The Queen’s Garden’. A little bit pricey for a student, but it is a must see before leaving London. Royal Botanic Gardens, Kew, Richmond, Surrey, TW9 3AB Times: Vary with season, so check website prior to visit £: £11.90 for students
Royal College of Physicians Museum As the oldest medical college in England, there is an impres- sive museum and garden with artefacts dating f rom its founda- tion in 1518. Current exhibition ‘An end to good manners: The Royal College of Physicians and the English civil war’ is on until 15th March 2012 and is free entry. 11 St Andrews Place, Regents Park, NW1 4LE Times: Mon-Fri 09:00-17:00 £: Free
Royal College of Surgeons Hunterian Museum Home to a wealth of exhibits on surgery, anatomy and modern art. There are a number of exhibitions currently on, including ‘Abnormal: Towards a scientific model of disability’ which is running until January 2012. 35-43 Lincoln’s Inn Fields, WC2A 3PE Times: Tues-Sat 10:00-17:00. A free curators tour takes place every Wed at 13:00 £: Free
Museum of Royal Pharmaceutical Society With over 45,000 exhibits, some dating back to as early as the 1600s, this museum has a wealth of information on the history of British pharmacology. The society holds free talks every few months - the next one is on the history of doping in sport. More info can be found on their website. 1 Lambeth High Street, SE1 7JN Times: Mon-Fri 09:00-17:00 £: Free
Royal Society of Medicine The RSM hosts many excellent events during the year, with re- duced entry for students. The library on site, has over 600,000 volumes, of which there are 45,000 rare manuscripts. Use of the library is f ree for all RSM members and temporary use can be arranged. The current library exhibition is ‘Protectors of sight’ by Sophie Gerrard. 1 Wimpole street, W1G 0AE Times: Mon-Thur 09:00-19:00, Fri 09:00-17:30 and Sat 10:00-16:30 £: Tours are free. However, pease see website for details on library entry.
Old Operating Theatre & Herb Garret The only surviving 19th century operating theatre, this mu- seum feels like going back in history. Free weekly demon- strations take place every Saturday entitled ‘Speed surgery- surgery in the 19th century’. On 30th November, there is also a talk entitled ‘The reality of civil war medicine and its interpretation’ 9a St Thomas’s Street, SE1 9RY Times: Daily 10:30-17:00 £: £4.90 for students. ‘The reality of civil war medicine and its interpretation’ costs £5.90
Royal London Hospital Museum & Archives The Royal London Hospital Museum has exhibits covering as- pects of medicine and surgery across the 18th, 19th and 20th centuries. There is also a video viewing facility showing a range of films, detailing topics such as the elephant man and the television drama ‘Casualty 1906’. St Philip’s Church, Newark Street, E1 2AA Times: Tues-Fri 10:00-16:30 £: Free
Wellcome Collection ‘A free destination for the incurably curious’ is the tagline for the Wellcome Collection, and it fits it perfectly. Hosting a wealth of exhibitions all year long, it really is a must-visit. Currently on is ‘Charlie Murphy: The anatomy of desire and other experiments’ and two exhibitions making up ‘Miracles and Charms’. 183 Euston Road, NW1 2BE Times: Tues-Sun 10:00-18:00 (Late opening Thur till 22:00) £: Free
Wellcome Library The Wellcome Library is a haven for anyone interested in the history of medicine. With over 750,000 books and manuscripts and over 250,000 images, this really is the place to go to write any project on medical history. The library is f ree to the public, but you will have to register in advance. 183 Euston Road, NW1 2BE Times: Mon-Fri 10:00-18:00 (Thur til 20:00) , Sat 10:00-16:00 £: Free
Worshipful Society of Apothecaries The society has a fascinating history which details the change from apothecaries who would roam the streets to today’s com- munity pharmacists. Their archives hold a wealth of infor- mation and are interesting to anyone from a healthcare back- ground. The society also offers a multitude of diplomas (more info on their website). Apothecaries Hall, Blackfriars Lane, EC4V 6EJ Times: By appointment only, contact via website for more info £: Free
Science Museum Perhaps the most visited museum in the group, the Science Museum has a large range of exhibits on a range of disciplines. Free exhibitions of interest to medical students include ‘The science and art of medicine’, ‘Glimpses of medical history’ and the interactive ‘Psychology: mind your head’. During term-time, the IMAX cinema is also free to Imperial students. Exhibition Road, SW7 2DD Times: Daily 10:00-18:00 £: Free
St Bartholomew’s Hospital Museum & Archives
Freuds sofa at the Freud Museum
Situated within St Bartholomew’s Hostpital, showcase the his- tory of the hospital and its scientific achievements. The col- lections on show include Rahere’s grant from 1137 - the deed from the founder of Barts hospital. There is also a selection of paintings on site, including by Hans Holbein the younger. St Bartholomew’s Hospital, West Smithfield, EC1A 7BE Times: Tues-Fri 10:00-16:00 £: Free
Chelsea Physic Garden
!"#$"%&'()*&& !"#$%&$'()$!"#*+ 2A$9)<$J6-&;-(
%8..-(-0=$2&(+%$645:$+,-4($')8*0%$4*$ +,-4($04%,)*)8(&<6-$4%)6&+4)*4%31
!"##$ %&'$ '&($ )*$ +,-$ %+(--+%$ ).$ /)*0)*1$ 2&%3&+4$ (45-$ .6)'-0$ 0)'*$ 78--*%+)'*$ 9)&0$ 64:-$ (4;-(%$ ).$ <6))0=$ 3&**->84*%$ .-66$ 64:-$0)34*)%$4*$+,-$64*-$).$<&++6-?$ %+(4@@-0$ *&:-0$ <A$ @(A4*B$ ,&*0%$ 4*$ +,-$ *&3-$ ).$ 5)*%83-(4%+$ <6))068%+1$C,-(-$'466$4+$-*0D
R(-%,-(%$ '466$ *-;-($ <-$ %&.-$ &B&4*1$ N%$ +,-A$ %&46$ )*$ +,()8B,$ +,-$ )5-&*$ +,&+$ 4%$ +,-$ %833-($ <-.)(-$ %+&(+4*B$ 8*4;-(%4+A=$ %-++6-0$ )*$ +,-4($ 0-%+4*&+4)*=$ %8<3&(4*-%$ %8(()8*0$ +,-3$&*0$6-&0$+,-3$&%+(&A$+)$.)(-4B*$ @)(+%$).$5&66$&*0$,)8(%$).$K2/$+,-A$ *-;-($'&*+-0$+)$,&6.H%6--@$+,-4($'&A$ +,()8B,1
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
E,-$ '&(0%$ '466$ <-5)3-$ ;-,456-%$ .)($ @()@&B&*0&=$ @&%+-0$ .()3$ .6))($ +)$ 5-464*B$ 4*$ .&6%-$ 40)6%$ &*0$ %6)B&*--(4*B1$ P-5(-+$ %3&66$ @(4*+$ &+$ +,-$ <)++)3$ ).$ 5)*%-*+$ 6-++-(%$ '466$ 5)*%5(4@+$ @&+4-*+%$ +)$ +,-$ 5&8%-?$ +,-$ )@+$ )8+$ 56&8%-$ +,&+$ *)<)0A$ -L@-5+-01
<-A)*0$-;-*$K&L3&*I%$5)*+()61
<&++6-1$E,-A$%+&6:$+,-$0&(:$5(-;45-%=$ %+-+,)%5)@-H%+(&*B64*B$'&+5,3-*$+)$ M+$ &66$ 6-&0%$ +)$ )*-$ 0-%@-(&+-$ B&4*$ &55-%%$ +)$ 5)33)*$ ())3%$ .)($ 5)*568%4)*1$N(3-0$3464+4&$).$3-045&6$ *)+,4*B$ 3)(-$ +,&*$ &$ 38B$ <-&(4*B$ %+80-*+%$ %*-&:4*B$ &()8*0$ ,)%+46-$ +,-4($)@@)*-*+I%$5)&+$).$&(3%1$ 5&3@8%-%$ 4*$ +,-$ 0-&0$ ).$ *4B,+$ A-&(*4*B$ .)($ +,-$ %'--+$ 0-64B,+%$ ).$ N$5)60$'&($%+&*0%$68:-'&(3$)*$+,-$
%+);-=$'&4+4*B$+)$<)46$);-(1 O)$0)8<+$+,-(-$'466$<-$5&%8&6+4-%$)*$&66$ %40-%1$ 2&(+%$ '466$ %4B*$ &$ %-5(-+$ @-&5-$ +(-&+A$ '4+,$ FJ/=$ )*6A$ .)($ +,-3$ +)$ <-$ 0)8<6-$ 5()%%-0$ )*$ &*$ &66$ )8+$ &%%&86+$ )*$ P+$ Q-)(B-%1$ C4+,$ 5(4@@64*B$ 6)%%-%$
,)"#'$-.#/)#0 2A$E,-$/);-$Y)5+)( 7V$MI3$@(-++A$%8(-$+,&+$MI;-$.&66-*$ 4*$ 6);-$ '4+,$ +,-$ &*&+)345&6$ 0(&'4*B%$ 4*$ Q(&AI%$ N*&+)3A=$ <8+$ +,-A$ *-;-($ (-+8(*$ 3A$ &0;&*5-%1$ T)'$5&*$M$B)$&<)8+$+-664*B$+,-3$ ,)'$M$.--6D NV$C,-*$.&5-0$'4+,$+,-$8*(->84+-0$ 6);-$ ).$ 4*&*43&+-$ )<G-5+%=$ +,-$ <-%+$+,4*B$A)8$5&*$0)$4%$+)$3);-$ )*$ '4+,$ A)8($ 64.-1$ E,-(-I%$ )*6A$ %)$ 3&*A$ +43-%$ &$ @-(%)*$ 5&*$ <-$ (-.8%-0$ 4*$ ()3&*5-$ <-.)(-$ +,-A$ B)$4*$%-&(5,$).$&*)+,-($6);-(1$W&A$ M$ %8BB-%+$ +)$ A)8$ +,-$ 4*+-(&5+4;-$ XY$ %).+'&(-$ )*$ +,-$ 4*+-(*-+$ &%$ &*)+,-($-64B4<6-$<&5,-6)(1 7V$W-$&*0$3A$B4(6.(4-*0$,&;-$5)3-$ +)$<6)'%$4*$+,-$<-0())3$);-($3A$ ')(:$4*$5)6)(-5+&6$(-%-&(5,1$T)'$ 5&*$M$'4*$,-($<&5:D NV$ E&:4*B$ A)8($ ')(:$ ,)3-$ '4+,$ A)8$ 5&*$ ).+-*$ <-$ &$ +,)(*$ 4*$ &$ (-6&+4)*%,4@I%$ %40-1$ M.$ A)8$ 5)*%+&*+6A$ (-+8(*$ ,-($ &..-5+4)*$
'4+,$ 5)6)(-5+&6$ (-%-&(5,=$ ,)'$ 5&*$ A)8$ %&A$ +,&+$ A)8$ '&*+$ +)$ :--@$ +,-$ (-6&+4)*%,4@$ B)4*B1$ E,-(-I%$ &$ +43-$ &*0$ &$ @6&5-$ .)($ )..6)&04*B$ ')(:$ %+(-%%1$ T&;-$ A)8$ +(4-0$ &%:4*B$ ,-($ &<)8+$,-($')(:$(-5-*+6AD
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
N*0$ %)$ '-$ %+&*0=$ @)4%-0$ )*$ +,-$ <(4*:$ ).$ '&(=$ @)64%,4*B$ )8($ SL.)(0$ T&*0<)):%$ ).$ 3-0454*-$ &%$ 4.$ +,-A$ '-(-$ @4%+)6%1$ F*(-%+$ B()'%1$ E,-$ -L58%-$+)$B-+$0(8*:$&*0$%+-&6$&$%4B*$ .()3$ +,-$ QUE$ 5&3@8%$ 4%$ +))$ B))0$ &*$)..-($+)$(-.8%-1$C&($4%$+,-$@-(.-5+$ '&A$ +)$ %>8&*0-($ +,)%-$ 6&%+$ %,(-0%$ ).$%,(&@*-6$.()3$A)8($%+80-*+$6)&*1$
./,0#,12,30456270)806-09-: ;6<<0=52<
#'()*'
'():D&)$ *>>$ 7)7<)&,$ "%$ '()$ +*,*>$ ,:76("+.;$"&;(),'&*3 GK34567 8$ -"+A)&$ .%$ .6>*:)&$ (*,$ A"-+>"*A)A$ '()$ +)-$ )6.,"A)$ "%$ O&"C)+$ P>*+)'Q$ R*9.A$ S'')+<&"0=($ (*,$ '()$ 9".;)$ "%$ *+$*+=)>3$8$&)*>>:$("6)$+"$,)*>,$A.)$ '(.,$-))#3 GG3L467 8$%)>>$*,>))6$%"&$'-)+':$%"0&$7.+0'),3$ T"<"A:$+"'.;)A3 GG3M567 U+)$"%$'()$6*'.)+',$7*A)$*$+".,)$.+$ '().&$<)A3$8$&0,()A$'"$,))$-(*'$(*A$ (*66)+)A3$ I().&$ (*+A$ (*A$ ,>.66)A$ "%%$'()$<)A3
?:$W*&&.)'$X"+),
&)*A.+=B$*+A$7:$6))&,$-.'($(*')$7)$ %"&$.'3
234567 8$ *&&.9)$ %"&$ 7:$ %.&,'$ )/6)&.)+;)$ "%$ <).+=$ "+$ ;*>>$ '"+.=('3$ ?&.=('@):)A$ *+A$<0,(:$'*.>)AB$8$-*>'C$'(&"0=($'()$ -*&A$ -.'($ )/;.')7)+'$ *+A$ *+/.)':3$ 8$ %))>$ >.#)$ 8D7$ 6*&'$ "%$ '()$ ')*7B$ *+A$ '(*'$ '"+.=('$ 8D7$ =".+=$ '"$ 7*#)$ *$ &)*>$A.%%)&)+;)$*+A$,("-$("-$70;($ 8$ *>&)*A:$ #+"-3$ 8D7$ =".+=$ '"$ 7*#)$ '()$ 7",'$ "%$ '(.,$ )/6)&.)+;)B$ *+A$ 8D7$ =".+=$ '"$ ,("-$ ("-$ 70;($ 7:$ A)=&))$ 7)*+,$ '"$ 7)3$ E"+,0>'*+',$ -.>>$<)$.76&),,)A$<:$7:$<*;#=&"0+A$
F3GH67 I()$ ,">.'*.&)$ =*7)$ "+$ 7:$ 6("+)$ .,$ 6*&'.;0>*&>:$ *AA.;'.9)3$ 8$ -"+$ '(&))$ =*7),$ .+$ *$ &"-3$ J:$ <*'')&:$ (*,$ A&"66)A$%&"7$'(&))$<*&,$'"$'-"3$8$-.>>$ (*9)$'"$;(*&=)$.'$-()+$8$=)'$("7)3 GK3LM67 8$ <"0=('$ *$ ;"%%))3$ 8$ A"+D'$ >.#)$ ;"%%))3$8$A&*+#$'()$;"%%))3$N"7)$"%$ '()$ 6*'.)+',$ 7*#)$ %0++:$ -(.,'>.+=$ +".,),$*,$'():$,>))63$8$.7*=.+)$'(*'$
GH3HM*7 8$ *7$ '()$ "+>:$ "+)$ "%$ '()$ ,'0A)+',$ >)%'3$ 8$ *7$ .+$ '()$ '".>)'3$ 8'D,$ <);"7)$ 7:$,*+;'0*&:3 43KM*7 8$ %)>>$ *,>))6$ %"&$ '(&))$ ("0&,3$ 8D9)$ <))+$%*;)<""#$,'*>#.+=$6)"6>)$%&"7$ ,;("">3$N"7)$"%$'()7$(*9)$;(.>A&)+3$ 8$&)V".;)$.+$'()$%*;'$'(*'$'()$;(.>A&)+$ *&)$0=>:3
!""#$%"&$'()$*+,-)&,$.+$'()$+)/'$.,,0)1
53LK*7 E>.+.;*>$ N#.>>,$ ')*;(.+=$ *'$ GK$ (*,$ <))+$ ;*+;)>>)A3$ 8$ ,("0>A$ (*9)$ V0,'$ ,'*:)A$*'$("7)$>.#)$)9)&:<"A:$)>,)3
+,-()*' S$ Y)+Y)+$ .,$ '()$ .+')>>.=)+'$ ;"0,.+$ "%$ '()$ N0A"#0$ Z$ )*;($ &"-$ *+A$ ;">07+$ .,$ ;"76>)')A$ -.'($ '()$ +07<)&,$ G$ '"$ [3$ T"$ +07<)&$ ,("0>A$ &);0&$ .+$ *+:$ &"-$ "&$ ;">07+3$ SAA)A$ '"$ '(.,B$ '()$ +07<)&,$ .+$ '()$ ()*9.>:$ "0'>.+)A$ <"/),$ ,("0>A$ ;"7<.+)$ '"$ =.9)$ '()$ 9*>0)$ .+$ '()$ '"6$ >)%'$ ;"&+)&B$ 0,.+=$ '()$ ,6);.%.)A$ 7*'()7*'.;*>$ "6)&*'."+3$ W*9)$ %0+1
! " # $ % & #
! " # $ % & # U;'"<)&$HKGG$S+,-)&,1
medicalstudent
Sport
UH Tennis Presentations Medical Students win UH Challenge, UH Mixed Doubles and MPS Mixed Doubles
UH Take Top Tennis Titles
Edward Norman Guest Writer The All England Lawn Tennis Club was the spectacular venue for the an- nual United Hospitals Tennis Club AGM midway through October. Mem- bers of all five London medical schools were in attendance for the even- ing during which the UH Challenge Cup, UH Mixed Doubles Shield and MPS Mixed Doubles Cup were pre- sented to the teams. There were over 50 students in attendance and some alumni also turned up to help support the event. It was the first AGM to be held at The All England Lawn Ten-
nis Club and it encouraged a big turn out from across the medical schools. The evening started with the stu- dents regaling stories of the last 12 months of UH antics over a drinks re- ception in the Champion’s Room in- side Centre Court. The night then got underway with the previous year’s committee, headed by Zain Juma, giv- ing its report on the highly successful year. UH Tennis Club has flourished getting more students involved in both the matches and socials. 2011 also saw a number of training sessions held to help the team try and get more com- petitive before the season commenced. Over the year the UH side played matches against Kenton Lawn Tennis Club, Cambridge Grasshoppers and
the President’s Match which took place on the grass at Wimbledon shortly af- ter the Championships had finished.
“Members of all five London medical schools where in attendance for the evening during which the UH Challenge Cup, UH Mixed Doubles Shield and MPS Mixed Doubles Cup were handed out.” After the reports from the commit- tee the presentation of the UH league champions’ was made. Every summer the UH leagues take place with each
medical school playing each other and the top two advancing to the final. This year it was ICSM vs St. George’s in the mixed final and ICSM vs RUMS in the men’s. ICSM managed to do the dou- ble, winning both the men’s and mixed doubles’ titles. The trophies were pre- sented by Professor Mortimer, a for- mer UH champion with Barts, to the winning captains, Edward Norman and Beth Nally. The MPS Mixed Dou- bles Cup, which took place in Novem- ber 2010 was won by the RUMS team of Robin Vasan and Katie Groom. The election of the next year’s com- mittee took place with a large number of candidates standing, who repre- sented all five medical schools. Rob- in Vasan was elected the men’s cap-
tain and Hannah Kirk was elected the women’s captain. Dave Hillier was appointed secretary and Katie Groom social secretary. The newly elected committee is now busy plannign the 2011 MPS Mixed Doubles Cup taking place at Westway on 20th November. The tournament is a whole day of ten- nis followed by a meal and night out and is an UH Tennis Club tradition having taken place since the 1980s. Other plans for the year ahead in- clude holding more training sessions;; the reintroduction of the UH women’s league and the rediscovery of the ten- nis players at GKT. With the new com- mittee elected it looks set that UH Tennis will continue to expand and build on over 124 years of history
.