mediscope FRONT COVER
Issue 7 June 2010
New Medical School Curriculum Mediscope Guide to Foundation Applications History of the NHS - Who do we really work for? Which hospital has the best canteen?
Health at Home Manchester Medical School’s Student Magazine
EDITORIAL TEAM Q+A: What is your favourite brand of tea?
Foreword
Prof Paul O’Neill Head of School
I
n writing this introduction, I am wearing two hats. Firstly, as Head of the Medical School and secondly, as a Geriatrician (or Care of the Elderly Physician). In my early career training as a physician, my intention was to specialise in respiratory medicine and my MD was on the assessment of breathlessness. However, it was during my next post as a registrar in neurology that I began to re-evaluate my career choice. Breathlessness is a chronic symptom for many people at home that limits their day to day activities and is often not curable. Similarly, in neurology, I found that I was drawn to working with people with chronic disabling conditions such as multiple sclerosis or motor neurone disease and helping them live their lives at home. In doing this, I began to appreciate the role of the health care team and multiprofessional working in improving the quality of life for patients at home. In geriatric medicine, I specialised in stroke medicine and extended my experience of rehabilitation. Subsequently, I was the consultant lead in a community rehabilitation team, which was the first in Manchester. A key feature of this team was that health professionals worked across boundaries so that the physiotherapist did not simply deal with mobility issues, but would be the key professional in coordinating all aspects of care for that person. My other defining observation of the work of the team was that rehabilitation at home meant that the person was being supported in where they wanted to be and that rehabilitation was very broad. On a rehabilitation ward, the patient may only be seen by therapists for a short period each day, and the rest of the time they just sit around in a clinical, instead of a home, environment. Moving to the present day, in your experience in hospitals you will probably have noticed how busy acute medicine is with multiple admissions, which have been increasing year on year. Unfortunately for patients, there are variations in outcomes depending on the time of admission – weekday, night or weekend. Elderly people are particular vulnerable to this with increase risk of complications and putting community services on hold, which complicates discharge. Older people with complex needs have a 30% readmission rate compared to 10% for all people. Similarly, there is a much higher mortality rate. This situation has led to readmission being labelled as the 21st Century ‘Geriatric Giant’ with the challenges being integrated services, prevention and rapid action to support successful discharge.
Ambrose Boles Year: Intercalating: MRes Q+A: Anything in a pyramid bag
Justin Healy Year: Intercalating: Ethics and Law Q+A: Dilmah (yes, it is a real tea)
Lucy Hollingworth Year: Intercalating: Ethics and Law Q+A: Yorkshire gold every time
Chris Jacobs Year: 4, Wythenshawe Q+A: Tetley’s - it’s also a beer
Ami Pedersen Year: 3, MRI Q+A: Sainsbury’s basics
Khimara Naidoo Year: Intercalating: MRes Q+A: PG Tips
Changing back to my role as Head of School, what does it mean for your education. Firstly, the emphasis in healthcare is now, rightly, on the community and this is where most of our graduates will work and where you need to gain experience. Secondly, you need to learn how to work in teams alongside other health professionals and social services. The emphasis must be on using your skills and knowledge in prevention and early intervention. Lastly, unless your career is in a particular speciality, it is likely that your patients will be elderly with multiple problems. It will be your job to keep them as healthy as possible, in hospital for as short a time as possible and supporting them at home. You will need to have the right attitude or approach to do this, but I am sure that, like me, you will find this immensely rewarding.
CONTENTS info
4
Issue 7 web www.mediscopeonline.com editor editor@mediscopeonline.com articles articles@mediscopeonline.com
5
features
6 8 9
advertising funding@mediscopeonline.com design and layout Chris Jacobs
christopher.jacobs@student.manchester.ac.uk
Mediscope is a magazine for medical students and other healthcare professionals. It is designed and edited entirely by medical students at Manchester University. All articles and statements printed are the responsibility of the authors and advertisers, not Mediscope. All content is © Mediscope 2010. All rights reserved. No content contained may be reproduced or copied without the prior permission of the editor. Feedback We would love to hear what you think of this edition and any suggestions for improvement. Please email the editor!
Medical School News New curriculum Foundation Applications News Snippets Local, national and international news The NHS: Structure and Organisation How the NHS is structured Glasgow to Glastonbury Healthcare inequality in the UK The Postcode Lottery How much does where you live affect the healthcare you receive?
careers
10 11 12
Foundation Applications Mediscope guide to applying for foundation jobs How to get the best foundation job A student who has just been through the process gives us some tips on getting a successful job Manchester Medical Careers Society
reviews
14
Canteens reviewed Mediscope reviews the hospital’s cafe establishments
views and opinion
16 17 18 19
Future of Medical Education What med school may be like in the future When I grow up.. A students views on the transition from student to doctor International Summerschool Last years event reviewed Societyscope All the latest from the medical school societies
Want to write for us?
Writing an article for Mediscope is a great way to voice an opinion, share experiences and impart knowledge. It is also fantastic for your professional and personal development. We are always looking for talented writers from any year, course or university. We will be compiling a Freshers’ edition (issue 8) over the summer, so if you have some spare time please get involved. We are especially looking for personal stories, reports on interesting placements and educational articles. Writers guide: please email editor@mediscopeonline.com and ask for a guide Submit to: articles@mediscopeonline.com
news, events, snippets, local, natonal, international, news, events, snippets, local, natonal, internation national, news, events, snippets, local, natonal, international, news, events, snippets, local, natonal, in al, international, news, events, snippets, local, natonal, international, news, events, snippets, local, na
info scope
News, Views, Events
Lead News
MEDICAL SCHOOL ANNOUNCES NEW CURRICULUM FOR 2011 “MBChB 2011” - What exactly is this new development and where did it come from?
M
ost students by now will be well aware that the medical programme is currently undergoing significant change. Although continually updated since its introduction in 1994, the aim is to reassess the curriculum every decade, with the previous major review having taken place in 2004. Internal reviews conducted by Professor Alan Gilbert (President and Vice-Chancellor of the University) and Professor Alan North (Vice-President and Dean of the Faculty) have produced recommendations aimied at improving the course considerably. External influences include the National Student Survey (NSS) 2009 results, where a total of 61% of final year medical students took part. Areas of particular concern for the School were ‘Organisation and Management’ and ‘Overall Satisfaction’, for which the School came 29th out of 29 medical schools. However, the medical school development team stresses that the NSS results were only a minor catalyst for changes already taking place prior to their publication. The main external drive for this change is the GMC’s 2009 guidance Tomorrow’s Doctors, providing standards by which UK medical schools are expected to comply with. The GMC have also urged for the 2009 guidance to be applied by medical schools for the 2011/2012 student intake. This flurry of activity is aimed at two things: improving the current programme, and developing a new programme for 2011. These have been summarised below, although the exact details are still under discussion and may be subject to alteration, particularly in the clinical years.
years 1 + 2
- Modules on core body systems, with clinical cases - Some focus on basic speciality knowledge (eg: Orthopaedics) and a module on global health. - More additional support to ‘enhance’ PBL learning, such as more wrap up lectures and symposia - SSCs now known as ‘Personal Excellence Themes’
year 3
- Basic core clinical skills - New modules on ENT, Dermatology, Opthalmology, Oncology and Palliative Care. - Builds upon foundation set in years 1 and 2
year 4
- Speciality based modues (eg: Paediatrics, O&G) - Strong community focus with en-bloc community placements and management of chronic disease - New structured focus on acute care and infection
year 5
Supplemented PBL will still be the principle learning tool; however e-learning will take a bigger role in acting as a
- Similar to current year 5 - More focus on shadowing and preparation for practice, creation of “student assistantships” to ease transiton into FY1
Proposed changes to year structure
learning resource, by expanding blackboard and the use of IVIMEDS, a ‘virtual medical school’ with access to virtual patient cases, medical images, histopathology slides and learning modules. Academic advisors are already in place. These are clinicians who give advice and support, so students have an individual to whom they can report should they need to. Feedback is now to take place under the new University Feedback Policy, which states that feedback is to be given in a “timely manner” so students can “improve on their performance” and that it “must be tailored to the individual”. Senior university figures have stated that this means feedback should now be given to students for previous examinations, including OSCEs. The development team have confirmed they are working on trying to make the examiner’s notes taken in the OSCE available to students. Changes to the way in which students will be assessed are less certain. More formative assessments are to be introduced, similar to the 3rd year mock OSCE, in order for students to track their progress and identify areas for improvement before summative assessments. Sitting three Progress Tests per year has also been suggested by the development team. Other alterations include final examinations; written finals may be held at the end of 4th year, similar to other Universities such as Liverpool University, and practical OSCE finals may be completed in 5th year. The main change in organisation is the introduction of academic leads. This is a new title, rather than a new job, aimed to make roles clearer. They will act as liaison officers and co-ordinators to aid the development of a cohesive course throughout all years, alongside efforts of new administrative staff. The development team is also attempting to foster a more collegiate environment among medical students. This is being addressed by refurbishing the vast Stopford building aimed at producing a sense of identity and to make it more user friendly. Standard badges to wear are also to be issued, “to show you are still part of the medical school community even when you’re at the base hospital”. A more significant but tentative development is the suggestion of creating nonspecifically aimed societies within the medical school. These would allow students to belong to a particular group, similar to being allocated ‘house teams’ at secondary schools, which could potentially go on to take part in community work, international projects, and so on. A full interview with Dr Philip Burns and Dr Jo Hart, Directors of Curriculum Development and Delivery, will be published in the next issue of Mediscope with a more detailed picture of things to come. .................................................................................................... Wai Yee Cheung Year 4, Hope Hospital
PROPOSED CHANGES TO THE FOUNDATION APPLICATION SYSTEM
T
he UK Foundation Programme (FP) is a two year training programme that bridges the gap between medical school and specialist training. Applications for the FP are made in the autumn of fifth year. During the spring of 2010, planned changes to the foundation application system were confirmed by the UKFPO (UK Foundation Programme Office). The current application system is comprised of two elements: an academic ranking and an online ‘white space’ application form. Demand for change to the current application system has emerged because of difficulty in assessing the effectiveness of ‘white space questions’. Principally, there are concerns that it fails to differentiate students adequately, does not guard against cheating and lacks standardisation in the level of support afforded to each applicant. Although a number of options for foundation applications have been thoroughly considered, the revised system will include a situational judgement test (SJT) and an educational performance measure. The machine marked SJT will be an invigilated test to identify professional attributes and will be carried out
at individual medical schools. The focus of the SJT will ensure that material which is already examined at medical school will not be duplicated and subsequently it will not require the level of preparation that is required for other exams; a national exam was not regarded as a desirable option. The educational performance score will be complied by individual medical schools and will be combined with the mark from the SJT. The target date for nationwide implementation will be for the graduate year of 2012/2013, though pilot schemes will be conducted in the meantime. The first pilot scheme will take place in one or two medical schools in October 2010 and the second will be in spring 2011, which will include half of all medical schools. Participation in the pilot schemes will be voluntary and will not affect application scores under the current system. In April this year, a micro-pilot of sample SJT questions was completed by a small group of fifth years at Manchester, who were able to provide feedback on the proposed system. It is anticipated that medical students at Manchester will be further involved in the pilot scheme, but full details are yet to be released by the UKFPO and are expected within the next month. .................................................................................................... Lucy Hollingworth More information: www.isfp.org.uk
By Justin Healy
Also in the news... DIFFERENTIAL DIAGNOSIS INCLUDES GUNSHOT WOUND A patient admitted to Wythenshawe Hospital was thought to have suffered a stroke until a CT scan revealed a bullet lodged in his brain. Police suspect that the 61-year old man was hit by a stray bullet as he was gardening outside his home. The patient himself has no memory of the incident but he was found with his glasses broken and bleeding from eye, he has been left seriously disabled by the injury. Police do not think it was a deliberate attack but are still appealing for any further information.
Submit your news! Keep us up to date with any news relevent to the medical school by submiting your articles to editor@mediscopeonline.com
HOSPITALS FACE COSTLY READMISSIONS
A MOBILE PHONE MAY HINDER YOUR ENJOYMENT OF THIS PERFORMANCE
New Government plans will see English hospitals losing out financially if patients are readmitted as an emergency within 30 days of being discharged. The proposals are designed to ensure that hospitals take greater responsibility for their patients in the critical month after discharge.
While phone sex has been the saviour of countless longdistance relationships, the mighty mobile phone may be damaging everyone else’s sex life. Pioneering researchers from Japan recently decided, for reasons best known to themselves, to examine the effects of mobile phone radiation on male sexual behaviour.
Under the plans, hospitals will be paid for the initial treatment and any follow-up care delivered 30 days after discharge, but if in that time the patient is readmitted as an emergency the hospital won’t receive any additional payments.
The intimate nature of the experiment meant that the scientists did not use human volunteers, but rather enlisted the help of that most sexually proficient of animals, the bunny rabbit. The researches divided the male rabbits into three groups, one group had a switched-on mobile phone near their genitals for 12 weeks; one had a switched-off phone near their genitals for 12 weeks and one control group with phoneless love-apparatus. A scientist carefully monitored each act of fluffy-tailed love-making and the moment of ‘sexual exhaustion’ was recorded. Alarmingly, those rabbits subjected to the switched-on phones ‘got sexually exhausted earlier’ than the rabbits in the other groups. The validity of these findings in humans is yet to be established but it is safe to say that if you catch your partner actually using a mobile phone during sex then no amount of trail-blazing Japanese research can save you.
info scope
nal, news, events, snippets, local, natonal, international, news, events, snippets, local, natonal, internternational, news, events, snippets, local, natonal, international, news, events, snippets, local, natonatonal, international, news, events, snippets, local, natonal, international,
feature scope
THE NHS:
WHO DO WE REALLY WORK FOR? It will be the organisation we work in when we graduate, yet how much do we know about it? As future employees, it is important to know how the National Health Service (NHS) is structured since this does impact on how patients are treated. The NHS currently employs around 1.7 million people, with about 1 million people using its services every 36 hours. Zhi En Tan investigates: Structure of the NHS
Parliament
Secretary of State for Health
10 Strategic Health Authorities
NHS Trusts Acute hospital trusts Mental health trusts Ambulance trusts Foundation trusts
Parliament and the Department of Health The UK government sets aside funds to the NHS from taxation. The Secretary of State for Health (Andrew Lansley MP) heads the Department of Health (DH) and oversees how the money is allocated within the NHS. The DH is accountable to the Parliament for the expenditures and operation of the NHS. This is also reinforced by the National Audit Office which audits all departments of the government. The DH is based in London and Leeds and manages the NHS. It does not deliver healthcare directly but works with various organisations to do so. It sets aims for the NHS and is managed by three main people: the Chief Medical Officer (Prof Dame Sally Davies), NHS Chief Executive (Sir David Nicholson) and the Permanent Secretary (Sir Hugh Taylor).
Strategic Health Authorities (SHAs) SHAs manage the NHS locally and act as a bridge between the DH and the trusts and PCTs. There are currently 10 SHAs: North East, North West, Yorkshire and the Humber, West Midlands, East Midlands, South West, South Central, East of England, London and South East Coast. They are each in charge of the health services within their own region.
Primary Care Trusts GP surgeries Dental provision Pharmacists Optometrists
NHS Trusts NHS Trusts are healthcare service providers which have been commissioned by PCTs. There are different types of trusts, each focusing on a specific area (eg Acute Trusts, Mental Health Trusts, Ambulance Trusts). A trust gets funding from a PCT depending on whether or not they surpass contractual expectations. If it does deliver, then it will receive more funding. Foundation trusts were introduced in 2004. NHS trusts could apply for a change in status. With this change, they would have more financial control and autonomy. There are currently 122 foundation trusts in England.
6
Mediscope June 2010
Primary Care Trusts (PCTs) PCTs oversee the health services in a local area. There are currently 152 of them in England and they control 80% of the NHS budget. A PCT assesses the needs of a local population and commissions services for them. These include hospitals, dental practices, GP practices, NHS walk-in centres, community pharmacies and many more.
Regulatory Bodies The main regulatory bodies in the NHS are the Care Quality Commission (CQC), Monitor and the Audit Commission. The CQC ensures the quality of health and social care in England. It monitors all healthcare providers in the NHS, both public and independent. These include the various trusts, foundation trusts and primary care services.
How NICE fits in
During the course of our work, we will all come across the NICE (National Institute for Health and Clinical Excellence) guidelines for treating various diseases. It was established in 1999 and is an independent organisation within the NHS. It has offices in London and even right here in Manchester, near Piccadilly Gardens. NICE provides guidance on three areas of health, namely public health, health technologies and clinical practice. It produces guidance on the use of various medicines, treatments and procedures. The NICE guidance is developed by independent advi-
sory groups which are made up of health professionals, NHS staff, patients, carers and the general public.
Conclusion
As future clinicians, it is important that we know how the organisation we will work in operates. In my own experience, some doctors I have come across lament about the inefficiency of the “management side of things”. Perhaps if we understood a bit more about how they were run, we might able to help change and improve it in the future. Zhi En Tan Year 3, Hope Hospital University of Manchester
History of the NHS
I
t is hard to imagine life before the National Health Service; we have become so used to its presence in our personal lives, in the political agenda and often in a slightly more boring conversation down the pub. But there once was a time when it wasn’t there to moan about. In fact, the NHS celebrated its 60th birthday two years ago, marking the date when the oddly named Aneurin Bevan formally launched the government initiative (his parents must have predicted he was to be in the history books). Naturally, the NHS began in the epicentre of all things cool and progressive, Manchester, in what was Park Hospital and now is Trafford General. It was based on three core principals: 1 That it meet the needs of everyone 2. That it be free at the point of delivery 3. That it be based on clinical need, not ability to pay Before this, healthcare provision was patchy at best throughout society. A scheme introduced by Lloyd George gave a flat sum to those working who chose to pay into the scheme but the small matter of the women, children, unemployed, chronically ill and basically most other people being excluded wasn’t taken into account. This new NHS was,
and still is, funded through taxation and therefore contribution is dependent on income, and everyone from Altringham’s worried well to a homeless person’s metastatic melanoma is treated free of charge. Although started with good intentions, the NHS’s journey has been torturous and, at times faced with uncertainty for the future. When the idea was first aired the British Medical Association were actually strongly opposed to it as they feared the concept of being in salaried service from the government (something they needn’t have feared as we now earn significantly more than our continental colleagues). They weren’t the only critics, and the opposition party at the time even likened it to Nazi policy of extreme state control. However, a poll showed the majority of the population was in favour of the NHS and Bevan fought hard for its creation. The NHS quickly settled into familiarity and it took only three years for financial trouble to start; in 1951 prescriptions were charged at a shilling each. Fortunately, such financial woes are now unheard of in the NHS. In the 1960s the NHS saw a period of growth and the number of doctors,
other healthcare staff and health centres grew exponentially. Fast-forward to the 1980s, and it was here that the familiar media and political scrutiny of the NHS began with performance indicators and general management was first introduced. More recent developments have seen the NHS gain more autonomy; in 1990 the ‘internal market’ was introduced which created individual NHS trusts which competed to provide healthcare. Similar primary care trusts were set up in 2002 for GP and dentist budgets. The ethos of Aneurin Bevan lives on however, and in 2009 the NHS Constitution was created which aimed to re-affirm the original three core principles and make it near impossible for any government to make dramatic changes.
feature scope
T
he UK is a highly developed nation, the 6th richest in the world . We have enjoyed free and reasonably reliable healthcare for 62 years nationwide. However, the demographic figures released by the BBC in October 2009 suggest that an average male in Glasgow will live to only 70, the lowest life expectancy in the UK, whereas a male in South West England can expect to live until they are 83. For this vast inequality, some are keen to point the finger at the NHS, highlighting regional favouritism as a major issue resulting in such disparities in areas such as Glasgow. In some ways linked to this is the idea of a north/south divide. Some will therefore have you believe that the government provides more finance to healthcare in the south. Perhaps a little closer to the truth is the idea of a genuine north/south divide in terms of GDP per household and average standard of living; factors that in turn will have an influence on health. Finally, when explaining Britain’s regional health disparities, there are those who will bypass the idea of a ‘north/ south divide’ in favour of an ‘urban v country’ argument. Many stand by an ancient wives tale of simply associating the air you breathe with a long and prosperous life; whether it be country-air or sea breeze, you’ll have that advantage you need in the race
“..an average male in Glasgow will live to only 70, the lowest life expectancy in the UK”
8
Mediscope June 2010
towards the centenary telegram you’ve always wanted. Unlike medieval times however, the idea of ‘country air’ itself having medicinal purposes, cannot be taken too seriously. What is more worthwhile analysing, for the purpose of explaining the gap spanning, in some cases, a 13 year life expectancy, is the lifestyle comparison in the city compared to rural areas. Though air is a factor, with the obvious health issues surrounding the pollution of a big city, it is more worthwhile to look at definite health statistics. Statistics on smoking and obesity have led the media to stereotype certain cities, especially those further north such as Dundee, Glasgow and Newcastle as hot-beds for obesity and high rates of smoking. However to move to what has become glorified as the rich and healthy countryside of the south requires money. This is where we find the real and unavoidable source of the regional inequalities. With a lack of job opportunities in the country and ever increasing house prices, the rural lifestyle, though perfect for retired couples or affluent families, is simply not an option for many. Though in the UK, the poorest areas of our cities do not seem anywhere near as abysmal as perhaps those in Brazil, South Africa or even the US, they are still bad enough to see people struggling to scrape by. When people scrape by this is
when health issues arise. It is a fact (and in some ways a shameful one for the modern world) that healthy food costs far more than fatty, salty, processed foods. However for many there is no choice. Poor diet and low living standards are dictated simply by income and wealth. With these impoverished families come impoverished neighbourhoods and communities in areas of the city where housing is cheapest. In turn these areas are associated with crime and drugs, bringing life expectancy further down. To suggest therefore that the UK is home to some inherent regional divides or that ‘country air’ adds years onto your life, is simply to search for a scapegoat; hiding the real issues behind Britain’s inequalities. It is not the fault of the NHS, but it is something the government need to address. The strength of big supermarkets such as Tesco and Asda over prices means healthy food is just not cost-effective for many families. Helping deprived families to live a healthy lifestyle would definitely in turn lead to healthier communities and healthier cities. Until the help to those who scrape by is initiated however, the 13 year gap stands as a ridiculous scar for Britain, with no great chance of it disappearing.
Nick Stopard Year 1, History, UoM
feature scope
www.fastbleep.com
Fastbleep will be launched in September, providing comprehensive and reliable revision resources for all clinical medics.
HEALTH INEQUALITY it does seem a particularly large difference between the two areas and surely shows that IVF treatment is easier to come by in Scotland than the southwest.
T
he postcode lottery is one of those terms you often hear from politicians, journalists and healthcare professionals. There is generally perceived to be uneven healthcare provision across the UK. The main issue is whether this is an unavoidable problem of the NHS, a benefit or indeed an something that needs to be addressed. A casual Google search will bring up a whole host of news articles reporting discrepancies in the provision of health care across England and Wales. For example, a recent government report showed that there are huge discrepancies in stroke care across the UK. A patient in Grimsby has to wait 48 hours for vital brain scans to discover whether they can benefit from medication to dissolve the clot, whilst those in London need only wait three hours. It is well known that any delays in treatment for a stroke can lead to increased morbidity and mortality, so it seems ridiculous that such large differences in time between trusts are allowed to exist. It would appear that a patient’s home address greatly influences the likelihood of surviving a stroke. There is also a large variation in the quality of cancer care across the country, despite the previous Government’s commitment to improving cancer care. If standard cancer regimes fail, patients may apply for treatments not approved by NICE. A study at the Christie Hospital showed that there were large differences in the number of non-conventional cancer treatments being approved between primary care trusts (PCTs) – some PCTs approved all applications while others approved less than half. This may be due to a lack of central guidelines leading to variation in practice between PCTs, but this obviously produces unfairness as some areas will be much more likely to approve effective treatments than others. IVF has long been a contentious issue as services between postcodes have differed greatly. It seems unfair that two patients who have the same clinical need should have different standards of care depending upon their postcode. This is highlighted by figures from 1998, that show there were 21.5/100,000 people NHS funded IVF treatments in Scotland but a mere 0.3/100,000 people in the South-west of England. Even taking into account the possibility that fewer people in the southwest require treatment when compared to Scotland,
One of the main responses of NICE has been to publish a set of national guidelines, which state that IVF should be provided free of charge for up to 3 cycles to women between 23 and 39 years of age in heterosexual couples with a clear medical indication. However, in the case of IVF, the use of central guidelines seems foolish as differences in need mean that different centres will spend more on IVF as more patients will use it. For example, if PCT A has 48 couples requiring IVF and PCT B has only 12 couples, it follows that PCT A will spend more on IVF than B. However, this would obviously produce major discrepancies in service provision and mean that IVF services may be much better in A than B. A national standard for IVF service would mean that both A and B offer the same service but more couples in PCT A lose out in an attempt to create a ‘fairer’ system. Furthermore, other essential services in PCT B may suffer if funding is tied up in an underused IVF service. Therefore, it seems obvious that to create a fair system, there must be variations in service across PCTs as this means supply can react to demand. It is obvious that despite significant interven“..it seems tion from NICE and the Government, the postcode lottery seems set to be a part of NHS obvious that provision, at least for the foreseeable future. to create a Central guidelines can only be used in part to fair system, combat it and PCTs should be relied on to althere must be locate their own funding. Part of this is due to variations in differences in local funding which means that service” some trusts cannot afford to fund all required services as well as they may want. This then produces the need for prioritisation of different “..the postcode aspects of care, depending upon the demand. lottery seems However, what does require some thought is set to be a what is to be considered a ‘high priority serpart of NHS vice’ - stroke treatment or IVF provision. The reality is that a postcode lottery does exist with provision, at respect to some services and all that remains is least for the foreseeable the challenge to make sure that all treatments are balanced and funding is allocated approfuture. “ priately.
Chris Roberts Year 2, University of Manchester Mediscope June 2010
9
career scope
ns What is on the application form?
The Mediscope Guide to...
io t a c li p p A n io Foundat
The first few months of fifth year are a particularly stressful time. Not only are finals looming around the corner, but it’s also the time to fill in the infamous foundation application form. In this guide, we introduce the basic process and with the help of previous applicants, provide some tips to help you secure your perfect job.
What is the foundation programme? In order to practice medicine in the UK, each medical school graduate must complete two years of foundation training. These are the first jobs you will have as a doctor, and comprise of a number of placements (usually 6) during which certain competences must be reached. Allocation to jobs is a national process, where students fill in an application form, which is then marked and given a score. Applicants initially rank their chosen Deaneries (foundation schools), and then later on individual rotations (tracks), with top scoring applicants being allocated to their first choice, then progressing in a step-wise manner.
The application is an online process, run by the UKFPO (UK Foundation Programme Office). You can register online from 10th October 2010, and have until 22nd October noon to complete the form. The application form is worth a maximum of 100 points and consists of two parts: academic ranking and application questions. The academic ranking provided by your medical school is worth a maximum of 40 points, and your answers to the questions are worth up to 60. There are a total of five text based questions (200 words) which draw upon your experience and skills demonstrating compatibility with the foundation person specification, which is worth reading and bearing in mind when you answer them. The questions tend to draw upon a mix of clinical situations you have been involved in, extra-curricular activities and ethical scenarios. To get a flavour for what might be asked, last year’s questions are presented in figure 2.
What help is available to help me? In the past, medical students have been provided with varying levels of help during the application process. As a result, the UKFPO and MSC (Medical Students Council) have joined to develop guidance for medical schools on the level of advice and support they should give medical students when completing the appli-
Figure 2: 2009 A
A Student’s Perspective October, the month when you realise that revision for finals actually needs to begin and that those multiple lists and timetables you’ve made do not constitute as revision. Unfortunately, it also happens to be the month that FPAS (Foundation Programme Application System) applications begin. And rightly or wrongly, these five, two-hundred word answers potentially have more bearing on your future than your finals exam grade. As I am not the most creative of writers, this scared me somewhat! Given the fact that, like many other medical students, I’d also dropped 10 marks out of 100 from the outset due to a lack of degree or any publications, it became clear that the manner in which I tackled these questions was extremely important. Having now come through the other side, these are some of the things I learnt that helped me to complete my answers and may help you optimise your opportunity. The North West deanery gives us a lot of support and direction in the lead up to the application process in the form of various lectures and one-to-one sessions, typically available on a first come first served basis.
10
Mediscope June 2010
Geraldine Donnelley, a fifth year student, successfully applied for 2010 entry.
They emphasise the importance of getting used to reading the questions and help ensure that you can recognise the hidden sub-questions that comprise each one. Essentially, each question tends to have around 5 points that it wants you to address, and if you fail to meet each criteria then you fail to get a good mark. Consultants wisely suggest downloading previous years’ questions, in order to practise interpreting them and formulating examples, helping you not to become too overwhelmed on the release of your FPAS questions. The panic I went through made me realise how useful this advice is; it gives you the chance to practise writing concisely ,maximising the use of each word, whilst also providing you with an opportunity to witness how limited 200 words per question really is, before being challenged by the real thing. Furthermore, those fast enough to get a oneto-one session gained invaluable feedback on their draft answers. It is worth noting that the careers service also offers special one-to-one sessions where they read your questions and give feedback. It’s important to remember that there is enough time to have your concerns heard if you plan ahead.
(1) Give two examples of you identified as part of training. Compare and con dressing these differing experiences to develop yo as a foundation doctor?
(2) Compare and contrast served for two patients w similar clinical problems extent to which it took i needs of the patients. Wh these observations and ho ing to your future clinic
(3) Describe one example you demonstrated or obser behaviour despite difficul apply what you have learn
(4) Describe one example, that has increased your u ing. Describe your role a the team. What have you l this to working with coll tor?
(5) Describe a situation, where you personally felt sure. Describe how you re from this experience and foundation doctor?
(6) Describe one of your Explain clearly why this What did you learn from t this influence your approa
Questions (60%) Q1 (10 points) Points awarded on qualifications: Extra degree: 1-6pts Publications: 1-2pts Prizes: 1-2pts
40%
Q2 - 6 (each 10 points) Five blank-space questions each with a 200 word limit. Questions will be made available when the online system goes active in October.
Academic Mark (40%) Quartiles Each student is assigned to a quartile based on a ranking of exam results within the year group: 1st quartile: 40pts 2nd quartile: 38pts 3rd quartile: 36pts 4th quartile: 34pts
Figure 1: Breakdown of scoring For More Information... Visit the UKFPO website at www.foundationprogramme.nhs.uk and download a copy of the foundation programme handbook
Application Questions
specific learning needs that your undergraduate medical ntrast your approaches to adneeds. How will you use these our competence and performance
the care that you have obwith the same diagnosis and s. Describe the care and the into account the individual hat have you learned from ow will you apply this learncal practice?
of a clinical situation where rved appropriate professional lt circumstances. How will you ned to your future practice?
, not necessarily clinical, understanding of team workand how you contributed to learned and how will you apply leagues as a foundation doc-
, not necessarily clinical, t challenged and under presesponded. What did you learn how will this benefit you as a
non-academic achievements. was an achievement for you. this achievement and how will ach to patient care?
Founda tion App Handb ook 20 licant’s 11
cation form. In the past, the careers service have provided oneto-one and group sessions on a sign-up basis. It is also a good idea to seek the advice of your tutors and colleagues.
Are there any special circumstances? In certain specific circumstances, you may be able to apply to your medical school for pre-allocation to a particular foundation school. These include if you are the primary carer of someone with a disability, the parent or legal guardian of a child or children and have significant caring responsibilities, or have a medical condition which requires local follow up and treatment.
Special Considerations A proportion of applications are audited. This means you must be in a position to prove that the answers you provide to the questions are truthful. Where documentation is not available, you need to ensure that any experiences you draw upon are outlined in the reflective pieces you write for your portfolio.
June 20 10
This year, the Department of Health (England) has decided not to fund additional places over and above last year’s number of vacancies, meaning there may be more eligible applicants than there are places available.
When you get stuck on a question it is often useful to “brainstorm” with others. My flat mates and I discussed how we had interpreted the question and each suggested what we thought were the main points, helping us to ensure that we had covered what the question had asked. I then found it useful to spend time coming up with various different possible examples to use to illustrate each question, making sure that the example lent itself to each of the points I needed to get across. A great piece of advice I received was that the example is not as important as illustrating the points well. Pooling information from your predecessors is also a great idea. I asked members of the year above for examples they had used and it appeared that it was those that drew upon everyday simple examples scored well, whereas those using complex, “impressive” situations wasted too much time explaining the example rather than hitting each of those five criteria in the question. However, bear in mind that your chosen example must be relevant to the question and not negative, as you will score a minimum mark. I tried to get my questions out of the way as fast as I possibly could. This proved valuable as it takes time to send the drafts off to be proof-read by various people, to then make the necessary amendments and resend on receiving again. A pleasant surprise though, was how willing consultants were to read and edit the application; none of my friends had a problem finding someone willing. It is more helpful if the consultant has particular experience in marking the questions.
Chris Jacobs, Lucy Hollingworth Mediscope Lucy Geen Communication Office UKFPO
Finally, I also think it is great to utilise your family and friends. Since a lay person represents one of the markers of the questions, it is important to make sure they flow well enough. Someone from an analytical or English background outside of Medicine can often be of great help. Principally, the more people that you get to read your application the better; in the end I used 2 consultants, the careers service and three non-medics. Undoubtedly, the most challenging part of the process is keeping to the strict 200 word limit; having to sacrifice lots of points that you want to put in and spending time furiously cutting words is not fun. At the end of fourth year we had a portfolio session that advised us to use 200 -word limits for portfolio pieces so that we could simply lift these from our folders to use for FPAS. Again, this was brilliant advice, but which I failed to utilise. Carrying through on this advice is a good idea because you must show evidence via portfolio to prove your examples are genuine if you are one of the few unlucky individuals to get asked to do so. Best of luck to everyone. FPAS does prove to be a lot more stressful than anticipated, but it is important not to play it down and rather spend your time making those questions tick the criteria.
Geraldine Donnelly Year 5, Wythenshawe Hospital Mediscope June 2010
11
career scope
100%
career scope Ajibola Omokanye on improving careers awareness amongst students at Manchester and the formation of MMCS “You need to intercalate if you want a good foundation year job, that’s why everyone at [insert your base hospital] is intercalating”, was the message circulating amongst my friends in year 3. Wrong. In fact, verging on the ridiculous. The medical school rumour mill is notorious for providing inaccurate insights to almost every conceivable situation, but it didn’t stop me believing it. My first taste of careers advice came via a chance meeting with my hospital dean. It proved invaluable. I was encouraged to think more deeply about why I wanted to intercalate, and whether it was right for me. The meeting helped me change focus from what subject to intercalate in, to what skills I hoped to gain during a year out of medicine. So why did it take me 3 years to get careers advice? The University of Manchester actually has an excellent (and very popular) careers service, with students from all faculties catered for. Even medicine. I have been fortunate to work as an intern for The University of Manchester’s Centre for Excellence in Enquiry-Based Learning (CEEBL). In this role, I spent time working with the careers service, trying to help improve careers awareness within the medical school. As it transpired, despite the wealth of resources available to us, medical students simply do not use the Careers Service. A recent survey of Manchester medical students, completed by 256 undergraduates from all year groups, highlighted just how big the problem is (figure 1). But why is careers awareness so important for the medical undergraduate? It’s important because medical training is always changing. There is now increasing pressure on graduates to
make careers choices much earlier on in their training. As a result, having the opportunity to explore different specialties and career paths during undergraduate training has become extremely important. Awareness of change is empowering, as it enables you to be better prepared. Manchester Medical Careers Society (MMCS) is an entirely student-led organisation that works with The University of Manchester Careers Service, The North Western Deanery , Manchester Medical Society and The School of Medicine. The society aims to provide medical students with better access to careers information, and advice on how to get the most out of undergraduate training. Given that its roots lie in CEEBL - much of CEEBL’s work centres around improving student engagement with the learning process - the society aims to deliver reliable information to students through highly interactive events and workshops, drawing on the experiences of practising clinicians. With the 2009/10 academic year now drawing to a close, the inaugural MMCS committee can look back on a series of very successful events. Most notably, the society’s role in the development of Manchester’s first Medical Careers Fair. The event, which took place in March, was open to medical students as well as junior doctors, had over 850 registered delegates. It was a huge success, and with enough positive feedback, it may become a permanent fixture in the Medical School calendar. This has been a fantastic year for MMCS, and the future looks very bright. In order to continue to make an impact, the society is keen to recieve feedback on its activities. If you have any suggestions or enquiries, or perhaps would like to be involved in the committee, please get in touch via e-mail (info@mmcs.org.uk). If you would like to know more about MMCS events (past and present), please visit the Facebook group (Manchester Medical Careers Society) and website (www.mmcs.org.uk). I would like to take the opportunity to thank everyone on the MMCS committee, all of whom have worked extremely hard throughout this academic year. Special mention is reserved for Joshua Jones, Andrew Green and Thomas Sherman, all of whom were crucial in the establishment of the society; Dr. Moez Zeiton and Lucy O’Connor, whose efforts during the planning of the Careers Fair were exceptional; Anli Zhou, Jasmin Farikullah and Sara Mahgoub, for their sustained efforts in ensuring a packed timetable of entertaining events in 2010.
Figure 1 2009 Careers Awareness Survey (courtesy of Janice Ellis, UoM)
12
Mediscope June 2010
Ajibola Omokanye Year 5, Wythenshawe Hospital
“Volunteering on a Medical Project in a developing country is an invaluable preparation for a career in Medicine” Patrick McGown, Medicine volunteer in Nepal
MEDICINE Volunteering overseas on a Medicine project is an ideal way to gain work experience whilst helping some of the neediest people and poorest resourced medical institutions in the developing world. Whether you are looking to get on to a university course, a trained professional, or somewhere in-between, you will have a role to play in one of the many hospitals, clinics and centres that we work with. Each placement is tailored, where possible, both to a volunteer's level of experience and their interests. As a Medicine volunteer, you are sure to see the huge gulf between the standards of medical practice in the developed and developing worlds. Hospitals are often very poorly resourced, medical staff underpaid, and the combined lack of experience and funds to pay for routine medical treatment means the patients you see will often have advanced illnesses and conditions that you will rarely see in the developed world.
DESTINATIONS Argentina Bolivia Brazil Cambodia China Ethiopia Ghana India Jamaica Mexico Moldova Mongolia Morocco Nepal Peru Romania Senegal Sri Lanka
MEDICAL ELECTIVES
DESTINATIONS
In developing countries, students will see diseases and conditions that have long been eradicated from the First World, such as leprosy and polio. Furthermore, due to a lack of both general health education and money to pay for treatment, the cases that you see will tend to be far more advanced than you are used to from your time in western hospitals.
Argentina
Because of the limited resources available in the countries where we work, our medical colleagues are always glad of extra help - and this is likely to come across in the way you are received by the staff in the clinics and hospitals where you work, as well as the patients you work with.
Nepal
Bolivia China Ghana India Mexico Moldova Mongolia Peru Sri Lanka Thailand Togo
Tanzania Togo
“I have loved every minute of my time on my elective placement in Mongolia, at times it has been frightening and frustrating but I wouldn’t change a thing. It’s a unique place that as a friend once said ‘gets under your skin’ and I couldn't agree more. When I leave I will be sad to go but I'm sure I will find an excuse to return. I would certainly recommend Mongolia as an elective destination with a difference, the challenges won't be easy but for me the rewards were plenty.” Adam Spong, Elective Volunteer in Mongolia
Tel. 01903 708 300 / info@projects-abroad.co.uk
www.projects-abroad.co.uk
review scope
Review Article
A Study Into The Refreshment Outlets of Four Manchester University Teaching Hospitals J. Healy, A. Boles, A. Pedersen et al. ABSTRACT Contrary to popular belief, a medical degree is not actually based on an encyclopaedic knowledge of physical aliments or telepathic communication skills. While an understanding of cardiac arrhythmias or an empathetic head-tilt may get us through OSCEs and Progress Tests, this knowledge rests upon foundations that have been neglected for far too long. When we graduate from this University we will all know, in our heart of hearts, that our medical education has been built upon a rickety scaffold of tea stains, sandwich crumbs and an unholy amount to procrastination. And so, fuelled by a dedication to the scientific method and a determination to avoid productivity, three intrepid Mediscope editors devoted an entire Saturday to a historic undertaking. For the first time in our medical school’s history, there would be a half-baked, unrandomised and utterly biased study into the cafés and canteens of Manchester’s teaching hospitals.
Figure 1: An X-ray of a teapot.
Methods All of the sites were visited on the same cold, grey Saturday in March. The three reviewers were a reasonable representation of the average medical student in that they were either hung-over, sleep-deprived or irritatingly overexcited. One café or restaurant was selected from each teaching hospital and were carefully assessed on four core parameters (cost, tea quality, ambience, friendliness) before an overall score was arbitrarily chosen.
1
MRI - The Conservatory
M
RI is blessed with a great many things. For those who hate commuting, it is preposterously convenient; for those with attachment issues, it is reassuringly close to the Stopford building. However, MRI’s sheer convenience and central location may be its own downfall when it comes to the hospital’s cafés and restaurants. With the prospect of Greggs across the road or a full meal at home, there is little incentive to stay in hospital for lunch or a mid-afternoon snack. This means that MRI sadly lacks an iconic hospital canteen where students, staff and patients congregate every day. That being said, we managed to find The Conservatory Café near the main outpatients department. The café is perfectly pleasant: the food is cheap and the tea is hot. However, you are unlikely to find yourself idly wasting hours in its somewhat functional surroundings. Moreover, the slightly out the way location means that there are limited opportunities for the dedicated people-watchers amongst us. Nevertheless, you could certainly do a lot worse if you need a snack and a sit-down.
14
Mediscope June 2010
Tea Prices MRI: 70p e: 84p Wythenshaw Hope: £1 Preston: 56p
Verdict!
2
Wythenshawe - Southmoors Restaraunt
F
rom MRI we ventured south towards Wythenshawe Hospital (or the University Hospital of South Manchester as it is officially known). Anyone who has visited this hospital will have noticed the pseudo-corporate messages that grin down from almost every corridor. Truisms like ‘Patient Safety Is Important!!!’ bellow at you as you scurry from ward to canteen, which itself is run by a company called Sodexho. While we at Mediscope are sure that Sodexho is a reputable and ethical corporation, there is something disconcerting about buying your lunch from a company that sounds like it belongs in a Bond film. If you can get over Wythenshawe’s interesting approach to public service then Southmoors Restaurants is actually a rather lovely place to spend time. It’s gloriously spacious and large windows on three walls provide plenty of natural light. Furthermore, its distance from the library helps dull those vague pangs of guilt as your lunch break extends into its second hour. However, Southmoors is marred by a fatal flaw. Buying a cup of tea from this restaurant is one of the most dehumanising experiences you could ever associate with a caffeinated beverage. An Orwellian system of cartridges, clicks and alarming brown fluid is as far away from the normal social experience of tea as is possible to imagine. The tea itself is passable but this experience alone is enough to cost Southmoors valuable points.
Verdict!
3
Hope - Cafe Royal
S
till smarting from the tea catastrophe at Wythenshawe Hospital, we meandered towards Hope in the hope (that’s an utterly brilliant pun – you should definitely have laughed) of better things to come. We found ourselves in the Plaza and the comforting surroundings of the Café Royal. Aesthetically speaking, the Plaza is a bit of a disaster. There is hardly any natural light and a noisy bazaar of hairdressers, cafés and various shops crowd around a central foyer. However, it does enjoy a near constant procession of patients, visitors and hospital staff and this makes it one of the best people-watching locations in any hospital. Supplied with sufficient snacks, hot drinks and an award-winning medical school magazine of your choice you could easily waste hours here. Within the Plaza you will find the Café Royal. On paper, the Café Royal does not look particularly appealing; it’s tea is considerably more expensive than the other places we visited and the variety of food is nothing to get particularly excited about. However, these objections simply melt away when a ridiculously cheerful lady hands you a steaming mug of tea (containing a real tea bag!). The food here is nothing special but the atmosphere and the service certainly is. Against all the odds, this place just works.
4
Preston - Cafe Maison
Verdict!
A
h Preston. All too often the subject of pitying stares and cruel jokes, Preston is easily the most maligned teaching hospital at Manchester University. It’s reputation is almost certainly unfair but every year dozens of medical students mutter a quiet prayer of thanks that they did not get ‘sent to Preston’. It was in this context that our car chugged away from Salford and as we drifted further north we were filled with an irrepressible optimism. We became convinced that, as a result of some glorious Karmic balancing act, Preston’s canteen would be ludicrously amazing. We pictured luxurious oak tables and stiff-collared waiters, food encased in crystal bowls and tea served from ivory pots. By the time we stumbled from the car and burst through the hospital doors, we could barely contain our excitement and breathlessly asked for directions to this gastric Nirvana: “Sorry love, it’s just closed.” Disheartened, so very disheartened, we were forced to regroup and, employing our finely honed problem-solving skills, we eventually found the small Café Maison. Unfortunately, there isn’t a great deal to say about Café Maison. The tea is fine and reasonably priced. We liked the custard. Yet despite the endearingly rickety table and the smiling staff, we were unable to shake the feeling that we’d missed out on so much more.
Verdict!
your scope
MEDICAL EDUCATION - BEN AMIES in the future Medical Education
S
ince the mid-twentieth century, reforms to medical practice have eroded traditional clinical apprenticeship. Waiting lists, research and private practice have reduced supervised training opportunities and legal restrictions on the involvement of medical students have been criticised as short-sighted, in that immediate benefits to patient safety may not justity the long-term disadvantages in training. The fact that students don’t easily ‘fit’ into modern practice needs to be accepted and compensated for, so students can continue to become great doctors in the 21st century.
As doctors do not receive the same recognition for teaching as they do for research, informal teaching time has declined. Clearly, if teaching is not well recognised then it needs to be but how to do this is tricky. If you consider the value of recognition, it seems that it is essentially for CVs. If those reading CVs regard research in greater esteem than teaching, then simply acknowledging and rewarding teaching may not be enough. The key difference seems to be the quantifiable nature of research output and the verifiable nature of its quality – elements that teaching simply cannot emulate. I think the solution is to protect teaching time under doctors’ salaries, and to reassert the collective responsibility for all doctors to contribute to training. Simulations have recently become more popular in medical education as they provide a great opportunity to practice skills and make mistakes in an environment where no-one can get hurt. Of course simulations, however clever, are not real patients. To become the next generation of skilled clinicians, students need to inherit the experience of today’s doctors, with real human patients.
16
Mediscope June 2010
I will always remember my experiences with expert and exemplar patients when studying neurology at Salford. This is a great way of learning high-quality clinical skills from consultants in a speciality that does not have enough patients for the 475 students in Manchester per year. The Dermatology Day I attended at Preston last year (an event I’d urge everyone to attend in future) demonstrated an excellent format of clinical exposure where we circuited around patients and experienced a wide variety of conditions. I see this sort of systemic patient exposure as a significant educational tool in the future. I would argue that exemplar patients should be integrated into every module, and in combination with circuits, take on the core of any undergraduate minor specialty training.
Just as the traditional preclinicalclinical divide has been broken down, the same may need to happen for the under- and postgraduate divide. One solution may be to protect final year students as paid employees of the NHS, as well as full-time students. This would be a new junior position with a limited number of responsibilities as part of the multidisciplinary team, along with a round of exams at the end of the year. This would also allow a sixyear course without risks to ‘widening participation’, diminish the influence of litigation, take pressure off Foundation doctors, and stimulate senior doctors and hospital managers to dedicate time and resources to students. Professional attitude ne other ‘problem’ I sometimes encounter in medicine is a crude sense of superiority that senior doctors can develop. Here, I must point out the difference between seniority and superiority. We gain seniority with experience and accomplishment, we
O
never, in any context, gain superiority. A sense of superiority serves only to intimidate and exclude students, junior doctors, and worst of all, patients. This ‘superior’ doctor simply does not do their job. This has somehow been culturally inherited in the medical profession, and persisted into the 21st century, colluded with under the guise of ‘respect’. However to respect is a reciprocal quality of relationships, and is therefore only justified for those who do not feel superiority over others. This criminally outdated attitude becomes clear when we meet and converse with the majority of fantastic clinicians and researchers who do not hold such ridiculous opinions of themselves, and thus, a sense of self-importance becomes exposed as self-indulgence. This superiority also reinforces an exclusive professional culture, in turn contributing to the continued dominance of the middle-class in the medical profession. Opportunities he new opportunities in medical education are enormously diverse; but what is critical is the leadership and courage to reform medical education for the modern era. I see simulation and exemplar patients as good supplements to apprenticeship. Eventually, a more holistic view of healthcare provision will need to better include students in the system, allowing expertise to be inherited and generated in new doctors. I hope that medicine overcomes the last vestiges of poor institutional culture, to embrace a more open profession that better represents the society we serve. Ultimately, the development of medical education lies with us. As the teachers of tomorrow, we must collectively contribute to providing students with the best learning opportunities possible.
T
Ben Amies Intercalating: Medical Education MRes
How can we use our experiences to become great foundation year doctors?
“When I grow up, I want to help people...”
T
his was the key phrase that many of us used in our medical interviews, hoping to impress the interviewers and secure our place in the world of medicine. At the start of fourth year, I was faced with a new challenge when a close member of my family was diagnosed with a life-threatening illness. Although this was obviously distressing, I have learnt an incredible amount from this experience about what it’s like to be a patient’s relative and have used this insight to decide on some of the qualities that I wish to use as a Foundation year doctor.
patients, they are hospitalised for several months.
What is hospital really like for the patients?
The importance of the social impact of medical conditions has never been more evident in my eyes. Diseases affect not only patients but their families and friends. PBL provides us as students with the perfect opportunity to share our experiences and really think about how these conditions affect people. It is difficult to understand what it is like to live with a disease until you, or someone you know, has experienced it.
From the many patients I’ve spoken to during my clinical years, it appears that being in hospital is boring and lonely. Although the staff on the wards may be constantly busy, the patients are not. They can be left waiting for hours to be disconnected from a drip if an emergency comes along or staff are simply too busy. The majority of hospital in-patients are elderly and may not have family or friends who are able to visit them regularly. This can add to their sense of isolation and can make the ward a lonely place, especially, if like many
As a student ward rounds can seem very long and monotonous, but to some patients it is the most important part of their day. It provides them with one of few opportunities to talk directly to their consultant and the other doctors involved in their care. This is the time for them to have their questions answered and to talk about what is to happen next.
What should we be doing now as students?
“As a student ward rounds can seem very long and monotonous, but to some patients it is the most important part of their day”
There will be a lot of adjusting to do when we make the step from being a student to an FY1 with real responsibilities. But I feel that I want to embrace the opportunity to make the hospital as welcoming a place as I can for the patients on my ward. It isn’t difficult to make a difference. Stopping for a brief chat with a patient to find out how they’re feeling could take a few minutes of your time as a junior doctor but could have a positive impact on a patient who hasn’t had any visitors that day. Prioritising your jobs on the ward can make a difference. You have a list of blood reports to look through but are desperate for a coffee break. A patient may have been waiting all morning for their results, which take only a few minutes to view. You could put that patient’s mind at rest by reporting back their results and then taking your break. Most of all, I aim to enjoy the experience of Foundation years. It provides us with an opportunity to really work on our communication skills and perfect our manner before we start seeing patients in the clinic setting. From a patient’s point of view, knowledge isn’t everything. They’ll remember the considerate doctor, who stopped to talk to them when they were feeling unwell and lonely, not the doctor with fountains of information and little time to share it. Elisabeth Wright Year 4, Wythenshawe Hospital Mediscope June 2010
17
your scope
We should embrace the chance to learn what living with different conditions is really like, so that one day we can nod empathetically and say that we really do understand ‘how that must be hard for you.’ We should always remember that a doctor’s role is to treat a patient with a disease, not a disease that has become part of a patient.
International Medical Summer School
Jemma Boyle reviews last years international summer school, see the back page for details on this years event.
W
hen I first read about the International Medical Summer School last year, I was intrigued. I’ve always had my heart set on a career in surgery but to be honest, I didn’t have a clue what this decision actually meant in terms of my future. In retrospect, it seems quite unreasonable that I had made such a bold choice with no real knowledge about how I was going to get there or what awaited me. Recent changes to speciality training within the NHS mean that we have to choose our career pathways within a year or two of qualifying. Exposure in medical school to different specialities, particularly to super-specialities such as ENT and plastic surgery, is limited. The principal aim of the summer school is to provide students with an overview of all medical and surgical specialities as well as greater understanding of their chosen speciality. The advice and guidance is provided by consultants who are at the top of their fields. The school also delivers information on how to start developing a strong, tailored portfolio to complement essential core knowledge about the speciality. The first of its kind in the UK, the school ran from 17th – 21st August 2009 and was supported by The Royal College of Surgeons of Edinburgh, North West Postgraduate Deanery and Manchester University, amongst others. On the first day, we were divided into medical and surgical groups and received a selection of inspiring talks which provided an overview of the different sub-specialities within the area we’d chosen. This was great for people like me who weren’t sure which sub-speciality to go into. On the second and third days, we were split into the sub-specialties we had picked and given further in-depth information, including current advances and the future of the sub-speciality. We also practised basic surgical skills
18
Mediscope June 2010
“The principle aim of the summer school is to provide students with an overview of all medical and surgical specialities” and used laparoscopic simulators which were fantastic! Getting hands on experience reinforced my desire to do surgery. The fourth day discussed methods of getting papers published and performing presentations. These were things that I’d never considered, but which are essential components to an impressive portfolio. The final day covered the specific training programmes and the attributes you’re expected to have as an applicant, which was certainly an eye-opener. During the evenings there were numerous social events including, of course, a customary curry. This allowed interaction with consultants, registrars and fellow medical students in a relaxed environment. Furthermore, we were granted mentorship from consultants, allowing us to contact them directly after the event. Although slightly overwhelmed at my prior lack of knowledge, I finished the week empowered and determined, and with such fierce competition for training posts I feel I’ve at least been given a running start. It was certainly a week well spent. Jemma Boyle Year 3, Hope Hospital
SocietyScope EMSOC
E
MSOC is the European Medical Student’s Orchestra and Choir Society and we’d like to tell you a little bit about an exciting event that we are organising for this summer. EMSOC involves medical students from all over Europe and this year the event is coming to Manchester for the first time ever. The event has been organised by Manchester medical students who have been working hard all year to create an event that will live up to EMSOC’s history. EMSOC was established in Germany in 1993 and gives medical students the chance to meet other students from different cultures and perform music together. To make this year even more exciting, both the EMSOC orchestra and choir will be performing in concert together! The event will run for ten days, from 30th July to the 9th August, culminating in two concerts at the Royal Northern College of Music in Manchester and Chester Cathedral. We will be rehearsing a fantastic musical programme of Brahms, Mendelssohn and Prokofiev, which the choir and orchestra will perform together under the guidance of our conductors; Daniel Parkinson and John Anderson.
SEXPRESSION MANCHESTER
I
don’t know about you, but sex education at my secondary school was almost non-existent. I remember being taught in science about the birds and the bees but there was never any discussion about the choices and contraception available to young people, leaving many of us to turn to other, potentially unreliable, sources. In fact, the rate of teenage pregnancy in the UK is amongst the highest in the Western world and this figure has been rising for years, especially among under 16s. Alongside this, the incidence of sexually transmitted diseases (STDs) in under 25s is increasing. The government long ago recognised the need for discussion about sex and relationships in schools and published Sex and Relationships Education Guidance in 2000. This guidance states that “effective sex and relationship education is essential if young people are to make responsible and well informed decisions about their lives”. Sexpression is an independent student organisation, not affiliated to any religious or political cause, with the sole aim of trying to promote relationship and sex education within
Join our facebook group: Sexpression Manchester
EMSOC is also about raising money for charity and every year the event raises thousands of pounds for its chosen charity. This year’s charity is the Teenage Cancer Trust: which is based at The Christie Hospital in Manchester. The charity funds specialist units that provide treatment for teenage cancer patients within an environment tailored to their needs. The charity aims to provide a place in a specialist unit for every teenager by 2012 and we want to help them achieve that goal. All the profit we make from ticket and program sales will go straight to the charity. So this is where you come in! If you are in or around Manchester at the beginning of August and enjoy classical orchestral and choir music then come along! It may be too late to be part of the event yourself but you can come along and support your fellow students and help us raise money for an excellent cause as well as enjoying quality classical music. Tickets should be on sale now, so look at for out for our posters and check out our website www.emsocinfo.org for more information. Kate Walker Year 4, Wythenshawe Hospital secondary schools. It is a national organisation run with branches based at different universities around the UK. Sexpression Manchester is a growing society, getting involved with local schools and bringing sex education to the classroom by stimulating debate and conversation. We send in student volunteers to talk to 14-15 year olds about sex and relationships, contraception and STDs. Our aim is to educate young people in these areas and empower them to make informed choices about their reproductive health. As volunteers we use games and scenarios within the class to try and get the students relaxed and talking about what can often be an embarrassing topic. Many teenagers are unaware of the services available to them and the help that they provide, so we also give them this information. We are always on the lookout for new volunteers to our group. If you think this sounds like a project you’d like to get on board with then please get in touch! Email: sexpressionmanchester@googlemail.com Website: www.sexpressionmanchester.yolasite.com Tom Cullen Year 4, Hope Hospital
Mediscope June 2010
19
BACK PAGE - AD FUTURE EXCELLENCE
INTERNATIONAL MEDICAL SUMMER SCHOOL “Empowers students to gain advantage in highly competitive and specialist fields in surgery and medicine”
Dates : 23rd August (Monday) to 27th August (Friday), 2010 Venue : The University Place, University of Manchester Brief description: This week-long event is aimed at helping medical undergraduates develop a strong clinical, academic and research portfolio that will help them to pursue a career in a competitive surgical or medical speciality on completion of medical school. It will also help students obtain essential knowledge about their chosen speciality and develop the confidence to interact with consultants whilst undertaking clinical placements.
Specialities covered: • Acute Medicine
• Neurology
• Anaesthesia • Cardiology
• Neurosurgery
• Cardiothoracic surgery
• Orthopaedic Surgery
• Critical Care • Dermatology • Emergency Medicine • Endocrinology • ENT
• Oncology • Obstetrics and Gynaecology • Paediatrics • Paediatric Surgery • Plastic Surgery • Psychiatry
• Gastroenterology
• Radiology
• General Practice
• Urology
• General Surgery
• Vascular Surgery
• Nephrology
Key note lectures from… . Space Medicine . Royal Air Force . Royal Navy . British Army . Territorial Army . World Health Organisation . United Nations . Médecins Sans Frontières
To secure a place, please visit: S U Feedback from Summer School M 2009 M “Very informative and opened me up to a whole E array of new sub-specialities that I wasn’t sure of R before which I can now explore over the rest of my medical school career. The lectures on what happens S after we graduate were particularly useful. Thanks!” C -Hammaad Khalil Year 1 Surgery Student H University Of Liverpool O O L Course fee: £145/- 2010
www.doctorsacademy.org Quotes from Invited Faculty - 2009 “Fantastic concept! There is a real need for such innovative programmes that will help the current medical students to understand and appreciate different careers, and help them choose what is best for them.” - Mr Ravi Goyal Consultant Orthopaedic Surgeon Royal Blackburn Hospital
“The place to come if you want to know what happens after medical school!” - Prof David Rowley Director of Education at the Royal College of Surgeons in Edinburgh Deputy Dean of the Medical Faculty, University of Dundee