Mediscope Magazine - Issue 1

NEWS FEATURES EDUCATION COMMENT SOCIETIES LIFE

mediscope Dec 2007

Regeneration 5th Year changes Portfolio explained Coping with death Dr Mark Hamilton interviewed

Manchester Medical School’s Student Magazine

mediscope

Issue 1 Dec 2007

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CONTENTS A word from the editors...

04 News Infoscope keeps you up to date with the latest local, national and international medical news.

06 Feature article In every issue of Mediscope there will be a thought provoking feature. In this issue we hear about Rosie and the effects of her craniopharyngioma.

09 Education Portfolio 09 Intercalation 10 The future of academic medicine 12 X-ray Quiz 14

16 Comment Sorry but that’s not my speciality 16 Questionable ethics? 17

18 Society Find out about medical student activities past present and future

21 Life Difficult times 21 Ask the Dean 22 Dr Mark Hamilton interviewed 25

l Team

itoria The Ed on Anders James oquhoun C Jessie Kelley s a m o al Th Saberw i n i h o R s m a illi Anna W

Welcome to Mediscope!

We have revived Mediscope, Manchester Medical Student’s Magazine. Initially established in 1898 and subsequently becoming very successful, it unfortunately ceased production in the late 1990s. Our aim has been to produce an informative and entertaining magazine for you as Medical Students here at Manchester. It contains a number of sections ranging from medical education to societies to international news and much more. All of our articles have been written by students or medical school staff and so we hope that you will find them interesting, informative and perhaps enjoyable too.

This is our first edition but we intend to publish approximately four times per academic year. We would therefore, really encourage you all to write for Mediscope in the future. If this is something you want to do then please e-mail

subeditor.mediscope@manchester.ac.uk to enquire.

We hope you enjoy reading the magazine.

Regards,

The Editorial Team

mediscope Front cover and layout by James Anderson

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Issue 1 Dec 2007

infoscope Year 5 Changes Prof. M A Horan On 18 September 2007, the Curriculum Committee reaffirmed its previous decision for the changes to Year 5 to go ahead, as planned, in the academic year 2008 – 2009. This means that students who are now in their 4th year will be the first cohort to experience the new format year 5.

The reasons for introducing the changes are twofold: firstly to ensure that as many students as possible will be able to start Foundation Training in August 2009 and secondly that they will be well prepared for what will be expected of them.

The general pattern of organisation is similar to that which operates now.

However, blocks will last 4 weeks instead of 8 weeks. From the start of the academic year until the Christmas vacation, there will be 4 such blocks (blocks 1-4), to which students will be allocated by the teaching sectors.

Swapping blocks will generally not be permitted, except in exceptional circumstances. It may be possible for European Option students to undertake a 4 week period of elective study over this time period.

An Exempting Examination will take place in late January. The format will be similar to the present Final Examination except that it is planned that there will be no OSLER stations in the clinical examination. We anticipate the results will be announced two weeks after the end of the examination. Students who pass the Exempting Examination will not be required to do the Final Examination in May 2009. Students who do not pass the Final Examination will not be able to do a re-sit until January 2010.

In addition to these formal examinations, we shall introduce work-based assessments to be done while on clinical attachments. These will be demonstrations of practical skills (DOPS) and short clinical examinations of patients (mini-CEX). Regular group meetings will not include PBL sessions, but will include case-based discussions (CBD), which will be assessed. We also antici-

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pate requiring all students to achieve the intermediate standard for life support. Students will be required to maintain a portfolio throughout the year and this will form the basis on an “exit appraisal”. Students will need to pass all these additional tests in order to graduate.

After the Exempting Examination, there will be a further 4 blocks of 4 weeks duration (blocks 5-8), all of which will be chosen by the students from a bank of “quality-assured” placements. Placements that are not “quality-assured” will be permitted provided the student makes a sufficiently convincing case. European Option placements are all “quality-assured”. No more than two consecutive blocks may be spent on the same placement. It is anticipated that most students will undertake a “traditional elective” period of study during this time. For organisational reasons, students will be allocated to either blocks 5+6 or blocks 7+8 for this purpose, though swapping will be permitted with other students in the same sector. Because students must consider their future careers, we shall encourage short “career tasters” during blocks 5-8.

Because no news is bad news

The Final Examination will take place in late May 2009. This will be followed by a period of shadowing (mandatory) and an exit appraisal (which must be passed) prior to graduation. For students whose FY1 posts are outside the NW Deanery, shadowing will be done according to the rules that apply in the host Deanery. Students will be required to provide evidence that they have undertaken the appropriate period of shadowing. Any failure to provide such evidence will result in a letter being sent to the responsible Postgraduate Dean, informing him/her that we cannot confirm that the student has undertaken the required period of shadowing.

Hospital Deans have already been asked to undertake the necessary block allocations and to make the information available as soon as is reasonably possible. Precise details of how the year will run are not yet available.

Information will be released to students by email and through MedLea as soon as it is confirmed. Please do not try to chase information that has not yet been released – this will just slow down the process of implementation.

A series of information bulletins will be issued over the coming months giving you all of the information you will need.

Professor M A Horan is the Chairman of the Phase 3 Committee

National News No Registration MRSA on the for Students decline Recently, the GMC has decided that under its Fitness to Practise plans it will not be recommending to the government that students should be registered. The GMC have decided to try and work more closely with medical schools to try and ensure that medical students are fully aware of their responsibilities.

Recent figures published on the number of MRSA cases show a 10% decline between April and June 2007.

There are also early indications suggesting a fall in the number of Clostridium Difficile cases. However, there is a still a very long way to go and it’s crucial that trusts don’t start to become complacent.

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Diet is a major cause of cancer What people eat is a significant cause of cancer, but many Americans still incorrectly believe that factors such as pesticides are bigger cause. The report, by the World Cancer Research Fund and the American Institute for Cancer Research recommends that diets based on fruits, vegetables and whole grains with less red meats, dairy products and fats protect against heart disease, diabetes and cancer. Keeping a healthy weight is the No. 1 recommendation to reduce the risk of cancer.

The American Institute for Cancer Research also released a survey which showed that U.S. adults do not understand these risks. Only 38 percent knew of the link between cured and processed meats and cancer, 49 percent knew that diets low in fruits and vegetables raised the risk of cancer and 46 percent knew that obesity was a well-documented risk. However, 71 percent thought that pesticide residue on produce was a cause and 56 percent thought stress causes cancer, neither of which have ever been proven. "Americans are increasingly likely to attribute cancer to factors over which they have no control, and for which no proven links to the disease exist," the report reads. [www.reuters.com] et hpers, g photogra d n a s r porte News re : c.uk in touch chester.a pe@man o c is d e r.m subedito

World Toilet Summit: India aims to eradicate open-air defecation by 2012 According to the WHO, one-third of the global population do not have access to a proper toilet with India accounting for about 700 million people. Defecating in the open can contaminate water supplies and spread diseases such as cholera and dysentery. The UN is aiming to provide clean sanitation to all by 2015.

At the World Toilet summit, Rural Development Minister Raghuvansh Prasad stated, "By 2012, India will be free of defecation in the open and will meet international commitments in this regard." Health and sanitation experts from 40 countries are attending the conference to find ways to provide toilets for everyone and discuss other clean sanitation issues. [www.reuters.com]

Key HIV strain "came from Haiti" The strain of the HIV virus which predominates in the USA and Europe has been traced back to Haiti by scientists at the US National Academy of Sciences.

The strain passed from Haiti to the US via a single person in about 1969 before spreading further. They hope knowing this could help find a cure for HIV. The team examined archived blood samples from five early AIDS patients - all of whom were Haitian immigrants to the United States.

The Tooke Report A report recently published by a group led by Professor Tooke (Dean, Peninsula Medical School, Chair Council of Heads of Medical Schools) looked into the problems surrounding MMC. Firstly, one must not forget that despite the huge problems over the past few years, Modernising Medical Careers (MMC) aimed to accelerate training and to assure the fundamental abilities of the next generation of doctors.

However, it has been a disaster and the report suggests a number of changes: 1. It suggests that the link between FY1 and FY2 should be broken. All UK Medical Graduates should get an FY1 place to register with the GMC. FY2 should then become

The new research suggests HIV first arrived in Haiti in the mid-1960s probably from Africa where HIV is thought to have originated - before making its crossing into the US. The group want to continue their research by tracing the virus further back. The suspicion is that it probably arrived in Haiti from the Congo via Haitians who were working in Africa during the 60s.

It is hope that understanding the origins of this and other strains of HIV will better enable scientists to predict how the virus may mutate in the future. [www.bbc.co.uk]

info

International News

Pope's "morning after pill" speech criticized Politicians and pharmacists in Italy responded angrily to an appeal by Pope Benedict for pharmacists to refuse to dispense drugs such as the "morning after pill" if they object on moral grounds. The Pope told an international conference that pharmacists should be guaranteed the right to conscientious objection in cases where medicines they distribute can block pregnancy, provoke abortion or assist euthanasia.

The Church teaches that artificial birth control, abortion and euthanasia are wrong. It holds that nothing should block the possible transmission of life, which it teaches starts at conception and ends at natural death. Italian media interviewed pharmacists who are practicing Catholics. Some said they were obliged to put aside their personal beliefs and sell the prescribed medicine, while others said they preferred to ask a colleague to do so. [www.reuters.com]

the first out of three years of core clinical training, comprising six, six month rotations. Application onto this three year programme would be centred around computer based assessment.

2. The new FY1 year should focus on principles of chronic disease management as well as acute care. There should also be better harmonisation with year 5 at Medical School.

3. Following completion of the three years of core clinical training junior doctors will then enter into higher specialist training. Application to these training posts would involve interviews.

4. A number of other recommendations have been made involving more senior doctors i.e. consultant and associate specialist posts.

Summarised by Thomas Kelley http://www.mmcinquiry.org.uk/draft.htm

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Issue 1 Dec 2007

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the name has been changed for reason’s of confidentiality

Dr Leena Patel Rosie and the effects of her craniopharyngioma scan confirmed this [Figure 1]. Over the next few days we met numerous specialists: neurosurgeons, anaesthetists, endocrinologists, ophthalmologists, oncologists and many nurses. We asked many questions, all of which were answered truthfully.

Rosie was given dexamethasone to relieve the brain swelling which was intermittently blocking the flow of cerebrospinal fluid (CSF) around her brain. It was explained that she would require a craniotomy to debulk the tumour.

The surgery on 11 January 2001 lasted a very long 6 hours and 85% of the tumour was removed. The tumour had been compressing Rosie’s left optic nerve but amazingly her sight survived apart from some loss of peripheral field of vision. But she was left with two major problems: extensive hypothalamic damage and pituitary hormone deficiencies.Q4 The hypothalamic damage affected nearly

This article presents a mother’s account of her daughter’s medical problems and its impact on the family. The subsequent discussion highlights the important medical, social and psychological aspects relevant for medical students. Questions to probe and enhance students’ understanding are interspersed throughout the paper. Answers are provided at the end of the article.

Mother’s account

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osie’s first symptoms were at age 5.3 years (August 2000) when she changed from being happy and confident to moody and tearful. Within a month she stopped sleeping and would stay awake for hours. A few weeks later, she started waking up with headaches.Q1 We consulted the GP who tested Rosie’s urine and reported all was well. By November the headaches occurred daily and lasted most of the day. The GP therefore referred to a paediatrician but the appointment was for February 2001. By Christmas Rosie was gaining weight despite eating practically nothing and started to develop breasts.Q2 Things worsened dramatically after the new year with Rosie becoming intolerant to light and vomiting. The GP arranged for us to see the paediatrician the next day.

We took a list of all Rosie’s symptoms to the paediatrician, who had spent several years working in neurology. During the examination he paid particular attention to Rosie’s visual fields and the backs of her eyes. He was concerned and informed us that further tests were required. The wait for a head CT scan was 6 weeks. We decided to pay for it and it was done 2 days later. The scan showed a mass several centimetres in diameter in the region of Rosie’s pituitary gland.Q3 Rosie was referred to the neurosurgical team at the children’s hospital.

The doctors and nurses explained that she most likely had a brain tumour called a craniopharyngioma. An MRI

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every aspect of Rosie’s life. She hardly slept, could not control her body temperature, had an uncontrollable voracious appetite and suffered huge mood swings.Q5 This damage and dexamethasone treatment caused her weight to double within 6 weeks [see pictures].

Over the last 6 years since Rosie’s diagnosis we have been on what can only be described as a rollercoaster.

After surgery and a 5 week course of radiotherapy we went home, and coming to terms with what had happened took a long time. It rapidly became apparent that Rosie had changed in every single way: our funny bright happy daughter had turned into a difficult, reclusive and sometimes violent, child who thought about nothing other than food. Things gradually improved as we developed a very structured home life to try and cope with the constant hunger. Rosie learned that she would get nothing to eat between meal/snack times but it didn’t stop her constantly asking. We also became expert in managing Rosie’s pituitary hormone replacement treatment (recombinant human growth hormone, levothyroxine, hydrocortisone and desmopressin (an anRosie six months before the diagnosis (age ~5y), when she was “funny bright happy”

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Manchester Medical School

been many times in the last 6 years when Rosie has been unwell and we have met doctors who have never come across her condition.

The majority of these doctors were exemplary and used us as a resource.

There is only one incident when the seriousness of her

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travenous hydrocortisone. Questions Rosie produced large vol- Q1. Headache is a common symptom which most umes of very dilute urine of us have had at some time. What characteristics owing to the lack of ADH of a headache suggest raised intracranial pressure? and we also learnt to ad- Q2. Explain whether or not it is normal to develop just the dose of desmo- breasts at 5½ years. pressin.

Q3. What important structures close to the By 2004 Rosie was doing pituitary gland are likely to be affected by a tumour well, coping with fulltime in this region? mainstream school, had Q4. What are the hormones produced by the joined the netball team anterior pituitary and posterior pituitary glands? and done a YMCA sum- Q5. Rosie’s craniopharyngioma has disrupted mer camp. But that sumimportant physiological functions of the mer her fluid balance hypothalamus. What are these important became very erratic, she drank 8 litres of fluid a physiological functions? day and required huge Q6. How does hormone replacement treatment doses of desmopressin.Q8 differ from pharmacological treatment?

An MRI scan showed a Q7. Why is cortisol deficiency life threatening? small amount of tumour What common cause of cortisol deficiency are you regrowth and we than most likely to encounter? played a waiting game. Q8. Explain why Rosie drank excessive volumes of Scans every 3 months fluids. What electrolyte disturbance is likely in a showed that the tumour person with central diabetes insipidus? growth was slow. Howev- Q9. What might you do if you were asked to er, in January 2005 Rosie manage an ill person with cortisol deficiency? again became ill with se- Q10. What can doctors do to assist patients like vere headaches, noseRosie and their families cope with such devastating bleeds every time she sat conditions? up, vomiting and being uncharacteristically sleepy. A CT scan (no MRI available) condition was disregarded. Rosie had Rosie 10 weeks after diagnosis at the local hospital revealed a large fallen down a hill whilst out walking fluid filled cyst; this had rapidly and broken her elbow. An ambulance alogue of antidiuretic hormone grown from the main tumour and was took her to A&E where she was treat(ADH)).Q6 Inability to produce corti- blocking the flow of CSF. Rosie was ed. Although she carries a steroid sol can be life threatening especially at rushed to the children’s hospital emergency card and wears a Medictimes of acute stress, illness or injury where she had endoscopic surgery to alert bracelet which explain the risks and we learnt when to increase her perforate the cyst, and a third ven- of cortisol deficiency, she was not adoral hydrocortisone.Q7 But we still triculostomy and septostomy to pre- mitted. Sending Rosie home so soon frequently ended up in the local hospi- vent future CSF blockages. She had tal when she was ill and required in- Stereotactic Radiosurgery in NovemCSF ber 2005, and has had no re1 year after diagnosis showing Cerebral hamisphere currences since. progressive weight gain associated Corpus callosum There have with hypothalamic damage Third ventricle

Large suprasellar tumour with cystic solid coponents Midbrain Cerebellum Discussion

by Leena Patel Optic chiasm Pons Medulla Sella turcica Figure 1. MRI scan with sagittal midline view of the brain. The location of the large space occupying tumour with cystic and solid components in the suprasellar region is a challenge for neurosurgeons.

The pituitary gland, optic chiasm and optic nerves are antero-inferior and the hypothalamus is lateral to the tumour.

Spinal cord

THE COVER UP TEST Top up your brain anatomy knowledge.

Cover up the labels and see if you can name all the labelled areas.

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mediscope after a major trauma could have been life threatening.Q9 Rosie is now doing well, is in year 8 and in the top set for most of her subjects. She will have to take full pituitary replacement therapy for the rest of her life and have yearly scans.

She still suffers many headaches (migraines) and we are still fighting her constant appetite; with support we hope she can learn to live with this too.Q1 She is beginning to get back some of her old enthusiasm for life, and it would be an understatement to say we are very proud of how she copes everyday with this devastating condition.Q10 This personal account from a recent photograph (age approx. 12y) illustrating the family’s success at controlling the constant hunger mother allows an insight into and Rosie regaining her old enthusiasm for life the “rollercoaster” experiences of a child and her family. It also emphasises that while professionals symptoms occur. Knowledge about might be experts in different fields, anatomical relations and physiological patients and their carers have signifi- function of the important surrounding cant expertise about their own individ- structures helps understand the likely ual medical problems. Many factors problems from a space occupying compound the anxieties brought by ill lesion.2 Rosie’s symptoms reflect the health, including major uncertainties space occupying nature of the tumour about the present and the future, long and its close proximity to the hypothwaits for appointments, consultations alamus and pituitary [Figure 1]. Inand diagnosis, and disruptions to nor- tracranial hypertension and visual mal family life. Awareness about pa- impairment are common at presentatients’ and carers’ anxieties is essential tion. The duration of symptoms can for any professional involved with vary from a few days to few years managing patients. before diagnosis. Management is challenging owing to the location, naraniophayrngioma is a rare ture and size of craniopharyngiomas tumour that can present in and includes total or partial excision, either childhood or adults, oc- with or without radiotherapy. Like curring in about 1 per 1.5 Rosie, the long term consequences can million population.1 The tumour is be substantial. slow growing with both cystic and solid components [Figure 1]. Al- Dr Leena Patel is a Senior Lecturer in though histologically benign, it be- Child Health and as an Honorary haves like malignant tumours by Consultant Paediatric adhering to adjacent structures and a Endocrinologist tendency to local recurrence. Craniopharyngiomas arise from embryonic Patel to Contact Dr remnants of the oral ectoderm, which Feel free d an s question forms the Rathke’s pouch and which with your : ts en gives rise to the definitive anterior comm pituitary gland. During development, l Dr Leena Pate , in Child Health these ectodermal cells migrate from Senior Lecturer Manchester of y sit the roof of the mouth to the sella The Univer Paediatric Department of turcica and abut the structures which y og ol in cr Endo eventually form the posterior pituiter Children's Royal Manches tary (the floor/infundibulum of the Hospital central forebrain/diencephalon). A Manchester UK M27 4HA craniopharyngioma can therefore 2 2585 00 44 161 92 Tel: 2 2583 92 1 arise anywhere along this migration 16 00 44 Fax: r.ac.uk te es anch path. It is frequently more than a few E-mail lp@m centimetres in diameter by the time

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References 1. Karavitaki N, Brufani C, Warner JT, Adams CB, Richards P, Ansorge O, Shine B, Turner HE, Wass JA. Craniopharyngiomas in children and adults: systematic analysis of 121 cases with longterm follow-up. Clin Endocrinol (Oxf) 2005;62:397-409. http://www.blackwell-synergy.com/doi/full/10.1111/j.13652265.2005.02231.x 2. Lee YY, Wong TT, Fang YT, Chang KP, Chen YW, Niu DM. Comparison of hypothalamopituitary axis dysfunction of intrasellar and third ventricular craniopharyngiomas in children.

Brain Dev 2007 Sep 14; [Epub ahead of print] http://dx.doi.org/10.1016/j.braindev.2007.07.011

Answers A1. Headache on waking in the morning, occurring with change in posture (lying down to upright) and associated with vomiting suggests raised intracranial pressure.

A2. Breast development is the first sign of puberty in girls and normally occurs after age 8 years. If it occurs before 8 years, it is defined as precocious puberty and needs investigating.

A3. Important structures close to the pituitary gland likely to be affected by a tumour in this region are the pituitary gland itself, hypothalamus, optic chiasm and optic nerves.

A4. The hormones produced by the anterior pituitary are growth hormone, prolactin, thyroid stimulating hormone, adrenocorticotrophin (ACTH), leutinising hormone and follicle stimulating hormone. ADH and oxytocin are produced by the hypothalamus but stored and released by the posterior pituitary.

A5. The important physiological functions of the hypothalamus are regulation of sleep, thirst, appetite (and body weight), body temperature and behaviour.

A6. Hormone replacement treatment is given to correct physiological deficiency and doses used are comparable to normal endocrine secretion (eg. corticosteroids used to correct cortisol deficiency). Pharmacological treatment comprises supraphysiological doses (eg. corticosteroids used as anti-inflammatory agents).

A7. Cortisol is essential for maintaining metabolic homeostasis and the body’s normal response to any type of acute stress.

The normal physiological response to stress includes increase in secretion of ACTH and cortisol. A person with cortisol deficiency (from primary or secondary adrenal insufficiency) subjected to acute stress can become hypoglycaemic, hypotensive, unconscious and may die if not given adequate corticosteroid replacement. A common cause of cortisol deficiency you are most likely to encounter is pharmacological corticosteroid treatment resulting in hypothalamic-pituitary-adrenal suppression.

A8. ADH deficiency leads to polyuria, which leads to hypernatraemia and hyperosmolarity. The latter stimulates the thirst center in the hypothalamus.

A9. An acutely unwell person with cortisol deficiency is at risk of potentially fatal adrenal crisis and management includes prompt administration of hydrocortisone. If asked to manage a person like Rosie at the time of an acute illness or injury, it does not matter if you are completely unfamiliar with the primary condition (such as craniopharyngioma). It is important to listen to the family, respect their concerns and expertise, take note of any information the patient carries, and seek advice promptly from a senior if not sure about the management.

A10. Consider what it might be like if you were on the receiving end and what you would expect from doctors.

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Medical education demystified

educationscope

Kate Fletcher Portfolio. “Sorry, what?”

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or some time now, I have Now in Phase 2 with my knowledge viewed my portfolio ses- of portfolio on a par with my knowlsions as a chance to zone edge of the Aztec nose flute, I decided out, to relax and to allow to take matters into my own hands. the keen beans in my What I needed to find out - minus all group to regale those the present with countless touchy feely developmental/conceptual/reflective reflections on how they ‘really feel jargon - was: What is a portfolio; why that they have developed as a I need a portfolio; what I need “If you to put in it; and finally why person’ or how ‘taking blood for the first time really assumed having a good portfolio is gochanged their life’. ing to benefit me in the future? that As a third year, I have had After lengthy discussions the pleasure of being the first portfolio with other medical students, year at Manchester to start junior doctors and my Dean I would my portfolio from year 1 and I have finally found eventually believe would love to say that these the answers. I am proud to first two years of portfolio disappear, announce it is not rocket scihave been time well spent, but I hate to ence, despite what the GMC I’m afraid I’m not so sure. have us believe. disappoint might Phase 1 training all seemed to According to our Phase 2 you” blur into a series of indistinhandbooks, a portfolio: guishable episodes under”draws the evidence together pinned by the main themes of into a coherent tale of learning, of pointlessness and misapprehension. sense made, of new ideas developed, In an attempt to rectify my opinion tested and sometimes discarded” of portfolio, I decided to train to be- (Baume2001:8). come a student facilitator. Surely in No wonder we’ve got no idea what’s order to perform this task I would be going on. Basically, the GMC want us able to understand why we needed a to be able to prove what we are doing portfolio? Apparently not, as I during our years at medical school. emerged from two days of intensive Apparently we can do this much bettraining having successfully achieved ter by writing about it and putting it the auspicious title of “Student Facili- in a folder. tator” I was still no clearer about So, what is a portfolio? It is what was going on. written, somewhat subjective, evidence that you, as a medical student, have developed as a learner and as a professional.

We need to have a portfolio because the GMC think it’s a good idea and what they say goes.

Why is having a good portfolio going to benefit you in the future? Because it forms the basis for your F1 job applications. I repeat, IT FORMS THE BASIS OF YOUR F1 JOB APPLICATIONS, and once qualified we are expected to maintain a portfolio for the rest of our medical careers.

So unfortunately there does appear to be method in the madness. If, like

me, you assumed that portfolio was just some daft notion dreamed up by a deluded academic and that it would eventually disappear, then sorry chaps, I hate to disappoint you, but portfolio is not going anywhere.

There is no magic formula, no wrongs or rights, no instant portfolio - it’s just something we have to do.

And the sooner we get used to it, the better.

In the meantime, I am going to try and work out how to fill in an F1 application with my spotty folder from Smiths, yielding a crumpled CV c.2004 and 50 plastic wallets. Wish me luck.

portfolio necessities What needs to go into a portfolio? Anything and everything you can think of that shows your development: An up to date CV is vital Reflective writing about anything. PBL, clinical skills, a particular experience, or a colleague for instance; anything that has made you angry, happy, sad, worried or just made you stop and think.

Firm and PBL group evaluations Other people’s evaluations of you such as Firm lead evaluations Achievements and Certificates. You may be a Student facilitator like me, part of Rugby team, or part of HeartStart for example.

Log of sign up sessions and additional lectures attended

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Issue 1 Dec 2007

Thomas Kelly Is Intercalation worth the bother?

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irstly, one must consider science or into neuropathology? Why exactly what we mean by did they enjoy what they were doing? an intercalated degree. For By considering such questions, stuthe purpose of this article, dents will know upon completion of an intercalated degree is an their intercalation whether they are additional degree for example, B.Sc., interested in a research career. From M.Res, obtained during the medical the deanery’s perspective, the intercacourse in addition to the standard lated degree is a useful tool as past M.B, Ch.B. research experience can be takIntercalated degrees have “Students en into consideration when seplayed a role in undergradulecting students for training have an ate medical education for posts.

Unfortunately, it is many years. According to a opportunity not this simple. – What about to paper written by academics at those who can not do the deEdinburgh Medical School in investigate gree they want because of poor the 1980s, the principal aim of an area that exam performance or lack of such a degree is to introduce funding? Does this mean cerinterests tain students do not intercalate students to the investigative them” work which is an important because they can not? Are component of many careers in intercalated degrees, theremedicine. Is this still the case? fore, unfairly discriminatory when it The GMC states two main reasons to comes to academic medicine? intercalate: There is overwhelming positive sup1. The development of research skills. port in the literature for intercalated 2. In depth study in areas of particu- degrees. Furthermore, intercalated lar interest over an extended period. degrees are considered to be an excelResearch shows that some students lent first step towards academic meditake an intercalated degree in order to cine. gain more exposure to academic mediWithin this article, Dr Caroline cine, whereas others simply see it is a Bearsmore, an academic clinician, exCV building exercise. Hopefully most plains how at Leicester each intercalatwill decide to intercalate because they ing student is attached to an academic have a genuine interest in that topic, mentor, for example a student doing be it pathology, law and ethics, or his- research into vascular surgery would tory of medicine; they are all impor- have a vascular surgeon as a mentor. tant subjects. At a recent conference, This provides an excellent opportunity one medical student from Peninsula to see both academic and clinical medhad intercalated in psychology and icine. Arguably, the best way to diswas the last person to present her cover the truth about a job is through work. She repeated on several occa- shadowing, especially when according sions how scared she had been as her to an article in Medical Education work did not contain “hardcore” sci- medical schools are notoriously bad at ence. However, it was clear to all of us careers advice. 2 For students intercathat (a) her work was of equal impor- lating in subjects like vascular surtance in the world of medical research gery, this is fantastic: not only are and (b) that it was actually interesting they are interested in the subject but to hear something that didn’t involve they experience firsthand how doctors intricate scientific detail. Therefore, balance clinical and academic medithe degree subject does not matter; cine. How about those students being what matters is that students have the supervised by scientists? Does this opportunity to investigate an area that give them a realistic insight into cliniinterests them, this wasemphasised by cal academia? I would argue that it Edinburgh in the 1980s. does not as there is clearly a difference The first question to consider is what between the basic scientist, their rebenefit intercalated degrees hold to search and the work of the academic both medical students and medicine as clinical doctor.

Therefore, when a whole? This is a very broad ques- reaching a decision about whether acation. What is important is what stu- demic medicine is for you, intercalated dents learn from the intercalated degrees are just one piece of the puzzle. degree? Do they enjoy research, Good experience can drive ambition. whether it beis research into social For example, if you asked a geography

student, why they chose their particular subject, some would recount being inspired by their teacher at school.

Medicine is exactly the same - good experiences and role models can help determine what people end up doing for the rest of their lives. This also applies to intercalation. Surely, therefore one could argue that bad experi-

ences and role models could deter people from entering the world of academic medicine? This only re-emphasises the importance of sound career advice and other research opportunities. Therefore, I believe students must have many different exposures to academic medicine, multiple experiences could mean several projects with different supervisors, or attending conferences. The emphasis being on seeing different research, different people and the different facets that makethat makes up the rich tapestry of academic life. Further, role models are paramount; a recent study in Medical Education suggests medical schools might consider appointing academic champions charged with enthusing and enabling students to

Manchester Medical School and help develop you as an individual, ultimately making you a better, well informed and well rounded doctor.

Lastly, it is useful to consider whether intercalation has any added advantages or disadvantages with regards to the recent changes in postgraduate training, namely “Modernising Medical Careers”. In order to do this, it is worthwhile to explain how these first few years after graduation will work.

There are two foundation years, split up into six, four month rotations.

Following this, there will be competitive entry into run through specialist training. The aim of the foundation years are for students to acquire a core set of clinical competencies whilst gaining exposure to a range of specialities. So they can choose, with confidence, the area in which they would like to specialise. During foundation year 2 (FY2) for example, it is possible to spend 4 months in academic medicine.

Furthermore, in 2004 the Walport Report suggested that there should be two academic posts during the foundation years. One that runs throughout FY2 and one that consists of a four month rotation. There is a very clear distinction to be made between these two posts. The first having a key strategic objective to develop an academic workforce with core clinical competencies and the latter being one of exposure i.e. to differentiate between those that have decided on a career in academic medicine and those that want exposure to it, but have yet to make a decision about their future career. The West Midlands Deanery, for example, has established a programme where academic training runs shown to be more likely to raise re- throughout the two foundation years. search grants and have better publica- These academic posts are in short suption records than those without., ply and competition is severe; likewise Having a mentor can be of great bene- competition onto specialist academic fit, particularly if they are an training programmes is high. academic clinician them- “There is Does this mean intercalated deselves. It must not be forgotgrees play a major role in deabsolutely termining ten that intercalated degrees successful also give the opportunity to no doubt recruitment onto such academthat develop many other essential ic programmes? In addition, skills including building in- intercalated will junior doctors that have terprofessional relationships, only completed a four month degrees an increase in relevant clinirotation be at a disadvantage cal knowledge and an insight have many compared to those that have into how the evidence base benefits” been involved with academic behind medicine is developed. medicine throughout their In addition intercalated degrees can foundation years? Possibly, and so provide a welcome break from medi- this illustrates the great importance of cine – however, do not be fooled into exposure to clinical academia during thinking intercalation is an “easy” medical school so that thoughts, opinoption. It can also broaden horizons

ions and indeed decisions can be made prior to foundation.

In conclusion I believe, experience in academic medicine is as important as exposure to accident and emergency during clinical attachments. However, simply having an intercalated degree does not guarantee a student this exposure. If students show interest and a passion for research then they will have found a chance to conduct research; this may be through an intercalated degree or it may be in addition to their standard studies. The many different types of intercalated degree mean that conclusions must be treated with caution. An intercalated degree provides an excellent opportunity but should be used as a starting point so one can reachcan reach decisions about academic medicine.

It is clear that increased knowledge and the development of crucial transferable skills as well as exposure to academic medicine are of undeniable benefit to the medical student. Therefore, I would strongly recommend doing an intercalated degree, whether that be because of an interest in academic medicine or to develop as an individual. However, if circumstances mean you cannot, then I would suggest doing all you can, if you are interested, in gaining exposure to academic medicine prior to foundation years.

education education

consider not just an intercalated degree but a future career as a clinical academic.

Despite potential problems, there is absolutely no doubt that intercalated degrees do have many benefits. Most obvious of all is their educational value. Articles in Medical Education and the BMJ have illustrated that medically qualified professors and readers are more likely to have an intercalated degree than not. In addition, those with intercalated degrees have been

mediscope

Thomas Kelley is a 3rd Year Medical Student with a B.Sc. (Hons.)

Pathology Intercalated degrees on offer at Manchester Anatomical Sciences Biochemistry Biomedical Sciences Cell Biology Developmental Biolog y Health Care Ethics & Law Masters in History of Medicine Masters in Public He alth Masters in Research Masters in Research – Tissue Engineering for Reg enerative Medicine Masters in Research – Translational Medicine Medical Biochemistry MSc Interdisciplinary Medicine and Engineering Neuroscience Pathology Pharmacology Pharmacology & Physi ology Physiology Psychology Further details contac t: intercalation@manches ter.ac.uk

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mediscope

Nick Kalson The future of academic medicine The University’s and Wythenshawe Hospital’s Plastic Surgery Departments are lucky to be led by the UK’s first Professor of Plastic Surgery.

Mediscope talks to Professor Gus McGrouther about the future of academic medicine.

NK: So you are a Professor of Surgery. What does this mean?

Prof: My role is two days at the hospital (Wythenshawe) and three days at the university running a research group – my ideal job.

You do both clinical work and research. Isn’t that difficult?

I actually find it easy to switch between one and the other – I see the problems in patients and then go to the lab and develop the questions I need to ask, and then take the answers back to clinical practice. Sometimes it is just a case of translating the knowledge without necessarily having to produce a new drug – if for example you look at scars and find they are stretching, you can go back to the lab and work out how mechanical forces influence scar tissue. Once you realise that if you pull on the cells they produce different proteins you can then go back to the patients and close the scars in a different way to encourage just a single line of force transmission through the wound. You can do this by supporting the wound with tape and immobilising the wound in plaster. Just by accessing the knowledge, you apply this to your clinical practice and get a better outcome - this practise has been adopted in our department (at South Manchester).

How did you get into academia?

As a student I was keen to move ahead into clinical practice.

I didn’t do an intercalated degree, I started doing surgery as soon as I graduated, and within two or three years I found results were less than perfect. I then did a masters degree in engineering as I was interested in the mechanics of tissue repair. I wrote papers all the time that I was a trainee doc, I wrote 2 or 3 (papers) per year during training - I started with haematology – you don’t need to start in the area you will end up in, what you need to learn is how to do research.

Then I did some papers on orthopaedics and then some on engineering. All the time I was trying to analyse results. I was a consultant at thirty two – most are still doing training at that age. After seven years as a consultant looking at results that were the best we could do but were still imperfect I realised I had to get involved with basic science research. I was offered academic posts in the States but stayed in London and set up my own basic science lab. I was an amateur researcher, my entry in to basic science came later as I realised how important it was. I had always read widely in those areas but I didn’t get involved in ‘wet’ lab work until I was a consultant and I was doing it alongside my clinical practice. However, people have to adapt to the era in which they live; what happened a generation ago is as relevant as the dinosaurs - what students have to know is how it will be in the future. One thing is for sure; training reforms happening now will not have any permanence. It will keep changing – do not get too focussed or anxious.

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How is your role different now compared with when you started, and how do you see the future?

The role of professor of surgery or of medicine has changed in the last 10 years. It used to be that the Prof should be a good clinician first and get difficult cases referred, as well as being involved in teaching and running research programs.

In the world we live in with everything becoming more professional and more complicated you can’t do all three roles. The academic of the future will be good clinically and take on research or teaching, although probably not both.

Research is becoming more professional; it used to be that you could simply report what you are doing to your patients, but with statistical tests and the need to show evidence based medicine this is no longer possible. With clinical research you need to do randomised controlled trials, this takes time and means that even within research you are going to have to go either into lab based research or clinical research, and not both. This will depend on the area of medicine you are working in, for example in respiratory medicine you will focus on patient based studies looking at drugs for asthma, for example. On the other hand looking at wound healing there is so little basic knowledge that my group is looking basically at healing of different tissues working mainly in the lab And the future of surgery?

We will see surgical specialities changing a lot in the next few years. Currently if you get a compound fracture of your femur you will have several different surgeons – one for the bone, and one or even two for the soft tissues; the skin and the nerve. We will see surgery reorganised, as has happened in hand surgery where we train specialists to deal with the bones, ligaments tendons as well as the soft bitsthe skin and the nerves. I think we will see surgery move more towards anatomic regions, and there will be a realignment of the academic component.

What is your group working on?

As a recon surgeon I need to know a lot about the repair process and how it affects different tissues – skin, tendon, and nerve.

Yesterday you were on Casenotes on radio 4 discussing wound healing. You state that the inflammatory process is unwanted and can be damaging. Is this a new concept?

When I was being taught we learnt that inflammation is a good thing. Indeed some inflammation is a good thing - it prevents minor infections and probably helps superficial wound healing. However if you look at evolution there is no evolutionary protection against a big wound - if you get a big wound something will come and eat you – we are evolved to heal very minimal wounds and quickly. We have a very strong inflammatory response to wounds; if you burn yourself you get a big reaction with recruitment of lots of cells and mobilisation of inflammatory mediators to try and heal. Most of this inflammation is unwanted in big wounds. It has been shown in meningococcal septicaemia that survival can be increased by removal of white cells and by reducing the immune response. The other interesting area in wound healing in burns is stem cells. We used to think that tissues just healed themselves but now we know

mediscope

Manchester Medical School

Is research essential to moving on your clinical career?

If you look at a group of doctors we are amateurs at management, medical legal practice and research and teaching.

We teach the way we were taught. In the future doctors will need a range of skills – currently we are too narrowly trained. Amongst a group of doctors in the future you would want someone with a professional approach to teaching, and to research, and to management. At the moment people have focussed on research side too much as it has been a hurdle to get over to advance careers, but we need to give the same value to other qualifications. If you are going to be represented nationally, let’s say by the President of a Royal College, that person must deal with politicians and economists. One of the reasons we have done so badly in the political sense is that we are doctors, most of whom have done research in the past, but we have no other skills.

Therefore in projecting our image to the public the government run rings round us, painting us as bad and greedy.

Nationally we need to acquire more organisational skills; most doctors can’t organise themselves out of a paper bag – they have no idea about costs, about markets conditions.

What I would love to see in the future is for people to be doing an expansion year, when people go and do a whole range of degrees, as intercalated degrees and / or as postgraduates – such as a medical legal degree so they can become experts in law, or experts in management, economics and business. There are so many other facets to life out there that we (the medical profession) do not understand.

This is a personal wish and it also means that those who are appointing doctors to training programs will need to respect those ideas and value these skills. Some of the most successful docs are those that have acquired a different skill outside medicine, for example Mark Porter, who presents Casenotes, has a completely different level of communication skills than the average doctor; we also need journalistic skills, and skills outside of medicine should be encouraged and valued. The advice I would give young people would be to develop your skills outside of your medical career, instead of just trying to find space in a ‘wet’ lab, unless that is your prime motivation. If you want to do lab work then do it. If you want to be a communicator, a manager, an economist or a politician then develop those skills too.

Having said that research doesn’t have to be for everyone, for those interested in research, what can they do to get involved?

The key thing if you want to be an academic doctor is to 1) get experience and 2) be recognised by the patients, and by your colleagues and nurses, as a good doctor. You must

learn your clinical skills and along side that if you are interested in academic work you need to get formal training on how to do research. This may be either in the lab environment – animal licenses, health and safety, learning the latest lab techniques, or alternatively in the clinical trials area you need to learn how to set up trials. This demands a huge amount of permission and clearance, and statistical evidence. For a student wanting to be an a academic you need to have a rough idea of what pathway you want to go down, and even as an undergraduate you can begin to get some of theses skills. The Tooke report (1) has suggested that you should do a one year masters qualification in the first three years of foundation training. People can either get into academia through an intercalated degree or as a postgraduate with an MRes or a PhD. Only a limited number of medical graduates should be doing this (going into academia). Many will simply want to be clinicians, and that’s good as they will be looking after me. Others may want to do some research in collaboration with basic scientists or pharmaceutical companies and a one year deg is suitable, but if you want to run a research lab only a PhD will allow you to raise the grant money. Ten percent of graduates should be looking at a PhD, but I believe the majority of graduates should have a one year exposure to research either as an intercalated year or a PG degree.

education

that it is more complicated - there are cells in tissues capable of contributing to the healing process but many of these cells come from the bone marrow - and the relative importance of these different cells is being investigated. As human beings we are inefficient at healing. If you look at a salamander it has the ability to generate new limbs de novo rather than repair with scar tissue, and we have the genetic ability to do this as we have done it once before in utero. We need to look at the way to go back to the regenerative mechanism – this area – regenerative medicine - is an area that has become very interesting because people are tying to find genetic strategies that go back to these mechanisms which are turned off, as well as turning off the immune inflammatory response. That will ultimately be achievable but it may take many years.

What is your favourite piece of research?

I have tried to promote a very broad filed of research because I have for many years been the only Prof of Plastic Surgery in the UK. I have tried to promote an interest in repair in all tissues. Personally I have been interested in tendon, which most people think is boring because you can’t eat it! Tendon is an organised structure and there is

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Issue 1 Dec 2007

an interaction between mechanics and the genetic and chemical influences on the repair process. It suited my interest in engineering and woundz healing. We have shown that if you put a stitch in a tendon the cells migrate away from the stitch – this happens in nearly every tissue, and whilst we are not sure of the consequences, putting a stitch in a wound may be a very bad way of closing it. We are now putting stitches under the surface so the damage is confined to the deeper layers – we changed our wound healing practices as a result of the research.

What are the big difficulties you encounter as an academic?

Two things. First the need to raise money for research.

There is a limited amount of money so people have to compete and this takes time. Secondly bureaucracy. Some is essential but some is needless; applying for an animal license takes months because there is political pressure on the number of licenses available, but it should be possible to get a decision in weeks. In Britain bureaucracy has risen to an unacceptable level; in the time it takes me to get through the bureaucracy my colleagues in China have got permission, done the work and published it. That is a worry. Much of the learning involved with research is how to get around this interlocking maze. We have gone from hospitals not having ethics committees to it taking forever to get the simplest thing approved. Ultimately ethics is in the soul of the doc. Regardless of whether a committee has approved research or not, the way it is conducted will only be ethical if the doc has high ethical standards, it does not

mean the research will be conducted in the most sensitive manner. Ultimately ethics are within the doctors own standards, and these are a consequence of his training. If you have been exposed throughout your training to doctors practising the highest ethical standards then you will too – ethics through apprenticeship is what medical training is about. The way medicine is going we are following British Layland cars 30 years ago just before it crashed, where everything was checked (during production). The result was fields full of imperfect cars because everyone relied on the checking company to sort it out. And then along came Nissan, they opened a factory and removed the checking process - it was left to the conscience of the workers on the production line - and they produced the most efficient cars in the world. We have gone from Nissan to British Layland.

We need to go back to the situation where the most important thing to teach a medical student is to listen to their own conscience.

And with that Prof retires to his two foot high hand shaped chair in the corner of his office…. if you come across him in the University, or in the operating theatre in Wythenshawe, feel free to ask him about it.

Further reading: Tooke report http://www.mmcinquiry.org.uk/draft.htm

mediscope Do you want to contribute to Manchester Medical School’s Magazine?

Using your vast knowledge of radiology, Mediscope challenges you to spot diagnose this patient

We want the best writers, photographers, cartoonists, interviewers and other talented, media-savvy individuals to get in touch so we can show just what Manchester Medical school is capable of!

Send your articles, comments and ideas to the team: subeditor.mediscope@manchester.ac.uk

Answer: a chest x-ray showing extensive bilateral apical fibrosis from chronic TB

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mediscope

Manchester Medical School

M6 Manchester >

I

Many new beginnings are marked by a right of passage. For St. Andrews students, this literal passage takes the form of the M6.

ROADTRIP

t's not as smooth a ride as

memories of the frequent mention of one lecturer's wife's cats, and a

some might hope. St. Andrews

plague of irradiated mice and holiday snaps from Mongolia makes any

to Manchester is to change

St Andrews student feel nostalgic. We have sauntered the same three

gears from preclinical learning

streets and strolled the same two beaches in this Auld Grey Town,

to clinical lessons; to move from one east coast, wind beaten town to a culturally mixed, energetic, ` English city. 300 miles ago we were

indulged in small town convenience (and gossip). Rubbed

Your Future Career

big fish in an overindulged puddle, now we feel more like scrawny spawn in a vast pond. Our pond preparation came in the form of three or four lectures a day, sat side by side in the same two lecture halls for three full years,

Added to these were Friday

afternoons spent pouring over cadavers in the dissection room. The first two of these years were also plagued with monthly pink-blob-slide-tests when wild histological guesses were made.

shoulders with golfers, pilots and occasional celebrities.

Having attended a multitude of balls, embraced quirky traditions, and ultimately graduated together.

With our mass exodus after three full years, we have left behind fond memories and non medic friends who get to enjoy it all for yet another academic year.

We have always been aware that St. Andrews was just the beginnings of something much larger. . Clinical days were never far from our thoughts, nor the anticipation of the fun to be had in a large city where there are actually clubs, something denied to us by the founding fathers' stern rule.(daily in St. Andrews a student can be heard cursing the small town for its troika of streets, dearth of clubs and parochial ambience). So we have arrived at the other side of our pre-clinical journey, wide eyed and beaver keen, but perhaps a little unprepared for some unanticipated home sickness and some necessary adjustment.

Afternoons had earnest students terrorised in the physiology lab by such things as the Nernst equation and a nystagmus simulating spinning chair.

We were told that there is something to be learnt from a frog's gastocnaemius and teams of staff would lead us forth to command the twelve cranial nerves. .

The relationships formed between

An understanding and receptive PBL group can make all the difference in the transition period.

However, invariably, returning to Manchester after a two week respite Christmas break, St. Andrews students patter down their base hospital corridors with lighter tread and greatly reduced trepidation. Behind you are the fond memories which can hold you back and draw you north in search of old comforts, but new enthusiasm for medicine takes shape, and new friends are made.

students and teachers is considerable,

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Issue 1 Dec 2007

commentscope Kaivan Khavandi The age of modernisation has finally cast its ugly face on the beautiful and traditional career that was medicine. We live in a world where technology moves faster than people, where there is a constant drive to improve, update and change. Whilst I was happy to see the arrival of digital stethoscopes, the new CT angiograms and the latest in keyhole surgery, the recent medical education proposals seem to be somewhat of a downgrade rather than an improvement.

Within a year of the introduction of the foundation programme there has already been a change in the application process, which effectively admits to an entire year of medical graduates that the assessment criteria which determined their two year job contract was completely flawed. Of greater importance, however, are the long term implications of the proposed changes. The new basic specialist training schemes place a greater emphasis on early sub-specialisation. Like factory workers on a production line, we are being designed to deal exclusively with the job at hand and nothing else. The romantic image of the village physician, armed only with his stethoscope, tendon hammer and long list of clinical signs,

Sorry but that’s not my speciality

“

“doctors need room and freedom to grow, develop naturally and specialise, rather than being suffocated by forced decisions”

which inspired me into a career in medicine, is fast being replaced with associate specialists in ‘echocardiography of proximal mitral valve vegetations in infective endocarditis of Staph. aureus origin’. Those subtle differences which make our favourite consultants so inspiring and unique are in danger of being standardised to fit the handbook. I worry that such consultants are an endangered species and the ‘new mark’ consultants shall forever be muttering the words ‘I’m sorry but that’s not my specialty!’

Indeed if we look further back in history, doctors were not only all round medics but all round scholars. You may recall Boris Pasternak’s fictional character, the medic and poet, Doctor Zhivago, or Sir Arthur Conan Doyle and John Keats to name but two real life examples. In addition, almost all of the historically significant scientists seemed to do a bit of philosophising in their spare time; for example, Aristotle. Would they have achieved equal brilliance in a system in which one is imprisoned by rules and regulations? Surely doctors need room and freedom to grow, develop naturally and specialise, rather than being suffocated by forced decisions.

I suspect that the increasing impact of government assessments for doctors and their skewed opinions on ‘performance’ have played a part in such changes. Taking surgery as an example, where assessment is based on procedure times and mortality rates, with no consideration to the complexity of the operations. A shift to government led education is forcing doctors to fit rigid protocols and guidelines. Perhaps I am being pessimistic. Certainly I am in favour of evidence based medicine and up to date guidelines. However, in medicine you treat individuals and not randomised controlled trials or questionnaires. The beauty of medicine lies in its variance and diversity. Patients do not sub-specialise or choose their conditions and so doctors must not. This is more true than ever before. Considering the ageing population, for example, it is important to consider co-morbid factors when deciding on management plans. The gauging of such decisions can only be achieved through substantial experience in a broad range of specialties. There seems to be a discrepancy between government aims and the reality of health issues in the 21st century.

My worry is that like dated or faulty technology, we will eventually be thrown away and replaced.

Whilst manufacturers of electronic goods have the luxury of trial and error in playing with new ideas, we get one chance to be trained; one chance to be the doctors we aspire to be and unfortunately can not be returned by guarantee when things go wrong.

“

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mediscope

Manchester Medical School

T

he ups and downs of pharmacological trials are a frequent media focus for debate. Students often willingly take part in the hope of cutting their debt, but while signing a consent form to confirm your voluntary participation seems self-evident to us, it may not be a privilege guaranteed to all those involved.

Drug trials are an international phenomenon often carried out in developing countries, where ethical guidelines are different to those in developed countries. India is an PharmAware example of a develPharmaWhat? oping country hosting presence to Ever questioned why those many of the drug reps are so happy to world’s largest provide you, a budding pharmaceutical medical student, with not only a year's supply of pens companies. By for PBL but also a tasty M&S 2010, some estiOakham, Chicken and mate there will be Pancetta Caeser sandwich?! two million patients in India on Accepting that sandwich clinical trials. and pen may not seem like much now, but evidence While an entire shows that doctors' industry has prescribing is influenced by sprung up specializsuch promotions... ing in recruiting patients and manPharmAware is a national student organization aiming aging experiments, to create professional and concerns have ethically aware doctors. Our arisen about how vision is a world in which the country peoples’ right to health is achieves its excepnot jeopardised by pharmaceutical companies’. tional recruitment rates whilst ensurPharmAware is a Medsin project, presently active in ing that consent is over ten universities in the fully-informed.

UK. Lessons learned from history and reflected by the Nuremberg trials in Germany after the Second World War have demonstrated how important it is that people’s autonomy and right to decision-making is respected.

Nobody should have to take part in research against their will. In developing countries it is true that consent

AIMS

1. To train medical students to professionally and ethically interact with drug companies

Questionable Ethics?

Lucie Collinson

comment

The continued development of new pharmaceuticals is an important cornerstone of the modern and global medical environment, but at what cost to people in developing countries? Lucie Collinson explores the ethical dilemmas we all face.

forms are given to participants but it is existing medication with the potenthe manner in which this is done that tial they could suffer unnecessarily. must be questioned. In India, for examOver the past ten years large comple, it is the impoverished and illiterate panies, such as Pfizer and Glaxowho become the patients involved in the SmithKline, have been the focus of testing of new drugs for the West. It is heated ethical debates; Pfizer for argued that some of these patients are testing a meningitis drug in Nigeria unaware that they are even taking part without proper consent during a in clinical trials. major epidemic, and GlaxoSmithKSix years ago, a cancer drug called line for testing a Hepatitis E drug on M4N, developed by an independent thousands of Nepalese soldiers – researcher in the USA, was tested on many of whom were illiterate – after animals. The research was insufficient rumours of bribing civilians to take for the treatment to gain ethics approval the drugs led to protests. in the US. The researcher subsequently approached an Indian hospital based in hen outsourcing clinical Kerala to carry out a trial on human trials, will the drug ever subjects, to which the hospital agreed. benefit the population The patients in this case believed they on which it is tested, or were receiving local anaesthetic injecwill it be patented and marketed at an tions, not an experimental treatment for unaffordable price for that country? cancer. The mortality of the patients The public has become aware of was incredibly high with only one surthese ethical issues through national viving, albeit bed-ridden and seriously newspapers and through films, such ill. Clearly there is an issue here regard- as the The Constant Gardener. More ing patient consent and whether or not recently, public awareness has been it was fully informed. further increased with the BBC docu"I was just told that the drugs were mentary The Dark Side of Drug American. They used to give me the Trials. Exposing these ethical quagtablets and I used to eat them. I was told mires in the media is vital in order to the old drugs were discontinued and stimulate open debate. Moreover, were no longer available in the pharma- educating patients about their rights, cies." says Parshottam Parmar, a patient and doctors about their responsibilion a drug trial for an anti-psychotic ties, is extremely important if new being conducted for the world's second medicines are to be developed in an largest drug pharmaceutical company environment safe and respectful for Johnson and Johnson. "We just sign all involved. because I believe the doctor takes the signature to help us. That's why I sign www.pharmaware.co.uk it."

Dr Shashank Joshi from The Manc he Mumbai Hospital believes their firs ster branch will b t e holding meeting that the idea of all patients Monday December of the year on in India giving informed 10th, 7p Friendship m in the consent is “a myth”. He looking fo Inn, Fallowfield.

W r elaborates, “I do not think plenty of new members and e are o the p portunitie it’s truly informed in the please co s to get in re are m e volved so along! In language the patient undercheck out the mean w w time w.pharm stands.”

Facebook aware.co "PharmA .u k or To take part in these cliniware." If questions you have , please cal trials patients are someem mancheste rpharma ail us at times told to stop their ware@goo glemail.co m.

2. To empower our members to educate others, including fellow students and physicians about evidencebased medicine and prescription practices

W

3. To campaign for a change in the relationship between doctors and the pharmaceutical industry through transparency, accountability and legislation.

4. To campaign for a change in the behaviour of the global pharmaceutical industry through raising awareness of developing world issues.

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Issue 1 Dec 2007

societyscope Surgical Society Resurrected

by Will Asher

After several years of inactivity, the University of Manchester Surgical Society was re-launched in early 2007 by a group of students headed by 4th year Jack Brownrigg.

Since its launch in March the Look out for Surgical Society, or Scalpel, has forthcoming events and put on a series of successful announcements on the Scalpel website at events encompassing surgical skills workshops and talks on www.manchester.ac.uk choice among medical /scalpel surgical careers and specialties. students.

The committee is eager to proOur speakers often commote active participation of the entire ment on how pleased they are to undergraduate population from presee the events so well attended. The med through to final year and encourScalpel committee urge all students to ages comments, questions and feedget involved and come to as many of back. the events as you can, to explore Allocation of the undergraduate whether or not surgery might be the timetable to surgical teaching has been career path for you. downgraded by many medical schools Recent highlights have included in the UK, with more emphasis on ‘Nose Picking for Life’, a light hearted other areas such as community medilook at a career in ENT surgery from cine. As a consequence it is much hardthe entertaining Mr Camilleri, as well er for interested students to get as Mr Baguneid's vascular surgery sufficient experience of surgery. event, which incorporated emergency In response to this worrying change aortic aneurysm repair condensed into in priority, The Royal College of Sur30 second video clips! geons called for all medical schools to Scalpel have also put on a succession develop a surgical society. As they put of intensive suturing and wound manit ‘surgical societies are one of the best agement workshops, run by specialist ways you can demonstrate your internurse practitioner Mrs Hilary est in a career in surgery while you are Elsworth at The Christie Hospital, still a medical student.’ Scalpel will which will continue for this academic make information regarding surgical year. careers much more accessible to undergraduates.

The society also has established links with the Royal College through the Medical Students Liaison Committee

by Will Asher (MSLC). This committee was established in 2000 in response to a growing Everyone knows that to be a proper demand to improve links between doctor you have to play golf. A sentimedical schools and the Royal College. ment echoed in an explanatory email The MSLC's primary objective is to last December by 4th year Wythenpromote surgery as a career shawe student Huw Jones.

Upon finding the University Golf or ts en Society fairly impenetrable, Huw deev Are there any on e se to cided to establish the level of interest e lik issues you’d for a potential Manchester Medics da? Don’t en ag the Golf Society. involved by hesitate to get Before you could say “but isn’t golf g e-mailin r.ac.uk te just a popular genre of pub crawl?” es ch an m l@ scalpe ember of Huw and friend/golfing nemesis Mark m y an t ac nt or co Dunn had enough interest to set up the committee.

Golf Society Swings Into Action

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Find out about medic societies and charities both new and old on these pages

two beginners’ classes and a separate group for more experienced players who were ready to traverse the fairways and swing into action.

The society comprises these two divisions so that beginners can learn the basics before graduating to the playing side of the society. A well thought out scheme which is inclusive of all abilities. Beginners’ classes take place on Sunday mornings at the Mottram Hall course in Prestbury, south Manchester. For the refreshingly affordable sum of £7, ten budding golfers get the divided attention and wise words of pro Tim Maxwell for an hour or so. I went along to a recent session to remind myself of exactly how rubbish I am at golf.

I played golf once before several years ago with some school friends but it didn’t exactly go well. After spending several hours ruining a good walk, occasionally making passing acquaintance with the greens, I somehow managed to tear a muscle in my back. With that, my illustrious golfing career was over. Quit whilst you’re ahead as the saying goes. I believe it’s also worth quitting when hobbling up the course in agony, barely able to stand up, wailing like a girl.

In the intervening years the thought of picking up a golf club would cause my heart to sink into my stomach and attempt to drown itself in a pool of gastric acid. However I have recently come round to the idea of giving it another go. Not least due to the frequency of comments from golf playing friends such as “you’re going to be a doctor and you don’t play golf? How are you going to get a decent job?”

The image of golf as stuffy, intimidating and expensive is dispelled by the informal nature of the lessons and £7 fee (£5 if you drive and give a few others a lift). An enterprising piece of negotiation by the society It really is good value when you consider hiring a driver and 100 balls at a driving range will cost near a tenner, and that’s without the expert teaching. If you’ve ever contemplated learning this is surely the cheapest and possibly best opportunity you’ll get.

Pro Tim Maxwell is enthusiastic, friendly and most of all patient. He certainly isn’t short of advice either.

Trying to remember each piece of in-

mediscope

Manchester Medical School

The MSRC is an annually elected student committee comprising a President, Vice President, Secretary, Finance Officer, two Social Secretaries and a Sports Officer. It has a two key roles: 1. Academic representation – Representing students at Manchester Medical School at both internal and external events. For example, the President and Vice President sit on the Undergraduate Medical Education Committee (UMEC), which is the group that oversees the running of the Medical School. In addition all members also sit on the Student Staff Liaison Committee, where student issues are raised to senior members of Medical School staff. The MSRC will also attend Medlink at Nottingham University, representing students from Manchester.

Representation is a very large and important aspect of the work that the MSRC carries out. Therefore, should you, as student, have any concerns or problems or general points that you wish to raise related to Medicine at Manchester then please get in touch with a member of the committee.

2. Social events – The MSRC is one of the principal organisers of social events throughout the year, ranging from the infamous pub crawls to many parties. The highlight of the year is always the Ball at one of Manchester’s top class Hotels.

We will be working really hard this year to try and make sure you have a great social calendar and to ensure that we represent your views as best we can to the Medical School.

Please visit www.medicine.manchester.ac.uk/msrc to find our contact details.

formation required to make up a basic swing is much harder than it sounds. I felt like Homer Simpson in the episode where he’s struggling to remember several things at once. Inside his head information is stored in precariously stacked boxes, as one more piece of information is placed on top of the tall pile they all crash to the ground and Homer is reduced to a vegetable-like drooling mess. I explain to Tim that it’s a lot to take in and he tells me to forget everything he’s said and swing naturally. It works and the ball flies (reasonably) straight and (reasonably) far. One of many encouraging moments.

In spite of the freezing, drizzling day I certainly enjoyed my first lesson. My overwhelming impression - apart from how much fun golf buggies are - was that golf involves a lot of discipline and practice. An opinion echoed by Society President Huw Jones, “Of all the sports I’ve played it’s definitely the hardest”.

That’s easy for you to say Huw, your handicap is nine.

For more experienced golfers most Sundays a weekly round is organised

by Nick Beattie, each player throws in

d in golf Get involve g by emailin hotmail. docjones@ ntact com or co on Huw Jones 2 0787751628

£3 and the winner buys a round of drinks at the 19th hole (the bar). Also on the agenda for this ‘elite’ group is elephant golf. Believe me, you don’t want to know (or maybe you do, try searching the internet).

The discounted membership available to the Medics Golf Society at Heaton Moor Golf Club is the result of another fine piece of haggling, at just £90 for the year. This allows you to play as much as you like and at whatever time of day, unlike many other student memberships which are limited to daytime tee offs.

I put it to Huw that a lot of the best players seem to have come from St Andrews. We discuss if this is because there is nothing else to do there, apart from play golf and learn an unbelievable amount of anatomy in order to embarrass their traditionally under prepared Manchester based counterparts. Huw diplomatically points out that it’s probably because there are several world class golf courses near St Andrews and a lot of golf enthusiasts choose St Andrews for that reason.

Tentative plans exist for ‘friendly’ competitions between the base hospitals and a possibly less friendly St Andrews vs Manchester match.

There already exists a yearly students vs consultants golf competition based at Wythenshawe every June.

The consultants are good enough to pay for the green fees, but not for the meal afterwards, which is provided by those good old drug companies. Huw was surprised at “how seriously the consultants take it”, and is looking forward to some good old fashioned revenge this year. “Now we’ve got the society started we can show off our professionalism with the club ties and everything, we’ll hopefully win the title back”.

If the ties don’t do it then the team shirts should do. In preparation for future plans to play matches against

Medsin National Conference

by Tolani Lewis, Medsin President

other university or medical school teams, a team kit was required. Choosing purposefully to oppose the pretentious and elitist image of golf societies, Huw has chosen a ‘Hawaiian’ shirt design. If there’s one thing you can be sure of with the Medics Golf Society, it’s that they’re not taking themselves too seriously.

On 26th November, 25 students from Manchester travelled up to Dundee for the Medsin National Conference.

They joined another 300 medical students from around the country to learn and talk about the issues surrounding an ever increasing global population, and its undeniable impact on health in today's world. It was a weekend of fun and laughter with an evening of fantastic food and a Ceildh.

Each day began with plenary sessions where expert speakers discussed a range of topics including Migration and Urbanisation, Food and Environment, and Development and Population.

Students could also attend workshops which allowed them the opportunity to explore some of the issues in more depth.

It provided a chance for Medsin and its members to act on some topical issues. For example, the need for individuals and communities to take action to fight climate change and minimise its impact on developing countries was highlighted. A giant banner was made using footprints, it read 'Don’t let our carbon footprint trample on health', a photo of this will be sent with a list of demands to government, world leaders, individuals and healthcare professionals.

Action was also taken to oppose the proposed restrictions on access to primary healthcare for vulnerable migrants. There was widespread concern among Medsin members about the ongoing government review of access to NHS services (which is due to report in December.) It is expected to propose removing access to primary care services from undocumented migrants, victims of trafficking and failed asylum seekers. A statement was signed opposing these changes and demanding universal access to primary healthcare that is free at point of access in line with the NHS founding principles.

The National Conference is held once a year during the autumn term. Its primary focus is to deal with current national concerns within the world of medicine, however in an increasingly globalised world, this can often be hard to do. There is also a Global Health Conference in the spring where medical students interested in global health can learn about various topics and take action on those of magnitude.

society

The Medical Student Representative Council (MSRC)

For those in terested in joining Medsi n, contact the co please m manchester@ mittee at medsin.org

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mediscope Claire Nissenbaum

Issue 1 Dec 2007

2006 Pantomime Review

Once upon a time, in a magical land called Manchester, an ambitious girl called Amelia embarked upon a challenging quest. She felt it her destiny to put herself through the anxiety of directing a Medics’ Pantomime. It was in ye olde inn of Solomon Grundy that she began that very quest.

After painstakingly toiling all summer with scriptwriter Karim she met with her trusty aide Tom to plan the great auditions for all the theatrically (or alcohol) inspired people in Castle Stopford and hospitals beyond. When the day arrived, Amelia was quite surprised by the sheer number of fresh faced freshers and tired panto old-timers who had travelled far and wide to show her just what they had to offer.

In a dark but welcoming inn named “Kro Bar”, Amelia brought together a fine fellowship of talents. This ambitious young lady, her able-bodied sidekick Tom, the incredibly talented scriptwriter Karim, dancer extraordinaire Jess and production queen Claire, with drinks in hand, made the casting decisions that would change lives forever!

The next few months were not wasted with rehearsals happening in Castle Stopford every Tuesday evening and Sunday afternoon. Amelia and her

resourceful team were quite aware they still had no final venue to perform at but they did not despair.

Everything carried on wholeheartedly regardless, until, like a Jimmy Choo, did a ray of hope shine down on the common room as the Dancehouse agreed to hold their spectacular production.

As the performance drew closer and with the assistance of the infamous Didsbury Dozen, all the citizens became like a family wearing their beautifully crafted and hard fought for t-shirts with pride. In the final week everyone worked their sparkly socks off, learning lines, perfecting costumes, selling tickets, stocking up on alcohol and rehearsing all hours possible until the first night loomed.

On this dark Tuesday night, everyone arrived, full of excitement and enthusiasm for what promised to be a great evening.. Microphone checks, drinking games, the usual spirit lifting pep talks and, of course, the Panto Song, left the family ready for treading the boards, not quite sure what to expect as the curtains opened in new surroundings. Would vegetables be hurled towards us? Would we have any unexpected naked guests? Just how drunk and rowdy would the au-

dience (and cast) be this year? It just so happned that the first night proved to be better than could ever have been anticipated. The adlibbing, flashing, and ‘slightly’ tipsy cast were quite an entertaining contrast to a relatively quiet but appreciative audience. To put all the new found adrenaline to good use Amelia lead her cast into the next morning with a visit to the Footage for some beverages and karaoke!

The final day of Panto 2006 dawned and the citizens of Stopford slept (apart form those who awoke to go to hospital or work!) to revitalise ready for the extraordinary night to follow.

As seven o’clock approached, as more alcohol flowed, and as flowers and champagne were hidden in the showers, the transformations from mere medical students to kings, queens, princes, courtiers, animals and evil beings began for the last time. The performance was amazing and the audience were the usual raucous and involved crowd that we had grown to love. To reward such an excellent cast for their effort, we all journeyed to Scu2 for a fitting end to our exciting few months together.

We all hope everyone thoroughly enjoyed watching and more importantly appreciated being involved in the Pantomime in 2006 but don’t worry if you missed it - Medics’ Pantomime 2007 is just round the corner!

Last years production of Cinderella was clearly a great success.

This years production of Jack and the Beanstalk aims to beat it.

It will be held in Owen’s Park Hall (those of you unfortunate enough to frequent the Bop know where that is) on the 5th and 6th of December and the bar will be open.

Tickets are already on sale so make sure you get yours soon.

The cast of the 2006 production of CInderella

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mediscope

Manchester Medical School

There is nothing worse than coping with a death in the family, but how do you cope when you are a medical student with a hectic schedule and exams coming up? Donna Pilkington tells her story.

I

was a 2nd year medical student and was happily floating along through my second year of preclinical. We had just broken up for October half term and I had the prospect of revising for my oral and written Anatomy exam. But I was not worried I had a week that was plenty of time. Having taken the weekend off I started early on Monday morning to get stuck into my revision. I had been at it for about an hour when the phone rang.

It was my Aunt. When I picked up the phone and realised who it was I groaned inwardly. I had revision to do and did not need the distraction of a catch up with the family. I had been getting a few calls from my Aunt recently, she had phoned me a while back to tell me that my Nan had been to the doctors as she had ‘turned a bit yellow’ and the GP had told her she had a problem with her liver. This phone call unfortunately was not about catching up, nor was it to tell me that my Nan’s funny colour was the result of over ingestion of carrots or something else equally futile. It was the kind with news that you dread, that you hope you will never be on the receiving end of and that turns your whole world upside down forever. It was cancer.

As I sat there clutching the phone while feeling like the rug had been pulled out from under me, my Aunty began to sob down the phone and to my shock and dismay shout at me.

Garbled bits of ’But you said she would be fine’ and ‘You said the Liver could heal itself’ came back at me. Yes unfortunately on a previous phone call I had said that the liver was one of the few organs that could regenerate itself and that you could remove half of it and it would regrow back. I had used this fantastic medical knowledge to reassure my Aunt that my Nan would

be fine. But now it was coming back to bite me in the ass. The one thing I learnt from this was that unless you have all the facts and you actually know what you are talking about, keep your mouth shut.

After the most horrific phone call to end all phone calls, I sat in a daze. I thought I was revising but after 2 hours I realised I did not recall reading anything from my notes. And then the news hit me and I burst into tears.

It pretty much continued like this for the rest of the holiday. I wasn’t sleeping well, couldn’t concentrate had lost all interest in food and could cry at the drop of a hat, as you can imagine the revision was not going well.

So I arrived back at Uni, knowing very little for my exam and terrified that when I went to explain the circumstances to the head of the year that I would be met with a stern ‘but you are a medical student now you need to be able to handle these things’.

When I went to meet the head of the year I was distraught, between the prospect of knowing that my Nan had cancer and would very possibly die and the idea of failing my exam I was a bundle of nerves. When I went in I pretty much just blurted it all out, that my Nan had cancer, yes that I know she is only my Nan, but she has raised me since the age of 4 and is the only mother I have ever known and she is dying. That I have been in a state all week worrying over this, waiting for more of my Nan’s tests results to come back and I have not slept and have got very little work done, and that if he makes me do the exam I will fail.

I expected to be met with a rebuttal that I should suck it up, and that the exam would go ahead and I could either do it and get what ever grade came my way or fail to attend and get zero. What I got in response was rather startling. I got sympathy and understanding. He understood my pain, my confusion, and my reasons for being unable to work and rather than just expecting me to crack on with everything because I was a medical student he was very kind and considerate. He sympathised with my problem and reassured me that my exam could be set back; I could do it at a later date once I had had time to get over the shock of it all.

The relief was overwhelming. He was so lovely about the whole thing.

My exam would only be an oral which would count for the whole grade rather than being split with the written assessment as that would be taken as planned. He set my exam for 10 days time and asked to be kept informed of how I was getting on.

Unfortunately a week later my Nan died. It took the wind out of all of us.

We had never expected it to happen so soon, but the liver cancer was a secondary cancer so she was quite far advanced when they had diagnosed it.

I went in to tell my head of year that my Nan had died and that I would still sit the exam but he would hear nothing of it. He told me to go home, sort out the funeral and come back. Then we would set a new date.

So nearly 3 weeks after everyone else I sat my Anatomy oral exam, and did quite well on it as it happens. But that would never have happened if it had not been for the kindness, understanding and consideration I had been shown by my head of year. It turns out this kind of thing happens all the time. People get ill, or end up in hospital or have a death in the family and due to this have had problems preparing for exams. So they have a backup plan in reserve for those candidates that need it.

If it had not been for the help I had received from my head of year, postponing my exam and informing other tutors of what was going on in my life I think I would have had a nervous breakdown. I just would not have coped with the stress of burying my Nan and the prospect of flunking out of med school, or at least doing very badly on an exam.

life

Difficult Times

Donna Pilkington

E

veryone was so nice and understanding so my advice to anyone going through a similar thing is to speak up. The academic staff are very understanding and if you have a genuine reason that is causing you trouble with your studies then they will take it into account and will maybe find ways for you to make up any lost time. At the end of the day you are not going to gain anything by struggling along and pretending everything is ok. And at least if the medical school is aware of your circumstances they can make allowances for you. If nothing else they can offer you advice and a sympathetic ear, and sometimes that is all you need.

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mediscope

lifescope As you meander down the corridor of your teaching hospital, dragging your feet on the way to PBL, you recognise the rather harangued looking man racing towards you as your Dean.

You pick up the pace a little, not wanting to look like you’re dilly-dallying, hoping that the “Student Doctor” written on your hospital badge doesn’t give away the fact that you are ultimately accountable to him. Yet, he’s dashed past and you’re left with all those unanswered questions, “Why did he choose to do medicine?”, “Does he prefer Scrubs or ER?”, “After a medics’ pubcrawl, does he prefer a Raj kebab or cheesy chips?”

Well, it’s a mystery no longer – Ask the Dean is set to be a regular feature in Mediscope. It will give you the opportunity to ask the Dean any question (within reason). It can be specifically about something happening in your teaching hospital or more general advice on life issues.

To help break the ice Mediscope have started with some of our own…

Why did you choose medicine?

Ged Byrne I had a scholarship and went to a catholic boys’ school run by monks; we could choose between becoming either a priest or a doctor.

Most memorable experience from medical school?

Simon Wallis First dissection where 2 people fainted and left medical school GB 4th year, which was a residential year consisting of five 8 week blocks – I don’t remember anything about it!

Lawrence Cotter I was in Manchester Medical School during the sixties. As has often been said, “if you can remember the sixties, you weren’t there”.

Best and first moments from when you first qualified as a doctor?

Tony Redmond Best: Running a tented hospital on the Iran/Iraq border Worst: Acting as medical officer at Lockerbie (after returning from the Armenian Earthquake) SW Best: making a difficult diagnosis, finally feeling as though you know what you’re doing Worst : going from student doctor and not knowing what you’re doing Why did you choose your speciality?

TR I loved the variety and the instant nature of the job. I have never taken to formal clinics - A&E is informal and unpredictable.

SW Diabetes and endocrinology – really enjoyed the physiology of it, was good at it and it was / still is a rapidly expanding area of medicine.

LC I initially thought I would become a neurologist. I actually spent 18 months doing neurology as a young doctor, but

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Issue 1 Dec 2007

Ask the Dean...

The Deans clockwise from left Prof Tony Redmond Hope Dr Lawrence Cotter MRI Dr Simon Wallis Preston Mr Ged Byrne Wythenshawe Interviewers Too ugly to picture Thomas Kelley Henna Cederberg Aditi Das Kate Fletcher

I also spent 6 months at that time doing cardiology. I found that cardiology had all the advantages of neurology, but with much more scope for effective treatment.

GB I have always enjoyed hospital medicine, decision making, building things, and doing things with my hands. I always liked A&E and general surgery best.

What has been the highlight of your career so far?

LC This was probably during my time at Oxford University as a clinical lecturer, where I was voted “the best clinical teacher in the Medical School” and given a golden stethoscope!

Most challenging moment in your career?

TR Working in Sarajevo- providing medicine in a warzone.

Getting supplies to a city under lock down was difficult.

Best and worst career choices?

SW Taking a job as a chemical pathology lecturer was the worst choice I made and the best choice was to give it to up. I knew it was wrong for me and the job I got subsequently, I was much better suited to.

What would you be doing if you weren’t a Dr? LC Vet GB Lawyer TR Musician SW Molecular biologist or a charity worker

mediscope

Manchester Medical School

Best story you’ve ever been told by a patient?

TR In A&E, I was once removing a table leg from a gentleman’s rectum as he told me how it had happened: ‘It was a hot summer’s day and he had taken all his clothes off. The kitchen table was turned over. He had climbed onto a chair to fit a light bulb…and then fell over in said position.

Describe your teaching hospital in 3 words : TR Caring, friendly, challenging LC Traditional, caring, excellent.

GB Warm, challenging, developmental SW New, student friendly

? o t o Ph ? y t i l a u Q

To help medical students get the most from their time at medical school, what advice would you give?

TR Engage with whatever you are doing and take part in anything. In medical school it may seem as though some things come to others more easily or quicker but just keep coming back to learn things. Most of all: enjoy being a student.

LC Get the balance right. Don’t work all the time, don’t play all the time – play enough, but work

enough.

GB There are several important things: take every opportunity, especially out of normal working hours; take every advice you get but don’t believe anything anyone says; rather find a balance of opinion and finally, look for a role model SW Get out there and see as much as you can. Be committed and engaged Best excuse you’ve ever been given by a student?

GB “A dog ate my mobile phone” “The ski lift broke” (a student returning from elective late) “It was medics’ pub crawl” (heard from half of students every year) “I was trapped in my bedroom by a rat”

Quick Fire Questions Red Wine Vs White Wine LC : White TR : Both GB : Red SW : Both

Night in Vs Night out LC : Night out TR : Night in GB : Night in SW : Night in

Week in the sun Vs Week in the Snow LC : Week in the sun TR : Week in the sun GB : Week in the sun SW : Week in the sun

Radio 1 Vs Radio 4 LC : Radio 4 TR : Radio 4 GB : Radio 4 SW : Both

The Beatles Vs The Stones LC : The Beatles TR : The Beatles GB : The Beatles SW : The Beatles X Factor Vs Strictly Come Dancing LC : X Factor TR : X Factor GB : X Factor SW : Strictly Come Dancing Scrubs Vs ER LC : ER TR : Scrubs GB : Scrubs SW : ER

life

What has been the most embarrassing moment in your career?

TR “Do you think I am really going to tell you that?” (following a little gentle coercion)…

As a reg in A&E, I decided to take some workload off the junior doctors and picked up an X-ray of a patient’s nose. I looked at it and thought, ‘Nah, there’s nothing wrong there’. So, I sauntered to the waiting room, found John Smith and preceded to grab his nose and flail it in every direction (with the audience of the doctors and patients around me). After a minute, I let go of the patient’s nose and allowed him to inform me that the X-ray in question belonged to his child. I looked at the boy next to him and he did indeed have a big black nose.

LC The most embarrassing moment in my career is far too embarrassing to tell you about.

Cat Vs Dog LC : Dog TR : Cat GB : Cat SW : Cat Town Vs Country LC : Country TR : Country GB: Town SW : Country Tea Vs Coffee LC : Coffee TR : Coffee GB : Coffee SW : Coffee

LC “I couldn’t attend because I fell out of a tree and fractured my skull last Saturday night.”

Tell us a joke you’ve heard recently : LC [please apply in person] What do you do when you’re not in hospital?

LC Reading, birds, rugby GB Travel, cook, play golf TR Play guitar with my friends SW Spend time with family, running, reading, cooking Favourite Music?

LC Mozart’s Clarinet Concerto / Marvin Gaye - I Heard It On The Grapevine GB Bohemian Rhapsody by Queen TR The Beatles SW Eclectic mix Favourite Sports team?

LC Not talking about sports at the moment (Wales had just been knocked out of the Rugby World Cup) GB Everton TR Everton

answered in it n o ti s e u q a t email If you wan Mediscope, f o n io it d e the next c.uk to us at: anchester.a m @ e p o c is ed subeditor.m

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mediscope

Issue 1 Dec 2007

Detectives, linguists, student doctors, but definitely not medical students any more; Welcome to 3rd year

by Jessie Colquhoun

I

t is Friday the 7 September 2007, and we are all dressed up to play the part of 3rd year student doctors for the first time. Our first day learning how to be clinicians.

The atmosphere is one you might find at a black tie dinner, or a fancy dress party where the invite had specified a 'grown up and important' look. We were now being called student doctors as opposed to medical students, and the thought that we would be on wards introducing ourselves to patients thrilled and terrified me. But it is OK, we are safe for now as we sit down in lecture theatre one of the teaching block of Wythenshawe hospital. Our introductory morning left me feeling proud. We are now each worth £20 an hour, £22,000 a year.

Intelligent men and women at the top of their fields wanted to teach us.

They, in their scrubs and suits, commanding their costumes, without a hint that they were at the same fancy dress party that we had been invited too.

The huge responsibility that we now had dawned on me as we walked round the hospital. For the first time basic life support was something we might really need in the next hour, not an OSCE station where we were straining to imagine that a plastic model was actually a sentient being next to an electricity pylon on deserted hill top.

How to use hospital beds, was now just as useful to know as the mechanism of an NSAID. We need to be able to help a patient stand up and walk to the toilet safely just as much as we need to know the Theory of Planned Behaviour.

This sudden right of passage from student to doctor in training brings with it a need to learn the language.

This is a world of abbreviations you dare not guess, and words you need to say three times over to get right.

Mesotheleomas and 'Ch' instead of cheese (a useful abbreviation for triggers to migraine). Even the bins on the wards boast a 'lid shutting device system' to ensure infection control. It is important to remember you can speak this baffling language. I was talking to a patient who was telling me

24

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how difficult it was to understand what was going on. 'They kept talking about an ECG or something'. I realised that I would probably assume that a patient knew what an ECG was, and remembered not to assume that a patient should know what any three initialled abbreviation was in future.

Something else I found out is that we were being trained to be expert detectives. As we were being shown how to perform an abdominal exam by an SHO doctor, a consultant came over to survey us. In a low voice so that the SHO could carry on, the consultant asked us what we know about our 'colleague' having the exam performed on him. 'That he's healthy,’ I said. 'Yes, but what else?' he urged.

There was a pause. 'Is he right or left handed?' 'Oh, I don't know', thinking he was trying to make a point about all the things we could not tell from the exam. 'He's left handed, look where he's wearing his watch. And is he married?' He was, I could see the ring.

'And what about his shoes?' He was wearing a rather smart pair of back shoes, which he had probably polished that morning. Maybe that made him meticulous. Or that he likes shiny things. Point was he cared enough about them to make them shine.

This is my experience of the first week. Mr. Byrne told us that now we had made it to 3rd year, statistically we had a 99.9% chance of becoming doctors. I think I'm going to be a doctor.

Knee surgery: a patient’s perspective

L

by Keith Colquhoun

ike most people with wonky knees I hoped for a magic remedy that would spare me from the knife. I had, in fact, for several years`kept the glucosamine industry in profit! Doctors tend to be evasive when you ask them what they think of glucosamine. “You could try it,” they will say, or, more bravely, “It seems to take some time to work.” No one says it is snake oil. Painkillers work, briefly, but they make you feel awful. The most useful aid is the one

that has helped cripples since antiquity, a good walking stick.

In the end though I found myself face to face with a surgeon. He was telling me what could go wrong. Infection was the enemy. Infection and infection. They took a lot of care over infection. A knee replacement did not last for ever, but he knew of patients who were happy with theirs after 20 years.

It was not a five-star endorsement, but what is? An appointment was made to operate on my right knee, the worst, with another to follow later.

I told several people about my impending operation. You feel, stupidly, rather proud, as though you have signed up for war. Their reaction was rather alarming. They offered stories about people they knew whose knee operations went wrong. But I could not cut and run. I had signed up for the duration.

My memory of the operation is of going into a pleasant sleep, the best sleep I had had for ages. Next day nurses got me out of bed, wobbly on crutches. I was to be taught to walk again. Learning to walk takes time and lots of patience and encouragement from nurses and physiotherapists. It continues for weeks after leaving hospital. The operation itself is said to be no different whether it is done on the national health or privately, as mine was through insurance paid for by my employer. No doubt this is true. But after the operation, in a public ward, possibly understaffed and always under pressure, a patient seemingly otherwise healthy, may not feel able to demand the attention accorded to a private patient. Attention costs money. The bill for my hospital stay and some physiotherapy was £10,708; the surgeon’s fee was £902 and the anesthetist’s £374.

Eventually, my physiotherapist discharged me and I went to see the surgeon. I bent my knee to what he judged to be a satisfactory angle. We looked at an x-ray of the new knee. “It looks very neat,” I said. “A piece of carpentry,” he said modestly.

A year later I had the left knee done by the same surgeon. Both have been a success, although that is a layman’s term, not that of a cautious professional. What I can say is that my legs behave reasonably well. I can walk reasonable distances. I am thinking of trying cycling, but I’ll wait for the better weather. I occasionally have dreams that I am back with a stick.

Best not to hurry.

Manchester Medical School

mediscope

Clinical fellow, as registrar would indicate that I’m on the training which I stepped off years ago.

How is that?

I love it, it’s perfect - I couldn’t have asked for a better team to work with, they’re really supportive. There’s no way I could do all of the media stuff and be able to practise as a doctor, without their support. There’s lots of flexibility – sometimes at very short notice they’ll allow me to go off and do a bit of media work.

How do you find striking a balance between being a broadcaster and a doctor?

I prefer it that way. I suppose with all the broadcasting jobs that I do I couldn’t really have the same credibility unless I did practise. Plus, I actually quite enjoy it, strangely enough, but when I had to do it [pure medicine] all the time I didn’t enjoy it as much because I didn’t see a goal at the end that I wanted to reach. I didn’t really fancy the idea of just becoming a consultant as there were other things I felt I wanted to try.

This is the perfect balance for me; I get to do the medicine, which I enjoy doing, on the shop floor without loads of admin, and then I get to do writing, radio and TV work.

Does one take priority over the other?

If some TV opportunity comes up, then you’ve got to take that opportunity when it’s there. It doesn’t take priority in the sense that if they needed me in hospital, then I wouldn’t just clear off, I would stay in hospital. It does take priority in the sense that it is only every now and then. So if there is a priority it is, slightly, the media.

When did you want to be a doctor?

I don’t know - I always fancied the idea of how things worked when I was a kid. I suppose it was when I was choosing university. I knew I wanted to go but it could have been engineering, marine biology… I finally decided on medicine.

So did something happen when you were practicing when you thought, “Actually, maybe this isn’t quite what I was expecting”?

Yeah, I think it was quite soon into it <laughs>. When I started, there weren’t protected hours and that was quite demoralising. When I moved on and did other specialities and found that I liked accident and emergency. I did a bit of anaesthetics, care of the elderly, but I could never really pin down something that I wanted to do. If anything it was going to be A&E but even that didn’t seem to be enough, I just wanted to try something else. It was

Clutching my hastily scribbled notes, standing in an eerily quiet part of A&E in Salford Royal, I was very aware that I had never interviewed a celebrity before. That’s what Dr. Mark Hamilton is, I mean, he’s on the radio, TV and everything, but he wasn’t around, at least, I couldn’t find him. After generally being in the way for a little over five minutes, a nurse kindly pointed me towards the staffroom. I entered, nervously, clumsily, to find a scrubwearing, shaggy blonde-haired doctor, eating toast. We shook hands and he suddenly looked very normal. Before long the interview was underway, and at times I liked to think he was nearly as nervous as I felt. My first question revealed the hastiness of my background research – damn you Wikipedia!

an interview with...

So you’re a registrar in A&E?

life

Dr Mark Hamilton

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Issue 1 Dec 2007

early 1998 when I decided to step off the eyed in front of them. Moyles is great, “this is not a substitute for a proper career ladder and started locuming. I he’s a good mate. I get on very well with consultation”, I don’t always say it in was doing a similar amount of work but Chris and Dave and all their team. They those words, but even here, in A&E, if I locuming frees you up to do something are brilliant fun, they are really nice guys discharge someone, I say if it gets and they’ve got their own worse, or changes, seek help, never just else at short notice. So I started looking around at “I’ve met some persona. I’ve met several rely on this as the be all and end all. comedians and I like my other things to do. I didn’t When you work in hospital, do you find fantastic comedy, so any comedian at really know what I wanted people, I’ve all. They are the first people a lot of people recognise you from the to do - it was about 18 TV or the radio? months later, so it was also met some that came to mind so they It’s mostly the staff. If the patients do, must be the ones. starting to get a bit twats, but they don’t let on most of the time. precarious - I was thinking You’ve broken into TV that’s life Although one patient wanted to make “What am I doing just recently with a TV show sure I was actually a real doctor! I drifting here”. It was in the really isn’t it?”

“How Long Will You Live” wouldn’t want it to be another barrier BMJ, in the classifieds, it just said Radio 1 wants a doctor to do That’s been going in Ireland now for between me and the patient; it’s this Sunday Surgery and I’ve been three seasons, just finished recording the difficult enough half the time. third series. It keeps getting repeated all Sometimes it actually helps – it breaks doing it since September 1999. over the place. So in Ireland it’s very the ice, they recognise my voice or my Are you still doing that now? different; I am known over here for the face. As soon as I reach Dublin airport Yeah, I’m not doing it as much. Kelly radio and I am known over there for TV. I am conscious of it – you see people Osbourne has taken over now. I record It seems the TV side of things has grown looking and you catch their eye and stuff for it every week - I’ll be there this over there. they look away and then they look back Sunday and do that once a month. again. Its just weird the way I have to Do you like the TV side of things?

There are quite a few things going on at conduct myself in public, not that the minute and something needed to I love it, it’s all a laugh. I’m in the there’s anything wrong with it, you’re give and I didn’t want it to be me. It’s enviable position of being paid to do jobs just aware that people are watching you. the best of both worlds because I get that I really enjoy. I was thinking about that the other day when I was talking to With your position as a broadcaster more time to do other things. my son about what he wanted to do, and a doctor, what do you think of the What’s she like to work with? something about being a doctor on the media’s way of sensationalising I don’t know her well but from what radio and TV, I don’t know where he gets medical news, for example the MMR I’ve seen of her she seems very nice. I that from! The TV has been a really vaccine? was pleasantly surprised. Having seen enjoyable part of my life, but quite a People like a good story and that’s what her on TV, I had never imagined she responsibility as well. In A&E its one on sells newspapers and gets people to would be unpleasant; she’s exactly as one, you’re helping somebody on a watch news programmes. Somebody you see her on TV. personal level, but in TV or in famous once said “never let radio its more like public the truth get in the way of a “It’s a case of You have worked with a lot of girls on health medicine. It’s a new good story”, and it is true, Sunday Surgery, who was first? making way of looking at things, you they print bollocks and then Sara Cox, then Emma B, then Laitita, need to know different facts opportunities. they’ll print a tiny and now Kelly Osbourne. and different statistics. The Don’t wait for retraction a week later. I see How is it working with all those way you present information it to come to that as part of my job, to is crucial to how you get that find out what are the facts celebrities? you” message across to the public. and the balance between You get used to it as the years go by but hysteria and cover-up. I it took me a long time. It’s still kind of Do you ever find it frustrating remember going on Richard & Judy and exciting and giddy. I just get so easily on the radio when you can’t get as much discussing it with Quentin Letts, from starstruck. It’s nice to have the information across as you would like? the Daily Mail, who was completely opportunity to meet the people you see Yeah. As a lot of medics do, I want to be against the MMR jab, and Lauren on TV or in the papers. I’ve met some completely comprehensive, cover all Booth, who’s Cherie Blair’s sister, and fantastic people, I’ve also met some options, all variables, all possibilities, side she was against vaccinations as well. I twats, but that’s life really isn’t it? effects, and complications, which you sat down before I went on with a Who is the most fantastic celebrity or just can’t do because people switch off. So learned colleague of mine, a consultant it’s trying to get that balance between in MRI, and we went through all of the person you’ve met? making the point and being safe as well, studies. All that you can present is the <laughs> I was very starstruck when I you have to be very careful that you are facts as you see them, without the met Bonehead from Oasis, I was giving the right advice without over- hysteria of anecdotal evidence and judging a battle of the bands contest egging the pudding. That’s a balance I thankfully its bourne through. That’s with him and he’s so humble and so always struggle with. really evidence based medicine, that’s cool. Mike Joyce, the drummer from all you can go on whether it’s here or in The Smiths was also there. Those are Have you had any close calls with callers the public domain. I don’t have any two bands that were big influences on on the radio? agenda because I would like people to me when I grew up and I was trying to As far as I’m aware there have not been become empowered to make decisions be cool, and the more beer I had the less any major close calls or dodgy advice. I for themselves but it can be difficult. cool I became. I was slightly too starry- start from a point of safety – I always say “Media” means “to go between” and

Manchester Medical School my CV. I didn’t even think at the time that when you phone a radio station they are judging you by your voice as well, but that got me ahead of the pack and shortlisted. So little things like that; its always handy to know people who know people – make lots of contacts, make lots of friends and don’t burn bridges, is a Where do you see yourself in 10 or 20 good policy, because you never know years? when you need to go back. I think in any I have no idea. walk of life, whether you stick with medicine or not, always be nice to people What would you like? on the way up because you’ll meet them I am quite happy now, the way things again on the way down. are, I really am. I met Miriam Stoppard, she used to be on Tomorrows World You used to DJ. Did that help and do you when I was growing up. I met her at still do funky house? some media medics conference thing, Yeah, it’s more sort of progy house and and she said “once you’re in this line of breaks. Anything, I like playing allsorts, work, there’s no end of it, there’s it just depends on the crowd. I am going always plenty of work” and I was quite to DJ at the A&E Christmas do here, and relieved by that. In fact, the first time I it’s not going to be all house music there. met her I headbutted her. I sat down I’ve done that for the last four or five next to her and she dropped something and when I went to pick it up, she went “I just wanted to to pick it up and we clashed heads. So get out of that was a nice meeting, lovely woman.

Northern Ireland, I’ve only gotten to this place by taking opportunities as they arose, I don’t tend I was sick of it.” to plan too much. Other people I know are proactive and planners - I see where years. I DJ at festivals in the summer. It it goes, and make the best of what probably helped that when I was in my comes around. I’ll hopefully continue final year at medical school there was a to do that because it seems to suit me. If programme on BBC2 called “The Living it stays like this fine, if it changes to Soap” and I just took the opportunity something else, yeah I’ll go with that. and got into that and gained some Have you got any advice for some of experience on TV. Little things like that. the readers who may want to get into It may not seem much at the time but it’s the media and do something similar to the chaos theory; anything at this stage could have a knock on effect later on. It’s you? just a web, and hopefully it takes you in I think you have to look for the direction you want to go. opportunities, and sometimes make them yourself. If you’re interested in You are obviously very busy, how do radio, you could start by going up to you balance everything with family BBC Manchester and asking whether time? they need anybody to do health By trying to make it a priority. For reporting for the news bulletins, even instance, I was away filming for three just going in making the tea, getting months pretty much for this third series some experience in the evenings, of “How Long Will You Live”. I was in helping out – radio shows are always Ireland roughly about four days a week, looking for that. It’s the same with TV, every week for three months, so that’s a being a runner , you get the experience long time. It’s a case of when I am home, and learn the ropes: it is a totally making sure that we do things together different career. If you’re interested in as a family, I’ve got two young kids. If medical journalism, get into the I’m a long time away from them, I will newsrooms. It is a case of making the try and balance it out by spending a long opportunites; look in broadcast time with them. I’ll always phone them, magazines, BBC aerial magazine has to make sure they know I’m coming jobs in it (you can pick up a copy from home to see them. Just trying to get the the front desk of the BBC). Don’t wait balance right, so they don’t feel like for it to come to you. I was lucky that daddy is never there. When I was it did; somebody phoned me up and said growing up it was tough. My dad was a “I’ve just seen an ad in the BMJ and it’s shift worker so I didn’t see him much and just for you”. I hunted it down and then when he was at home he was phoned them up to make sure they got knackered and wasn’t there in spirit

either. When I am there, I try to properly be there.

It is difficult, especially when there are long stints away.

life

that’s what I like - translating the medical facts to the public. You come up against this with the media but then if they give you a chance to speak, you have to be ready to be brief, concise and accurate, and that’s just a skill like any other that you pick up over the years.

mediscope

Where was home when you were younger?

Bangor, about fifteen miles east of Belfast in Northern Ireland.

When did you decide to come to Manchester?

As soon as I was eighteen. I just wanted to get out of Northern Ireland, I was sick of it. I grew up throughout the troubles. Thankfully I didn’t see too much of it but we were close enough to it so that it did affect your life, your lifestyle. I wanted to get away and I did.

I didn’t apply to Queen’s in Belfast, I applied to three Scottish and two English Universities. I’m glad I went to Manchester and I still live here, it’s a wicked place. We’re moving house soon but we’ll still be in Manchester, South/Central. Now that things are settling down in Northern Ireland I’m actually working there a lot more. It’s great to go back. I was never ashamed of where I came from I just didn’t want bigots interfering with the choices I made for my life. There are more opportunities over here as well.

Unfortunately, with what happened in Northern Ireland, there is less investment in the place and less hope but now that’s changing it’s great news.

The “How Long Will You Live Team” are based in Belfast, so I’m back there in November a few times. I don’t know if I’d move back there yet, not just yet.

Well I think that’s everything, unless you want to tell us anything else, a joke maybe or…?

Oh, actually someone sent me a few jokes <searches for mobile phone> I don’t know if these are acceptable, hang on a second. <looks through phone> No, that’s rude. This one’s not rude but I suppose it is a bit...

I was at Liverpool airport for four hours the other day because there was this suspicious car. It was taxed, insured and had its own radio.

With that I thanked Dr Hamilton for his time and asked if he would ever be interested in DJing for the medical school. He seemed pretty enthusiastic about the idea, so if the ball organisers or the MSRC are reading, and you are really nice to me, I might be able to give him another ring.

Interviewed by James Anderson

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Issue 1 Dec 2007

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