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EDITORS-IN-CHIEF Rebecca Mackenzie Sophie Bracke SUB EDITORS Rebecca Kells Tara Carlin TREASURER Carol Chan NEWS EDITORS Anamika Kunnumpurath Emma Lewin Rebecca Kells RESEARCH EDITORS Andrew Cole Eng O-charoenrat Richard Bartlett ALUMNUS INTERVIEW EDITORS Adesh Sundaresan Bill Boucher Charlotte Leigh ARTICLE EDITORS Lucy Refell Melika Moghim Otso Pelkonen Rebecca Fisher SPORTS AND SOCIETIES EDITOR Lucy Porter BOOK REVIEW EDITOR Katie Hodgkinson EVENT REVIEW EDITOR Yul Kahn Pascual DESIGN EDITORS + COVER Joanna Lucy Gabrielle Hobbs Elliot Clifford Nash WATERCOLOURS Emilie Claire Marguerite Hobbs ARTWORK Alvin Lim Elva Choi Kate Alice Mackenzie ONLINE EDITOR Joe Hearle
rums-review@ucl.ac.uk www.rumsreview.co.uk
DISCLAIMER: The views and opinions expressed in this magazine are those of the authors, and do not reflect those of the editors, UCL Medical School or RUMS Medical Students’ Association.
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From the Editors
Sports + Societies
Predident’s Letter
Round Up
Director’s Letter
Farewell Stu
RUMS Reports
Q+A In Focus: Varsity
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News Bulletins
Comment + Review 15
Find Your Vocation
RUMS Research
Book Reviews
UCL MBPhD Programme
Event Reviews
Research Round Up
20 Articles Alumnus Interview ZIKA Dr. Dan Broman Dr. Patrice Baptiste Prescribing Prevention Demystifying Medical School
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2 mbbs year
editor-in-chief
sophie bracke
2 mbbs year
editor-in-chief
rebecca mackenzie
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A
s we write this, the weather is changing; as you step outside, you are tickled by a brief hint - a slight warmth and sweet smell to the air - that indicates summer is finally on the way. This summer will see thousands of athletes, support teams, officials, and spectators make the quadrennial ‘pilgrimage’ to Rio De Janeiro, Brazil, to partake in the 2016 Olympic Games. Like most things, sport has become increasingly medicalised, and there is a larger role played by doctors and medical research in athlete performance. Is this information to be afforded only to the elite, or can the average person benefit too? Whilst we all know that exercise is good for us, we may not know to what extent and in which scenarios this benefit can be ‘cashed’. Throughout this sports and exercise medicine special, we examine the wide spectrum of applications of exercise in health and medicine, from the powerful health benefits of exercise in preventive care, to its role in treating patients who are severely hypoxic in ITU. We also look at what a career in sports and exercise medicine entails in greater depth, and view the public health implications of this year’s Olympics in light of the recent emergence of the Zika virus. As always, medical students are leading by example, and have been taking part in and excelling at sport themselves. Term 2 always sees the conclusion to the sporting season, celebrated by the annual sports ball. In addition to this, we waved goodbye to final year students, battled it out in varsity, were victorious in Quality Improvement and voted in next year’s RUMS committee - it’s been a busy term! This issue features the first of a new section, Demystifying Medical School, which seems well overdue considering the many rumours that tend to fly around. Ravi Mistry, RUMS Education VP for years 4-6, will be trailblazing by setting the record straight on how our exams are really marked (perfect to reassure pre clins through the hefty revision period). As we publish our third and final issue of the year, it seems strange to consider that only a year ago the magazine was simply an idea. From that very first meeting in Warren Street Cafe Nero, Alex Maidwell-Smith (RUMS President) has been nothing but supportive and we would like to say a special thank you. During his time in office, he has put a tremendous amount of work into strengthening the RUMS MSA identity, maintained strong relations with the medical school to ensure students’ concerns are addressed and stepped up to the mark during a very difficult period externally (junior doctor contract), while ensuring the RUMS community was well informed and represented throughout. The RUMS Review editorial team looks forward to continuing this strong working relationship with next year’s committee. In the same light, we would like to thank the hard work and commitment of our editorial team, contributors and staff, both at the medical school, and at UCL. We look forward to further improving the magazine in the year to come, with the help of our new editorial team. But lastly, we would like to say thank you to you, our readers. Thank you for picking up the magazine, reading it, talking about it, integrating it into medical school life and hopefully enjoying it!
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5 mbbs year
rums medical student association president
alex maidwell-smith
In February, the whole RUMS Exec attended the first ever United Hospitals Conference. This allowed the committees from all five London Medical Student Associations to meet and share ideas. This was a hugely valuable experience for everyone involved as we learnt how best to improve our respective organisations and serve the students we represent. Hopefully some of what we learnt will be translated into real benefits for you!
Dear All, Welcome to the third edition of the RUMS Review! Once again I would like to congratulate Rebecca and Sophie on another stellar edition and for all their hard work this year to make the magazine a success. The last term has been fantastically busy and I would like to thank my team on the RUMS Executive for all their hard work! Furthermore, I would like to wish the newly elected Executive led by Raj Pradhan the very best of luck when they take over at the end of this year!
Our sports clubs and societies continue to go from strength to strength. Whilst RUMS were unlucky in the London Varsity Series and the United Hospitals Challenge Cup, the level of support was incredible and demonstrates the depth of feeling that underpins our sports clubs. Indeed, success was eventually achieved at the United Hospitals Head of the River, as RUMS BC picked up wins in 5 of 8 categories. As ever, The MDs demonstrated their wide array of talent in wiping the floor of the other London Medical Schools at the United Hospitals Revue with a unanimous decision reached by the judges. It’s all becoming too easy for them! As AGM season comes to an end, I would like to wish all the new committees the very best of luck as they look to the fast approaching 2016/17 season! Since January, RUMS MSA has hosted a vast array of events ranging from RUMS Dine with Me to the incredible Sports Ball held at the Royal National Hotel. With over 460 guests, it was the biggest and best Sports Ball we have ever put on. Its success was due in large part to Andy Webb (Sports and Societies Vice-President) and the huge amount of effort he put into it. Numerous awards were given on the night, the highlights of which were Sports Personality of the Year (Rob Tuckwell) and Team of the Year (Men’s Tennis 1st Team). In the coming term there are already grand plans for a Summer Ball, tickets are currently on sale for Finalists’ Ball and we have the Fifth Year Show to look forward to, which promises to
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be side-splittingly funny. The fun never ends! This term has also seen some quite large academic issues raise their heads. RUMS has worked hard to make sure that students are well represented at the highest levels of medical school bureaucracy and that the best outcome for us is achieved. Both Ravi and Ozzy (RUMS Vice-Presidents for Education) and the module representatives have been working closely with the medical school to make the changes that you want. Please keep filling in the feedback forms that get sent out - they are hugely valuable when we look to try and propose changes. Most notably was the disruption caused to final year OSCEs as a result of the BMA Industrial Action. This posed a huge challenge for the medical school but RUMS MSA were in near daily contact to ensure that final years were not disadvantaged by the changes. Thankfully everything ran smoothly and I would like to congratulate the finalists who will be graduating in July! We are all going to miss you but wish you well in the future! Sadly, the next term sees more exams on the horizon - especially for pre-clinical students. If anyone has any major concerns and would like to chat to someone who has been through it all before, please don’t hesitate to contact Vignesh Gopalan (Welfare Vice-President) who will be able to point you in the right direction. If you would like to get in contact with me with any suggestion or concerns my email is zchahx0@ucl. ac.uk. As this is my last update in the RUMS Review, I would also like to say thank you to you all for making my year in charge of RUMS MSA as enjoyable as it has been! Thank you to all, Alex Maidwell-Smith
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scanning the horizon
When Issue 2 went to print, the medical education and healthcare fields were buzzing with new activity and announcements: they have been just as buzzing in the last few months. The GMC has recently confirmed their plans to introduce a new national Medical Licensing Exam (MLA). Developing and implementing a large scale national examination is not a speedy process, and although activity is well underway it is unlikely to affect our final year students until about 2022. The GMC team came to visit UCLMS last month to listen to our views and ideas about the assessment and to meet with some of our current students. They plan to visit all of the English medical schools before announcing the format and structure of the assessment. UCLMS has significant assessment expertise and the GMC have asked us to stay involved in the design. We hope this will mean a robust but proportionate method of assessing final year students, and will keep students updated as more information is forthcoming. Reassuringly UCLMS students do very well in national assessments: all bar one of our finalists passed the national Prescribing Safety Assessment earlier this year at their first sitting so our students should not get too vexed about the MLA. As I write this the BMA has just announced a significant increase in scale of the planned industrial action by junior doctors. The proposed junior contract, and the industrial action taken in response, impacts on our students in many ways. Some students have been in contact about planned changes to teaching and assessments during the industrial action and we
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an improved medical school building
It can’t have escaped students’ notice that UCL is working furiously to improve the quality of the estate – particularly on the Bloomsbury campus. It is looking like the Medical School will benefit from some of this activity with improvements to the Rockefeller and Huntley Street buildings. Plans are in the early stages but are likely to focus on the skills centre (at last) and the student reception and social areas. The Postgraduate Dental School (the Eastman Dental Institute) will be moving into parts of the Rockefeller building and we hope they will make good bedfellows. Who knows, in a couple of years we might have a building that says ‘UCL Medical School’ over the door with a corresponding interior! In the meantime, we are pushing hard to improve what is already there. I will keep fighting until LT1 has a clock and a microphone that works!
meeting people
The Medical School is a big and complex organisation and as Director it is easy to become removed from the very thing that makes us special: our students. This term I have been making a concerted effort to get out and see more of our students and what they are up to. I was delighted to see so many of you at the UH Rugby final and the boys’ and girls’ varsity hockey. I even met some of your parents! Whilst we did not bring
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NEW SCHOOL
I am delighted to be providing an update about Medical School news in the third edition of what has turned out to be a really excellent publication (well done Eds). I hope you find this update useful and would, as always, welcome your views and comments.
MEDICAL
Deborah Gill, Prof. Peter Delves
have given some general advice. Because of local variation and unpredictability of teaching, attendance has not been formally measured on these days. The junior doctors we have spoken to have been clear that they do not wish to disrupt your learning and so if teaching is taking place we have urged students to attend. There have been picket lines at the entrances to some clinical sites. These picket lines are clearly not there to dissuade students from entering but we understand students may feel uneasy about crossing them. We, as a school, have not issued any guidance or an official stance concerning the industrial action. At UCL we respect a range of views and will not tend to tell people what to do or think. We have suggested students and staff may wish to show their support (or disagreement) with the industrial action in a range of ways: signing a petition, wearing a badge, taking part in demonstrations, etc. We are proud to say that the manner in which our students (and former students) have expressed their views have been professional and thoughtful. On a personal level my concerns are that the suggested changes to junior doctor contracts have the potential to impact on the morale of our students as they enter practice at the very time that new doctors should be hopeful and full of enthusiasm. Like you, I very much hope that the situation can be resolved quickly in a way that doctors in training, and future doctors in training, can feel valued and supported in their work and careers.
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home any trophies no one could say the players did not give their all and their supporters gave some pretty vocal support too! We had more success in the Be the Change Challenge: a national project to get healthcare students centrally involved in quality improvement in the NHS. ‘Team UCL’ were huge, well-coordinated, slick, and produced some fantastic work. Their victory was well deserved and we now have a trophy for the empty plinth in the cruciform hub. I have also met some delightful first years during the Monday Mixers who have been getting involved in all manner of UCL activities and events. Although I did not meet students face-to-face, I have also fielded all of the finalist’s queries about the emergency changes to finals. These e-mails have reminded of what concerns students about how we run the School, how resourceful and resilient our students are by year 6, but also how respectful and professional they are. I even discovered how funny they can be, even in the face of adversity*.
retirements
Finally, the medical school will say goodbye to a number of key individuals in the summer. After many years of service Brenda Cross, the Faculty Tutor, Irving Taylor the Vice Dean for Professional Affairs and stalwart of UCLH ward based surgery teaching, Peter Delves the Infection and Defence guru and Anthony Silverstone, one of our longstanding support tutors will all be taking well-earned retirement. We wish them well and hope they will stay in touch with us at UCLMS. If they have helped you in some way or you have good memories of their teaching and support of learning, please do send them a card, email or note to say thank you. It really means something to our excellent staff when they know they have made a difference. *A special message for finalists We are very proud of you and your performance in the PSA and the rapidly modified finals. Enjoy your SSCs and electives. Don’t forget to send those postcards and PLEASE COMPLETE THE NSS!
What this has reminded me of is that I don’t get to speak to or see students enough. My experience is that it is face-to-face conversations (or if all else fails, e-mails) that most effectively let us know what you are enjoying and want more of, what you want us to pay attention to or try to change and what makes being at UCLMS fulfilling and fun. So when you see me walking about in College, around Bloomsbury or one of the clinical campuses (or even in Sainsburys) – come and say hello, tell me how it is going and tell me what we need to do better. I look forward to it.
Follow us on twitter @doctordeborah @UCL_MBBS
Deborah Gill, Director, UCLMS
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i. You said: You would like to have an increased number of small group tutorials, to allow for more interactive learning. We listened: Overall, small group tutorials increased from 5 to 8 for this year (2015-16). ii. You said: There is too much lecture-based teaching in CPP. We listened: In response to this, two new small group work sessions have been added in year 2. iii. You said: You would like a
Some other accomplishments include the Cruciform Hub being open continuously for 10 weeks from Thursday 24 March through to Saturday 4 June. Additionally, there was the introduction of ‘Monday Mixers’, a series of informal social events for all first year students to meet with academic staff and converse about issues pertaining to both the course and university life in general. The main ongoing issues have been problems to do with audiovisual systems in LT1, and trying to increase both attendance and feedback response rates. With the time I have left, I will continue to work with the reps to tackle these issues as well as trying to ensure a smooth hand over to my successor.
i. Better communication to incoming Y4s Done. Students will receive an attachment with top tips about starting 4th year based on information we wish we’d known. ii. DGH Information In progress. Liaising with administration to ensure standardised information on provisions are circulated next year. iii. E-timetables Done. This has been a roaring success this year, surpassing my ambition of ‘common elements’; It is already implemented in 8 placements across Y4&5, with a view to keep expanding each term! iv. Lecturecast Not done. I gave focusing on formative/summative assessments (below) precedent given it was more high-yield and critical. v. Study spaces Done. Working closely with library staff, we’ve pushed for longer library opening hours at multiple sites, including DGHs. vi. Dispelling myths Done. I’ve worked with MedSoc Education (Y1&2 + Y4-6) to communicate that exams are blueprinted and that pass/fail quotas don’t exist. Other successes include: Year 5 IOM - is now dramatically reduced to 2 days and is more concentrated. Y5 CTWs will be less didactic and include more stimulating, interactive teaching. OSCE feedback - I led work looking at our OSCE feedback and am now working with the academic lead for assessment to implement changes for this year’s summatives. Formatives – given regular complaints that formatives questions don’t reflect the summatives’ difficulty or style. Y4s now have an end-of-module revision day with practice SBAs and later on, for the first time, a mock OSCE. Both Y4&5 have revised their formatives to better reflect summatives. Cases of the Month has been revised to involve less backtracking and repetition. Still have 5 months to go!
Ravi Mistry, MBBS Year 5, RUMS Education Y4-6 VP
fixed time for the release of examination results. We listened: We’re proposing to release all examination results at the fixed time of 10.00am the day after Examination Boards have made their decisions. The provisional date for this is the 8th of June 2016. iv. You said: You felt the FHMP module was disjointed and asked if there was a more systematic way of delivering the material. We listened: To tackle the ‘disjointed’ nature of the module, more linking themes on key diseases have been introduced for 2015-16. We have introduced more signposts to changes in topics and highlighted their context within lecture introductions throughout the module.
Years 4-6 Education
The last few months have seen many issues around the MBBS Year 1 and 2 curriculum arising, and the module reps and myself have been working with the medical school to ensure they are tackled effectively. Here are some of the accomplishments we’ve been able to achieve on your behalf.
Ozzy Eboreime, MBBS Year 2 , RUMS Years 1-2 Education VP
Years 1-2 Education
R U R
It’s been a busy six months for myself and the Y4-6 reps. In spirit of accountability, here’s a brief outline of what I promised when campaigning and how the last 6 months have gone.
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M S E P O R T S
Looking ahead to our Summer Ball still in the making! It will be held in the UCL quad on the 7th June, tickets will be cheaper than ever before and I hope to see lots of you there! More details, including the theme, will be released via the RUMS Bulletin and Facebook, so keep your eyes peeled! That’s it from me folks! Thank you all for supporting RUMS Events this year and making my job the best there is! I can’t wait to see what Ozzy will be getting up to next year!
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Welfare
I’ve had the great pleasure to be the RUMS VP for Welfare this year, and while it’s been tough negotiating the medical school administration at times, I know it’s been an incredibly rewarding year for myself and the rest of the team! It all kicked off with Transfer’s Mum’s and Dad’s in August, welcoming the new Oxbridge transfers into our RUMS family. This was quickly followed up by the largestever attended Mum’s and Dad’s event for the incoming fresher’s (hence we ran out of pizza very quickly, sorry!). This year saw the launch of the RUMS site and the new welfare section offers a succinct summary of all the services on offer, hopefully clearing things up for those of you confused about what the medical school offers in terms of student support. Over the course of the year we’ve dealt with welfare issues on an individual basis, and have noticed an increased awareness of welfare services, which was one of our aims this year. We’ve written a welfare spread, with pointers for how to cope with first and second year from students in the inaugural issue of the RUMS Review. The Medics4Medics scheme (set up by Becki Clarke last year) has continued to flourish, with students being trained up by the charity Rethink to provide peer-support and welfare services. This year, RUMS clubs have also been encouraged to sign the LGBT+ pledge, and in conjunction with UCLU, a very successful and well-attended talk was held last month with members of UCLU and RUMS clubs to raise awareness of LGBT+ issues in sport. Looking forward, there will be a housing talk for freshers, and a drop-in de-stress session before pre-clinical and clinical exams, so make sure to keep a look out on the RUMS page! vol.
Vignesh Gopalan , MBBS Year 3 , RUMS Welfare VP
Term 1 ended on a high at our Bondthemed Winter Ball. Dubbed the event of the year by many of the freshers, everyone scrubbed up (not like that!) pretty well and danced the night away in Leicester Square. 007’s donned feather boas and Christmas specs in our photo booth - a great night had by all! A brand new event was launched in second term. RUMS Dine With Me was a roaring success, so thank you to everyone who headed down to our paired curries on Brick Lane and made it such a massive RUMS - wide social! We hope to be extending it next year to involve even more RUMS members - who doesn’t like completely filling up ULU on a Friday night?
Frankie Cackett, MBBS Year 3, RUMS Events VP
It’s been an incredible year for RUMS socially, from a sellout fresher’s Boat Party to the biggest ever Sports Ball (great job Andy!), we’ve come together like never before. RUMS welcomed its new freshers with open arms. A massive fortnight of events included the traditional scavenger hunt (some fantastic public break-ups featuring Buckingham Palace’s biggest drama), a typically messy pub crawl (thank you second years) and a similarly messy scrubs party (it was fake blood, okay) to top it all off!
Events
From a financial point of view, this has been a relatively successful year for RUMS. After a smooth finance handover (thanks to Stef Kouts), our first goals were sponsorship. After multiple negotiations we were able to gain sizeable contributions over the summer, allowing us to subsidise Freshers’ Fortnight, hold one of the cheapest Winter Balls on record, and fund other events throughout the year. Furthermore, through working closely with the union and careful management of resources, we have managed to put aside a proportion of our grant over the course of the year, which can now be invested longterm for RUMS. We also incorporated the RUMS Review into our financial structure this year. Its huge success is a testament to the determination and perseverance of the chief editors. In recent weeks, finalists ball has been a priority. For those in younger years, this is a big send off party for the final years. Thanks to the phenomenal work of the organising committee of 6th years, this is set to be bigger and better than ever before; with over £50,000 expenditure I would urge any finalists reading this to make sure they attend. Most work of the Finance and Operations officer is projections and negotiations, and I believe our successes in these fields are evident. This year, the Finance and Operations role has also incorporated PR. We streamlined our social media presence and set up our first successful website. After some perseverance (and a lot of youtube tutorials) we now have a professional online presence that will offer a solid foundation for development in subsequent years, offering information to prospective and current students as well as alumni. As next year’s President, I would like to thank the rest of this year’s committee (and in particular Alex Maidwell-Smith) for putting together a solid foundation from which we can build. Without their efforts, RUMS would not be the organisation it is today. That said, there are many areas where improvement is necessary, and this is what next years’ committee is tasked with - we look forward to the challenge.
Raj Pradhan, MBBS Year 3, RUMS Finance & Operations VP
Finance + Operations
it can sometimes be difficult to remember that rums is so much more than simply sports and societies, but also the students’ association which protects our interests and welfare. as the current committee embark on their final term in office, rums review catches up on the work that has gone on both, in front of, and behind the scenes.
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Emma Lewin
news
inspire medicine conference
In its third year, the student-organised Inspire MEdicine conference was, once again, a big success. This year the conference was much more career driven, with a theme of “what does medicine mean to you/ where will medicine take you?”. It consisted of talks by speakers from various backgrounds, specialty workshops run by doctors and students in 17 different fields, a poster competition, a careers fair and a “Dragon’s Den” competition in medical innovation. Highlights of the day include the anaesthesia workshop, in which the attendees had the opportunity to learn basic skills required for anaesthetists such as intubation, the exciting talks on Wilderness Medicine and Battlefield Medicine and, of course, the MDs’ performance at the evening social. Congratulations to the inspireMEdicine committee for pulling off such an inspiring, entertaining and educational conference. We look forward to attending again next year!
sports ball
On the 23rd of March, the 460 strong RUMS sports community congregated, once again, for the annual sports ball. The evening, which was held at the Royal National Hotel, was a perfect way to celebrate the successful year of sport, featuring a 3 course meal, award ceremony and plenty of dancing. Team of the year was awarded to tennis men’s 1st team, whilst the coveted freshers of the year went to Josie Baker (women’s hockey and squash) and Josh Bryan (men’s football). Robert Tuckwell was the deserving winner of this years sports personalty of the year. Honorary life membership went to the following: Doris Chan, Karen Erskine, James Gladwin, Cleo Huang, Isabelle Goldrick, Katie Westbrook, Rishiraj Banerjee, Akash Maniam, James Oldman, Sunil Parthiban, Nicholas Makins, Tom Nash, Eleanor Croft, Karen Erskine, Natasha Graham, Christopher Bu, Harry Gross, Anya Borissova, Victoria Chelliah, Garima Govind, Robyn Brown, Charles Holden, William Rea, Jacob Wilson, Timothy Wagner and Matt Cox.
lumsden cup
On the 22nd of March, RUMS Netball held their annual charity event, the Lumsden Cup (a netball tournament held between each RUMS sport). The money raised this year went to Children’s House of Hope, which sends clothes, toys and medical supplies out to several communities in Ghana. The atmosphere was enjoyable and became particularly heightened when the MDs started to show great promise! The final involved MDs vs Rugby competing for 3rd place and a match of netball 1s vs 2s for 2nd and 1st place, with netball 2s ultimately winning the tournament. The money raised from the Lumsden event will be used to set up a room in the health centre.
NEWS
BULLETINS
finalists
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A huge congratulations to the finalists, who finished their exams on 15th March and have now received their results. However, their time at UCL is not quite over as they are currently having an exciting time on their various electives and “preparation for practice” SSCs. Their graduation on 7th July will be celebrated with a ball- dinner, dance and overnight stay- a few days later at the Beaumont Estate in Windsor. After a well-deserved break they will then start their first jobs as doctors on 3rd August. It is going to be an exciting few months for the finalists and we would like to wish them luck for starting their new jobs. Well done on completing medical school!
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On 26th February, an unprecedented event took place in which there was some rare mingling between the various RUMS sports teams (and MDs). Each team was grouped with at least two others and together they ventured to the Indian Restaurants of Brick Lane. The event was a huge success and there are plans for it to take place again in subsequent years.
rums summer ball
It has just been announced that the RUMS Summer Ball will take place on 11th June this year. The theme will be “A Midsummer Night’s Dream” and it will take place in the UCL Quad Marquee. It is bound to be an enchanting event so get your tickets soon!
nugsc
The National Undergraduate and Foundation Surgery Conference (NUGSC) 2016, organised by UCLU Surgical Society, took place on 19th March. The first undergraduate surgical conference officially endorsed by more than one surgical college, it was a professional and inspiring conference with a particular focus on the future of surgery in the UK. The conference was composed of a series of surgical skills workshops and talks from some very high profile surgeons as well as an academic research competition. The NUGSC was an exciting event and the perfect opportunity for anyone potentially interested in a career in surgery to gain an insight into such a varied field.
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news
ucl medical student commended emergency care
for
exemplary
Asma Ashraf
ucl medical students taught of forced marriage
Anamika Kunnumpurath
Ms Williams, a 5th year medical student, was recently commended on her “Willingness to help, for ensuring the patient’s safety with an ABC approach and for her calmness in the circumstances”, whilst attending to a gentlemen who had collapsed in a busy tube station during rush hour. Dr Lucy Bemand-Qureshi, a palliative medicine registrar who was also passing by, was impressed when Ms Williams ensured he was in the recovery position, checked his ABC, and gave a calm, brief handover. Ms Williams proceeded to assist Dr Bemand-Qureshi until paramedics arrived.
uclh institute of sport, exercise and health recognised as an international olympic committee research centre
to
spot signs
UCLMS has recently featured in the BBC news because of their emphasis on educating medical students about recognising the signs of forced marriage. NICE has recently called on healthcare to do more in terms of ways to tackle the issue. The BBC news report talks to a victim of forced marriage and then highlights what is being done at UCLMS and features Year 5 medical students talking about why it is important they learn about it. Watch this link: http://www.bbc.co.uk/programmes/p03pd5rp
The UCLH Institute of Sport, Exercise and Health (ISEH) has been recognised as one of nine International Olympic Committee (IOC) Research Centres for Prevention of Injury and Protection of Athlete Health from across the world. The newly appointed IOC status commends their eminence in the field of Sports and Exercise Medicine. The IOC’s partnership with this endeavour will facilitate financial support and collaborative links to a global team of clinicians and scientists working towards optimising care in elite sport.
free online dementia course In March 2016, UCL launched a new, open online course “The Many Faces of Dementia”. Created and led by Dr Tim Shakespeare of the UCL Institute of Neurology, this free four-week course is designed for anyone with an interest in learning more about dementia and its impact. It is also suitable for those who interact regularly with people living with dementia, such as healthcare professionals, students, families and carers. The course commenced on the 14th of March 2016. However you can still sign up by going to www.ucl.ac.uk/lifelearning/courses/dementia-many-faces. The course will also run again in autumn 2016. George Wall
uh match
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“13-12 to George’s.
The final whistle blows. The reaction of the crowd was felt instantaneously, elation from St George’s, and commiserations from RUMS. The disappointment for the team after all the hard work and training they had put in over the year was evident. Nevertheless, the RUMS supporters stood proudly by their team, knowing they had represented RUMS to the upmost standard on this night and all year; cries of ‘Middle middle middle’ went out to be echoed back by all with ‘sex, sex, sex’.” For the full match report by George Wall, MBBS Year 2, please visit: www.rumsreview.co.uk
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article by dina radenkovic
championship
Established in September 2015, UCL Be the Change (BTC) is a large student-led quality improvement initiative consisting of medical and pharmacy students. Medicine typically has a hierarchy which is detrimental to innovation, but UCL BTC aims to make full use of motivated medical trainees at all career stages, including students, in order to improve the efficiency of the NHS. This initiative proposes a model of how medical and pharmacy students can work (for free) with experienced healthcare professionals and carry out audit and quality improvement projects. Using Slack, a team collaboration tool used by leading global tech companies, UCL BTC functions as a small healthcare start up. Thus far, this student collaborative has developed unique digital solutions, customised for healthcare professionals, for project matching and efficient communication. The red book and implementing policy changes to improve the usage of Patient’s Own Drugs scheme and reduce medicinal waste. Other pursuits include testing virtual reality for clinical skills teaching and tackling issues such as patient nutrition and safeguarding patient property in a hospital setting. In March 2016 UCL BTC won the first ever NHS Quality Improvement University Championship. The competition was among all five London Medical Schools and took place in the BMA house. The judging panel comprised of representatives from the Health Foundation, Department of Health, NHS England, McKinsey, Institute for Healthcare Improvement and Directors of all five London Medical Schools. Winning the NHS Championship shows that this student-led model can be successful, but the mission does not end here; the team want to see a change in culture. UCL BTC wants a system that will support and nourish the innovative ideas of students and where quality improvement, not solely biomedical research, will be required for career progression. All healthcare professionals are also leaders and managers, and this leadership role starts now!
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More information is available on the UCL BTC website: http://btc-ucl.me.
projects are very diverse and include designing a new checklist for the
news
t
e
e
d
c
o
i
n
a u
n
t
l
c f
g
a e
t
t r
o
i e
n
n h
o
n
c
e
UCL students recently
child born with Treach-
together medical and
environment will be
played a major role in
er Collins syndrome.
pharmacy
students
familiar to UCL Med-
the recent Whitting-
Urvi and Alex have
for hands-on practical
ical students and the
ton Health Education
recently completed the
paediatric prescribing.
introduction of it for
Conference, held on
iBSc in Paediatrics and
This was evaluated as
NHS staff will ensure
the 23rd of March. The
Child Health.
a success, particularly
continuity in e learning
Conference
de-
It was then time for role
with breaking down
for Medical Students
signed to showcase in-
play, with final year stu-
the barriers of incorrect
moving to the Founda-
novation in education,
dents Dev Chatterjee
pre-conceived negative
tion Programme with
learning and training at
and Ciaran Megoran
views and stereotypes.
Whittington Health.
the Trust.
taking method acting
The afternoon began
During the conference
The morning plenary
to new extremes. They
with Megan Clear-Hill,
the visiting artist Lance
session was launched
played
themselves,
a 5th year Medical stu-
Bell
by Caroline Fertleman,
re-enacting a scenario
dent, describing the
the event. Lance im-
who is a Consultant
where a teenage patient
exciting UCL pre-hos-
provised cartoons to
Paediatrician
the
with asthma talks about
pital care programme.
illustrate some of the
Hospital, as well as the
why her smoking cessa-
This sees students gain-
educational innovations
UCL site Sub-Dean.
tion consultation had
ing invaluable insight
being presented.
Caroline
failed to change her
and experience in a
Ian Probert, novelist
habit.
range of settings, in-
and father of a recent
The general theme of
cluding days with am-
adolescent patient, who
the conference con-
bulance crews, dealing
gave a poignant and
cerned integrated edu-
with incidents ranging
eloquent speech about
cation and this was well
from cuts and bruises
his daughter’s recent
illustrated by paediatric
to cardiac arrests. The
illness. UCL medical
trainee
Birley,
programme is entirely
students, Urvi Patel
who described a teach-
student run and stu-
and Alex Harvey, then
ing initiative bringing
dent devised - a won-
was
at
introduced
Kate
read moving patient
derful step into inte-
journeys that are being
grated education. It has
published in a book
been carefully planned
due out this year. Urvi
to continue through
read out Ashoka’s story,
new
who received a kidney
uses Moodle as a vital
from her mother. Alex
education and admin-
read
istrative platform.
about
Wendy’s
experience of having a
leadership
caroline fertleman
h
t
&
i
illustration by lance bell
h
article by richard peacock
w
“live-scribed”
and
The conference concluded with the launch of
the
Whittington
Moodle. The Trusts’ new virtual learning
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words by constance wraith
news
UCLMS Student Gains Pledges for the Housing of 20 Camden Refugees One of the clichés that many of us used when writing our personal statements to get into medical school was that we wanted to ‘make a difference’ to the world. However, with the intense workload, busy social and sport commitments and a need to fit in sleep somewhere, many of us may feel that we have not yet made a significant difference during our time in RUMS. Issy Good, a second year student, wanted to start making this difference, so joined a charity called Citizens UK who are currently running a campaign to find homes for 5,000 refugees displaced by the Syrian conflict. She took on a major role and organised a large event in Camden Town Hall on 14th March, in a bid to raise awareness and get MPs to pledge to make an actual difference in the local area. Among those in attendnet (leader of the Green (QC and Labour MP for and Tim Farron (leader crats) as well as members Also
speaking
were
soldier who has done in Calais and Dunkirk. insightful as he has re-
PLE DGE
for trying to smuggle a
ance were Natalie BenParty),
Keir
Starmer
Holborn and St Pancras) of the Liberal Demoof
Camden
Council.
Rob Lawrie, a former huge amounts of work This
was
particularly
cently been prosecuted four year old girl who is
living in The Jungle, and reunite her with her family in the UK. Ahmad Al Rashid, a Syrian refugee himself who has lived in The Jungle and now lives in the UK, also spoke. Issy was responsible for organising and chairing the meeting as part of the Citizens UK charity. She took a leading role in asking these influential politicians to pledge to ensure that at least 20 refugee families are rehoused in Camden by 2020, as well as to try to raise the government targets. All the attendees, apart from Starmer, agreed wholeheartedly to this task. The event was a huge success, with a turnout of over 60 Camden residents all pledging to do their part towards finding refugees a home here in Camden. They intend to do this by talking to landlords and encouraging them to rent their houses to the government for refugees as well as attending Citizens UK rallies later in April.
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faqs and misconceptions myths,
cal and surgical conditions to help keep
UCL is currently only one of two uni-
your ‘book work’ knowledge up to date.
versities in the UK to offer a formal
New for this year, there are tutorials
MBPhD programme. This unique
with Dr Marks every few weeks, where
programme offers research-inclined stu-
we each get given a real-life case in ad-
dents the opportunity to take time out
vance. We then discuss how we would
of full-time clinical studies to pursue an
like to proceed with specific questions
extended period of research in the form
in the history, clinical examination,
of a PhD. This means students follow-
investigations, work-up, and short and
ing the programme will graduate with
long-term management. There is also
MBBS, iBSc and PhD degrees.
the opportunity to get involved with
–
rums research
p r o g r a m m e m b p h d u c l
WHAT IS THE MBPHD PROGRAMME?
the on-call team at UCH whenever you WHEN DO STUDENTS UNDERTAKE THE
want, and this offers a great opportunity
PHD PHASE OF THE PROGRAMME AND
to keep your independent clerking up to
HOW LONG DOES IT TAKE?
scratch. The clinical teaching delivered
There have recently been some changes
as part of the programme is certainly in
to the structure of the programme, and
line with - if not better than - the best
all students are now expected to enter
teaching which I received as part of 4th
the PhD part of the programme after
year. Besides a couple of random SBA
year 4 of the MBBS course. This means
facts which I may have forgotten, I do
that they will have already completed
not feel that my clinical knowledge has
pre-clinical years 1 and 2, along with
suffered as a result of pursuing the MB-
their iBSc year and first clinical year.
PhD. In fact, if anything, the excellent
The PhD phase then typically takes 3
clinical teaching is one of the best as-
years to complete, before students re-
pects of the programme!
turn to complete MBBS years 5 and 6. In total, the programme is therefore ex-
ALL THIS EXTRA TIME SOUNDS EX-
pected to take 9 years to complete.
PENSIVE, HOW IS IT THE PROGRAMME
DO I HAVE TO DO MY PROJECT IN THE
There are 3 aspects to the funding of
SAME LAB AS MY IBSC?
any PhD.
FUNDED?
Absolutely not! You do not need to choose your project until after you have been accepted onto the programme.
t h e
article by richard bartlett
Ever considered taking an MBPhD, or even know what it is? RUMS Review research editor and MBPhD student Richard Bartlett explores the programme, dispelling myths and explaining potential career benefits along the way.
Some people do indeed choose to con-
1
Bench fees – the money that goes your lab to pay for materials to allow you to conduct your research,
tinue projects from their iBSc, however, this is by no means expected. In fact, where the programme funds you personally - rather than a specific project as
2
Tuition fees – the money that goes to UCL to pay for the services provided by the Doctoral School.
with other PhDs - you are pretty much free to apply to any supervisor within
Stipend – the money that gets
UCL. This gives you great flexibility and
paid to you directly for living
choice in selecting your supervisors and project, since you can apply for projects
3
costs (akin to student finance e.g. a wage).
across all the UCL laboratories and specialist hospitals, in addition to affiliated
Although the programme organisers
organisations such as the NIHR and
cannot guarantee funding per se, to date
Cancer Research UK (both hosted at
there have been no instances where the
The Francis Crick Institute).
programme has not managed to fund MBPhD students in their entirety. This
WILL I FORGET ALL MY CLINICAL
means that pursuing the MBPhD pro-
KNOWLEDGE DURING THE 3 YEARS OF
gramme will not cost you a penny, nor
THE PHD PHASE?
will you have to repay any of it once
Unlikely! In recent years the programme
you graduate (as you would do with a
has really ramped up the amount of
student loan). All in all, this means that
clinical teaching which is on offer. Typ-
the programme should be financially
ically, there are 2-3 bedside teaching
accessible to anyone and financial wor-
sessions per week with consultants or
ries should certainly not be a barrier to
registrars - including the legendary Dr
applying.
Daniel Marks! In addition, there are also sit-down seminars covering core medi-
15
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“students
o
o n c e p t i o n scored top i the mbphd?
The programme puts you ahead of the game in terms
You will be-
of academic career progression – it means you are
come out of
able to apply for post-doctoral positions and re-
sync with your
search fellowships at an earlier stage than your
year
peers in the clinical academic training pathway.
group.
This was initially something I wor-
It offers 3 years to consolidate clinical knowl-
ried about, howev-
edge in an intimate and personable teaching
er, after seeing the
environment with some of the best clinicians
strong cohort spirit
at UCL.
amongst
current
MBPhD students, I You will re-enter clinical medicine highly
became much less wor-
research literate, meaning that you are
ried.
more likely to be asked to help ward
Maintaining
teams in performing research/audit.
phase comes at a cost – this
A number of specialties now require
can mean evening teaching
post-graduate qualifications such as
and early starts.
PhDs/MDs to progress to consultant level, and so undertaking a
An early PhD is not a ‘golden
PhD now as part of the well-sup-
ticket’ to securing clinical ac-
ported, integrated, and fully
ademic jobs – you will still have
funded programme is a very
to do all the other things required
appealing prospect.
for a training number. Nevertheless, 3 years of full-time research under
Doing a PhD now means
your belt will certainly help you to se-
that you do not have other commitments such as family/mortgages
and
so you are more likely
cure a competitive portfolio of peer-reviewed publications and conference presentations.
to be able to concentrate on producing high-quality research without other pragmatic barriers.
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knowledge during the PhD
16
disadvantages
advantages
what are the advantages and disadvantages of the
program
ften
have
the
misc
-
that they need to have n their year to apply to me
.”
should lower results automatically exclude you.
There is typically an information open day in
Rather, it would seem that the programme or-
mid-January and applications must then be
ganisers are looking for those students with a
submitted by mid-February. The application
genuine enthusiasm in their subject area, a good
requires you to submit a CV, application form,
all-round understanding of the scientific meth-
and two academic references. The application
od, and an honest desire to inform and improve
form is quite comprehensive and often includes
clinical practice through translational research.
a reiteration of what might be included on your
Of course, it is impossible to say with certainty
CV. There are specific sections on previous
exactly what the programme is looking for, but
qualifications, prizes, research projects, special
these were the main things which seemed to be
interests, extracurricular activities, positions of
asked about in my interview.
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WHAT IS THE APPLICATION PROCESS LIKE?
responsibility, and your practical experiences of medicine. There is also a 1-page personal
WHAT IS IT LIKE BEING AN MBPHD STUDENT?
statement to detail your reasons for applying
So far I have thoroughly enjoyed being a part
to the programme and for you to outline any
of the MBPhD programme. In particular, it
potential areas of research interest. People often
has been great to be able to pursue research to
have misconceptions about the latter, thinking
a higher level and with a greater level of inde-
that you need to have a specific project in mind.
pendence and autonomy than was afforded at
This is certainly not the case, and this section
iBSc. Equally, it’s also been really refreshing to
of the application is just for you to express an
learn clinical medicine without the constant-
interest in a particular area. For instance, I just
ly looming threat of exams. This has meant it
stated how I was interested in exploring the use
has been possible to learn topics properly and
of tissue-engineered and regenerative medicine
to a deeper level, rather than the usual mantra
strategies to repair the damaged central nervous
of cramming information during rotations in
system.
preparation for what is likely to come up in the
After submitting the application, shortlisted
end of year OSCEs and SBAs. Moreover, all the
candidates are then required to attend an inter-
people involved in the programme are nothing
view around mid-March and hear back whether
short of fantastic, and I feel incredibly well-sup-
they have been successful or not very shortly
ported, both in terms of my research and in
after. Generally speaking, you can either apply
maintaining my clinical knowledge. Further-
to the programme in your iBSc year or 4th year.
more, due to a long-standing arrangement with
The only exception to this is for projects hosted
the annual UCL Clinical Prize Lecture, last year
at The Francis Crick Institute, where, because
we were all fortunate enough to go for coffee
of an additional internal interview, you must
with the pioneer of somatic nuclear transfer
be accepted onto the programme during your
(cloning) and Nobel Prize winner, Prof Sir John
iBSc year.
Gurdon. This was an amazing experience, and not one I ever could have anticipated a year ago!
IS IT ONLY PEOPLE WHO ARE TOP OF THEIR YEAR WHO GET A PLACE?
Overall, the programme offers a fantastic and
Students often have the misconception that
unique prospect for anyone hoping to pursue a
they need to have scored top in their year to
clinical academic tract, and given the excellent
apply to the programme. It’s probably fair to
support and opportunities available through-
say that most applicants will have competitive
out, I would strongly encourage anyone inter-
academic results, however, these do not equate
ested to apply.
TESTAMENT // DR JOEL WINSTON
to an immediate place on the programme, nor
For young trainees interested in academic careers, it’s hard to know when is the right time to break from the clinical treadmill and take the plunge into a research degree. My experience of taking that plunge early and completing my MBPhD at UCL was a highly positive one, and one which continues to contribute to my academic progress. My PhD research was entirely pre-clinical and concerned the functional neuroanatomy that underlies human face perception. For me, doing an MBPhD meant the freedom to conduct research at a career stage when my ideas were still fresh, and allowed a depth of training in research methodology that is perhaps harder to attain later on. Additionally, it meant that I went back to full-time clinical training more mature, better equipped to evaluate evidence, and with a proven academic record (early publications, talks and other evidence of impact) that has helped me at every single subsequent career point.
For sure, there are downsides - it’s always going to be harder work to do a PhD than not to do one! The juxtaposition of finishing one’s PhD as the world expert on an (admittedly small) area and returning to being another one of 400 anonymous medical students is quite tough. Completing the clinical aspect of the course without any substantive scientific productivity is also a challenge, as can be re-entering into a different peer-group.
15 years after starting on the MB PhD programme, I am now pursuing post-doctoral research funded by the Wellcome Trust MBPhD Postdoctoral Research Fellowship. This has allowed me to build on the technical foundations laid during my PhD research as well as learn new research techniques, and tackle questions of much greater clinical relevance. I am also reaching the end of my clinical training in neurophysiology. Admittedly, there are other paths that would have got me where I am today, but I think that pursuing the UCL MBPhD programme was definitely the right one for me.
Useful additional information: www.ucl.ac.uk/mbphd
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vol.
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III
THE
OPIOIDS
H Y POT H E S I S
IN
I N S E N S I T I V I T Y T O PA I N . When mice are genetically
‘ M U LT I P L E OF
A LC O H O L I C
HIT’ NON-
A
NOVEL
TRIALS
IN
NOVEL
T R E AT M E N T O F D I F F U S E
UCL researchers found
SYSTEMIC SCLEROSIS.
I M P R O V I N G A U TO M AT E D
ACUTE KIDNEY INJURY (AKI)
that clerking improved in
Patients with established
Non-alcoholic fatty liver
almost every section, after
diffuse systemic sclerosis
To improve on the current
a loss of function in
disease
a series of interventions
were given an intervention
system used by UCL
their
SCN9A
gene,
the accumulation of fat
that
of hyperimmune caprine
hospitals to monitoring
the
subsequent
loss
in the liver of patients
clerking pro forma, a
serum
to
AKI alerts, a study on
sodium
who do not consume
guide to clerking written
determine
safety
and
patients’ outcomes found
excess alcohol, of which
by final year medical
tolerability.
This
the
understanding
students, and new lectures
was shown to be not
bicarbonate
correlated
to pain. This loss leads
its
development
with
mortality
to an upregulation of
progression
an
described by a ‘two-hit’
a
specific
channel congenital
results
in
insensitivity
endogenous
opioid
LIVER DISEASE. (NAFLD)
has
is
of and been
included
an
a
new
integrated
(AIMSPRO)
agent
ALERTS.
that
levels
of
only clinically safe, but
with
also
potential
and a greater chance of
introduced.
improvements in patients’
being admitted to the
mean Modified Rodnan
ICU. AKI alerts can detect
Skin
these
hypothesis.
Researchers
significantly to the pain
from UCL, however, have
SPECIALITY
insensitivity.
created a new model to
C O N S I S T E N C Y.
CHOICE
describe the pathogenesis
Students
of NAFLD: the ‘multiple-
penultimate
hit’ hypothesis. This new
medical
model may potentially
asked
+
showed
Score,
examination
in
their
clinical
levels
of
serum
technique,
bicarbonate and add them
suggesting clinical benefits.
to the patient’s clinical
of
report automatically. This
were
suggests these alerts can
specialty
be used to predict which
be used to help elucidate
they were interested in
patients are at higher risk,
the
mechanisms
as a career, and then
and ensure these patients
NAFLD,
followed up two years
receive
in
turn
later with a questionnaire
sooner.
inform new therapeutic
to see which specialty they
interventions
as
actual chose. It was found
targeted pharmacological
that only 65% of specialty
treatments.
choices were consistent,
which
in will
such
school which
with
post-graduation
experiences
significantly
influencing
people’s
decisions.
18
year
a
higher
venous
focus on clerking were
system, that contributes
involved
review
TO
modified and there is
of
rums
W AY
IMPROVE CLERKING.
F AT T Y
UCL RESEARCH DEPARTMENT OF INTERNAL MEDICINE
UCL RESEARCH DEPARTMENT OF INFLAMATION
UCL ACADEMIC CENTRE FOR MEDICAL EDUCATION
UCL WOLFSON INSTITUTE FOR BIOMEDICAL RESEARCH
UCL RESEARCH DEPARTMENT OF LIVER + DIGESTIVE HEALTH
rums research
ROLE OF ENDOGENOUS
interventions
UCL RESEARCH DEPARTMENT OF RESPIRATORY MEDICINE
UCL RESEARCH DEPARTMENT OF NEPHROLOGY
UCL RESEARCH DEPARTMENT OF METABOLISM + EXPERIMENTAL THERAPEUTICS P O T E N T I A L
P R O T E C T I O N
CHANGES
PREVENTION
A
THE
F E TA L
OF GROWTH
R E S T R I C T I O N THROUGH
GENE
G
A
I
N
S
T
IN INCIDENCE,
P R O G R E S S I V E
PREVALENCE,
KIDNEY DISEASE.
M O RTA L I TY
By reducing metabolism of
AND OF
B RO N C H I E CTA S I S.
asymmetric
Bronchiectasis is a chronic
Researchers at UCL have
dimethylarginin
respiratory condition that
been experimenting with
(ADMA), an inhibitor of
results in persistent airway
using gene therapy to treat
nitric oxide synthesis, a
infections.
fetal growth restriction,
study has shown that this
to 2013, a cohort study
failure of the fetus to reach
decreased
renal-specific
of the UK population
its full growth potential.
ADMA metabolism has
revealed that for each year
In a guinea pig animal
led to protection against
during this period, the
model, researchers have
progressive
incidence and prevalence
shown that by using gene
function decline.
T H E R A P Y.
therapy
to
target
the
kidney
From
2004
of
bronchiectasis
the
population
in grew.
maternal uterine artery,
Bronchiectasis
it increases the weight of
associated
is
the guinea pig at birth.
mortality,
This suggests that this
these
therapy may play a role
an important place in
in preventing human fetal
providing patients with
growth restriction.
the appropriate clinical
with
also higher
and
increases
so have
care.
RESEARCH ROUND-UP WORDS BY ENG O-CHAROENRAT ILLUSTRATIONS BY KATE ALICE MACKENZIE
19
vol.
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alumnus interview
Hugh Montgomer y WHAT WAS YOUR EXPERIENCE OF UNIVERSITY LIKE?
What I remember of Medical School is of great parties, lots of sport, Christmas shows and all sorts of other things…I probably had to work quite hard, but you don’t remember that! Imagine being lectured by people
like Eric Neil who discovered the carotid sinus; 78 of us, always hungover!
Hugh Montgomer y
I was in the rugby social team, ‘the dead ants’ (when it was almost clear we were going to concede, everyone would throw themselves on their backs, wave their arms and legs and then let them score!) and I was an MD - we
had our own theatre back in the day, the Edward Lewis theatre. It had a professional stage and sound system. At the time, the head of EMI, the
big record label, had been shot in the face nearby in Hampstead, and our Dean dug the bullet out. The head of EMI was pretty grateful and offered
to do something for the hospital, and being a great Dean, he said, ‘Why
don’t you give a load of money to the medical students?’ He didn’t, but he gave us the best EMI sound recorder for two weeks every year, so we’d have
Professor Hugh Montgomery, current director of the UCL Institute of Human Health & Performance, is both a
the guy who was recording the albums for the Rolling Stones doing the sounds for the MDs’ Christmas concert. I’ve still got my review from the Evening Standard – ‘the best entertainment in the West End!’
delight and a challenge to interview.
YOU ARE THE WORLD RECORD HOLDER FOR UNDERWATER PIANO PLAY-
To cover all of his accomplishments in
ING. TELL US THE STORY BEHIND HOW AND WHY YOU DID IT.
a single interview - let alone condense them into the mere 2 pages of A4 our printing budget allows - would be quite an achievement. From discovering the gene for fitness, to delivering the Royal Institute Christmas lectures, he appears to have done it all - spent time on Everest, written a series of children’s books, co-founded the UK Climate and Health Council, run ultra-marathons.… the list goes on. However, many of you will be familiar with Hugh from the inspiring, perception changing lectures he delivers on climate change, something he has taken a lead stance on in terms of its global health implications. Here, we delve into Hugh’s time at Middlesex Hospital Medical School, his most quirky achievements, thoughts on current affairs, how we can change the world and, finally, touch on some of his sports related research to tie in with this issues sports and exercise medicine theme - all in 2 pages!
I think I’d drunk too much beer when I agreed to do it for RAG week! [I was under for] 110 hours. It was in the John Astor House Nurses’ home swimming pool, on Foley Street – it’s probably not there anymore. It was an electric piano. I think the record before that was pretty short because pianos packed up, so as it turns out it wasn’t too difficult! We raised 17 and a half grand for the first portable ultrasound machine in Britain, which was about the size of a small car. Chris Tarrant used to present the Capital Radio Breakfast show, which was a big thing in London when I was a student. He decided we had to surface on the breakfast show, so we added an extra 10 hours to our 100 hour goal to surface live on radio! HOW DID YOU EAT, DRINK, SLEEP, ETC.?
[I slept] a bit, but I was largely awake. You are allowed five minutes an hour outside for a Guinness book of records endurance attempt, and you can stack them up so that you can have half an hour every 5-6 hours. HOW MUCH “OTHER STUFF” DID YOU CONTINUE DOING AS A JUNIOR DOCTOR? ARE CONDITIONS STILL THE SAME?
Not much. There wasn’t much time for doing other things. I swapped some sports like diving for things I could do quickly like skydiving, but I did go back to writing. I used to write with a guy called Rich - now head of discovery for Respiratory Medicine at Glaxo [GSK]. We wrote a bit for telly when we finished – I got my telly-writing career largely through that. We ended up writing a show some years later, where I met my wife, oddly enough – she was an MD too. I think junior doctors have a much worse time now. It sounds odd, given that we were working 160-hour weeks, but we had a much better life! Everyone was nice to us – if you got to casualty, you’d say, ‘I’m really sorry I kept you waiting,’ and patients would say, ‘Don’t worry, Doc, I know you’re busy,’ whereas now you get, ‘I know my ----ing rights!’. IS THE HEALTH SERVICE VIABLE IN THE LONG TERM?
In it’s current form? No, not at all. WHAT NEEDS TO CHANGE?
It’s prevention. We’ve got my generation getting old: loads of us with comorbidities, all living longer. Our care pathways are complex; we, the public expect more and more, and the number of you paying taxes is less and less. That’s a completely unsustainable system and we have three models: one, there’ll be efficiency savings – well, we’ve trimmed the fat to the bone
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On a bigger political scale, it’s about voting. It shouldn’t be that old people
keep spending money,’ that’s not going to work either. The third is you pri-
determine the policies of this country, but at the moment that’s what it
vatise it in one of two ways: either going public, which no one will do be-
is, when it should be dictated by you. Students understand things like
cause that’s toxic, or you do it through the back door – I think that’s what’s
social media, which got Obama elected. You can do extraordinary things
happening now. But there is an alternative – a lot of what we treat now
with social media - if you want to make it the way such that young people
is entirely preventable by public health policy. The health service is about
influence elections, you can.
alumnus interview
“When you get older, you realise that if you really wanted to change the world and you had a skillset to do anything you chose to do, you wouldn't do medicine. You would do politics or economics, because the drivers of ill health remain as they always have; poverty, inequity, conflict… as well as the environment.”
y
now. The second is a sort of, ‘oh no, the election will vote us out, we’ll just
treating diseases, and most of what matters in health isn’t in health at all, it’s in transport policy, it’s in alcohol and cigarettes, taxation, employment
YOU DISCOVERED THAT THE ALLELE FOR THE ACE GENE AFFECTS
and social equality. These are the things that determine when you get sick.
PHYSICAL FITNESS, THE FIRST DISCOVERY OF A FITNESS-RELATED GENE. WHAT DEVELOPMENTS HAVE YOU SINCE MADE IN THIS RESEARCH?
YOU STRONGLY SUPPORT PREVENTATIVE MEDICINE. HOW DID YOU COME TO CHOOSE ITU THAT IS SO FAR AT THE OTHER END OF THAT SPECTRUM?
It has got very interesting; it seems to have taken us into looking at the regulation of mitochondria. We realised that [the ACE gene] was linked to the regulation of oxygen consumption and then we started getting data
I like complexity and I like biology, so my skill set is better suited to in-
that suggested it was regulating efficiency of the use of oxygen. I remember
quisitive stuff. I would much rather deal with something here and now,
suddenly having the epiphany, realising that we were focusing on oxygen
where I have to make quick decisions. When I was at medical school,
delivery and that actually there were two other elements to it. You could
psychology and sociology made me think: “this is woolly nonsense, give
either, if you were short of oxygen, deliver more, or you could use less
me the big red thing that makes your hair fall out, that’s proper medicine!”
by switching things off or use less by improving their efficiency. Biology
But when you get older, you realise that if you really wanted to change the
is generally fairly straightforward - if you think of a really obvious way
world and you had a skill set, you wouldn’t do medicine. You would do
round, usually that’s the way it has evolved. So we held a meeting called
politics or economics because the drivers of ill health remain as they always
‘give and take’. We just got all the ‘big cheeses’ together up in Windsor,
have; poverty, inequity, conflict… as well as the environment.
at Christopher Wren’s old house, and it was the first time, I think, it had been put together: ‘is it possible that oxygen use is not just about delivery
WHAT FIRST INTERESTED YOU IN THE EFFECTS OF CLIMATE CHANGE
but about consumption, switching off and efficiency?’ That then led onto
ON HEALTH AND WHAT MADE YOU SEE THAT THIS IS SOMETHING THAT
Everest-related work and we were right, that is how you adapt hypoxically.
NEEDS INVESTIGATING?
It was accidental. I was doing molecular research in the 90s and I would
In terms of genetics of exercise, there’s a bunch of genes - though not
be looking up a paper [in Nature] and right next to it there would be
that many - we [UCL Institute for Human Health and Performance] have
something about a new fossil hominid, or a black hole or something that
published a couple, but is it good enough to select your athletes with yet?
made you think ‘ah, that looks a bit interesting’, you know what it’s like
No, it’s still better to watch kids playing on a football pitch than to try and
when you’re looking through a magazine. The general media line at the
select them genetically.
time was “there’s no such thing” or “maybe it’s getting colder” and yet the science appearing, to my eye, looked pretty convincing the other way. I’ve never quite got around to making those big decisions about God etc., but climate change is one of those big decisions that you ought to make at some point in your life. So I spent a few years trying to learn about it, to form my own opinion really and soon realised that it was that bad. The
MUCH OF YOUR RESEARCH INVOLVES DOING SOME REALLY FUN THINGS, LIKE CLIMBING EVEREST, MANY OF WHICH ARE SIMILAR TO YOUR INTERESTS OUTSIDE MEDICINE. WERE YOU ATTRACTED TO THESE AREAS OF RESEARCH BY THESE OPPORTUNITIES OR WAS IT A COINCIDENCE?
advantage that you have as medical students is that you are so broadly ed-
Neither. If you do enough things, you can make connections that people
ucated. If you’ve done enough physics and chemistry, you can understand
who don’t do all those things can’t make. I had a minor interest in hypoxia
the implications of what is happening to our atmosphere and weather sys-
but we were doing the ACE work in performance. I went off to climb a
tems, you understand how people live and what the drivers of health are.
big hill in the Himalayas and it was quite high- above 5000 metres. One
It was peculiar that no one had done that before!
night, I got woken up at silly o’clock in the morning by this Australian nurse saying, “are you the doctor?” So I said that I happened to be one and
AS MEDICAL STUDENTS, WHAT CAN WE DO TO COMBAT CLIMATE CHANGE
she asked if I could come quickly because her friend was dying. She [her
AND OTHER BIGGER ISSUES?
friend] was indeed really trying very hard to die so I got her down the hill
A lot, is the answer. The first thing is, just remember that you are amongst
very quickly... The climb up to that height had taken me 7 hours the day
the most loved and trusted community sectors in the world, for lots of rea-
before and there was a storm coming in so I thought “either I stay here
sons. Not just because you’re going to be doctors, but also because you’re
and I get stuck, or I go up but if I get caught in the storm I’m completely
young. People love young people! You’ve got a voice, a traction in a way
on my own without a tent, this could go horribly wrong.” As I was going
that many people are denied.
up I could see it [the storm] was coming in quite quickly but I got back up in a little under 40 minutes on a route that had taken me over 6 hours
There’s the political and professional, which relates to what you are doing
the day before. Admittedly a bit of adrenaline helps but it was then that
as students and that’s talking to people, saying “we don’t want it to be this
I thought, “hang on, this can not have been done by adaptation through
way, we want it to be a different way” and proposing solutions - “we’d like
increased delivery, which is what I had been told at medical school, it’s
to see UCL drop its carbon emissions by 20%. We will bully you”, because
just not possible, it cannot be that way. Something has changed about the
a big part of the role of students is to demonstrate and demand. Everyone
way I’m using oxygen because I’m not breathing any harder (I might have
I know in senior management at UCL is a really delightful, open-minded
been but it’s a marginal increment) and I can’t have an increased red cell
individual and they are on your side in a very big way, even if they can’t be
mass within 12 hours!” That made me realise it’s about use, not delivery.
quite as demonstrative.
Of course it’s a combination of the two, a happy circumstance that you end up finding these things.
21
vol.
I,
no.
III
article by enny s. paixão
the
spread
for
the
to
americas
olympic
games
and in
the
implications
brazil
Amidst eager anticipation of the 2016 Olympic Games, the Zika virus outbreak has taken the world by surprise. Questions surrounding the virus’s transmission and its contributions to birth defects are abound, while researchers are fervently working to find a vaccine. Here PhD candidate Enny S. Paixão, from London School of Hygiene and Tropical Medicine, outlines what is currently known about the virus and its transmission, and describes the measures taken to keep further spread to a minimum leading up to the Olympics.
rums
review
Zika is a mosquito-borne disease, not ob-
agents and are very difficult to control, so
served outside Africa and Asia regions until
vector-borne diseases that once were restrict-
an outbreak was reported in Micronesia in
ed to some areas are now apparent in several
2007. In the last three years, this disease has
previously unaffected regions. Zika is one
emerged in French Polynesia, Cook Islands,
such disease. The first evidence of humans
and more than 20 American countries - fuel-
infected with Zika is from 1952 and since
ling concern as its link to severe birth defects
then this disease circulated almost silently
and neurological syndromes becomes more
until 2007, when there was a large outbreak
probable.
in Yap, Micronesia.
The emergence or re-emergence of some in-
Outbreaks of Zika have a high rate of trans-
fectious diseases has been changing the epi-
mission, estimated at 73%, and a high rate
demiological pattern in many countries – es-
of asymptomatic disease, with just one in five
pecially the emergence of diseases caused by
infected patients developing clinical symp-
virus transmitted by mosquitoes of the genus
toms. When symptoms occur, they generally
Aedes (Stegomyia). These vectors have great
are characterised by acute fever, rash, arthral-
ability to transmit a number of infectious
gia, conjunctivitis and oedema. According to
22
illustration by kate alice mackenzie
articles
ZIKA
to ensure that the athletes are receiving med-
pitalisations and deaths are rare. Before the
ical advice along with information on mos-
outbreak in French Polynesia and Brazil the
quito bite prevention strategies.
articles
information from previous outbreaks, hos-
symptoms of this disease were described as mild and limited to the individual. However
However, Brazil’s decision to go forward with
more recently Zika has aroused the fears of
the Games is not unanimously accepted.
the society and public health authorities be-
Arthur Caplan from New York University
cause it is suspected of causing microcephaly
insists that it would be reasonable to post-
in several infants born to women who were
pone the games for at least 6 months, or even
infected during pregnancy. Guillain-Barré
cancel them entirely. Caplan and Igel argue
syndrome has been linked to Zika outbreaks
that young women cannot travel to Brazil
as well. However, more studies are required
safely and that men who are sexually active
to prove a causal relationship between Zika
could transmit the disease to a partner. They
and microcephaly and Guillain-Barré syn-
insist that it would be irresponsible to host as
drome, as well as the spectrum of outcomes
important an event as the Olympic Games
that could be associated with this disease.
during a public health emergency of international concern. The US Centers for Disease
The Zika virus (ZIKV) was detected in Bra-
Control and Prevention advised pregnant
zil for the first time in early 2015 and later
women to avoid travelling to countries af-
in the same year epidemiological evidence
fected by Zika.
suggested that ZIKV infection of pregnant women in Brazil might be associated with the
There is no information about the extent to
increasing numbers of microcephaly. Despite
which an international event like the Olym-
the connection between ZIKV and congen-
pics could contribute to the spread of Zika.
ital defects, according to the World Health
Travellers could be infected during the event
Organization (WHO), athletes and sports
and introduce the virus in their home coun-
fans should not fear travelling to Olympic
tries, and imported cases might result in lo-
Games in Rio de Janeiro this August. A study
cal transmission and spread the virus in areas
that analysed the risk of dengue during the
that have the appropriate mosquito vectors
2014 FIFA World Cup in Brazil showed that
already.
football fans were unlikely to get dengue dur-
1
To increase the evidence of infection and
2
To develop a serological test – the test avail-
potential outcome
ing the competition period, because dengue
The current situation with regard to Zika
is a seasonal disease and during the dry sea-
is challenging, and according to Margaret
son its incidence decreases and the density of
Chan, the head of the WHO, ‘things may
cases becomes residual even in North-East-
get worse before they get better’. There is no
ern Brazil, the epicentre of the outbreak. The
vaccine, no treatment, and no commercial-
study found that in Rio de Janeiro, located in
ly available serological test. The only way to
south-eastern Brazil, risk of dengue infection
prevent Zika is to avoid mosquito bites and
is close to zero. As Zika is transmitted by the
even this does not remove the challenge of
same mosquito as dengue, a low risk of tour-
vector control. The Brazilian Minister of
ists and athletes contracting Zika infection
Health warned that the country is badly
can be assumed as well. According to some
losing the battle against the mosquito. To re-
public health experts the fact that the games
duce the risk of spreading Zika, attendees of
are held in a single city during a cold and dry
the Olympics Games should take additional
month means that the risk of Zika will be
care and try to minimise their exposure to
reduced to an acceptable level.
mosquito bites.
involved in the infection, but current events
To assure the safety of travellers, Brazilian
There are more questions than answers about
cine.
authorities have announced plans to prevent
Zika, but scientists from different areas
the spread of Zika during the games, and the
are working to fill these gaps. Barreto et al
British Olympic Association will be moni-
(2016) suggested six central components to
toring the situation over the coming months
achieve success in battling Zika:
able now is the detection of viral RNA, which is present during viraemia
3
To control infestation by Aedes mosquitos
4
To define protocols for treatment
5
To develop a vaccine – because Zika is an emerging disease there is a lack of information about the immunological mechanisms have expedited the development of a vac-
6
To reprogramme the health-care system
For a full list of references, please visit: www.rumsreview.co.uk Despite the connection between ZIKV and congenital defects, according to the World Health Organization (WHO), athletes and sports fans should not fear travelling to Olympic Games in Rio de Janeiro this August. The New England Journal of Medicine has recently published a paper which confirms that the relationship between pregnant women contracting the Zika virus and babies born with microcephaly and brain abnormalities is causal: Rasmussen S, Jamieson D, Honein M, Petersen L. Zika Virus and Birth Defects — Reviewing the Evidence for Causality. New England Journal of Medicine. 2016;
23
vol.
I,
no.
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articles
WITH AN INTERVIEW
DR.
DAN BROMAN the field of sports and exercise medicine
(sem)
is the latest medical specialty to be recognised by the royal college of physicians. it is a highly dynamic
specialty
athletes,
but
that
rather
doesn’t has
a
treat
elite
preventative
just
focus
with an aim to improve the general health of the public. doctor daniel broman speaks to rums review about this evolving specialty.
who need to increase their level of exercise, and elderly women who have had fragility fractures and need help to reduce their risk of falls. We try to target mostly those who are sedentary and get them to incorporate a little bit of exercise into their everyday life: the Department of Health Hi Daniel! Thanks for talking to us!
recommends moderate exercise five times per week for thirty minutes.
Please introduce yourself. No problem. I’m a Sports and Exercise
Where did you study?
Medicine registrar in London, currently
I did five years at Birmingham Medical School and did my elective in
working out of the Whittington Hospital.
Sports Medicine in Sydney. I also worked in a Sports Medicine clinic.
I also work for the Football Association
Before my elective I wasn’t too sure about what specialty I wanted to
(FA) for the England Under 18 football
choose. I had considered Accident and Emergency which is a great
team as a team doctor, and for Reading
specialty but I also really enjoyed my elective. I did my Foundation
FC as a Doctor alongside Bhavesh Kumar,
Training in Mersey Deanery at Leighton Hospital. Then, I decided to do
who also works at UCLH. Bhavesh is my
Core Medical Training, which I did in London. After my core training
consultant supervisor for the work that
I did a full-time master’s at UCL Institute of Sport Exercise and Health
I do at Reading because anything that
(ISEH) in Sports Medicine, Exercise and Health.
is done outside of the NHS training programme has to be supervised by a
Brilliant. How was taking a year out to do a master’s degree after
consultant, just like in an NHS hospital. I
having worked as a doctor for two years?
also sit on the Royal Society of Medicine
It was great. At first it was a bit strange to go back into education but
Sports and Exercise Council and I am
a lot of my colleagues were in similar stages in their career as they had
the co-chair on the Junior Doctors
just completed either foundation training, core training or were GPs.
Committee for the European College of
The professors at UCL were brilliant. I would definitely recommend this
Sports and Exercise Physicians.
course to anyone thinking of doing SEM. I did have some time to keep up with my clinical practice and support myself by doing some locum
Wow, so you’re very busy then.
work. I also had time to do some work for the FA with the under 18s,
Yes, it’s good to be involved in those kind
where we played Holland, Poland and Russia away games.
of things. I have a passion for football medicine.
Why are you so passionate about Sports and Exercise Medicine? Exercise is extremely important to prevent illness and injury. An example
How would you define Sports and
of this was demonstrated in a paper that I read recently, which suggested
Exercise Medicine?
that regular moderate physical activity can reduce blood pressure by
It is a small specialty which can cater
12/5 which is a bit better than most single therapy antihypertensive
for anyone and everyone. We assist
treatments.
elite
rums
review
athletes
who
are
undergoing
rehabilitation, as well as patients in their
Do you play sport yourself?
fifties with hypertension and diabetes
Yes, I play football and tennis, and enjoy swimming and going running.
24
articles
2 words by fabianne viner, mbbs year
Could you describe a typical week in the life of Dr
What is the most difficult aspect of your job?
Broman?
My work in elite sport is probably the most difficult, be-
I am on an orthopaedics rotation at the Whittington Hospital at the moment, but within this I have lots of flexibil-
cause you are working under time pressures where the ath-
ity to meet my learning needs. On a Monday morning I
letes are rushing to get back to physical activity. You get
do a musculoskeletal ultrasound clinic with a radiologist.
pressure from the players themselves who want to return
On a Monday afternoon I do a foot and ankle clinic with
back to sport and from the coaches who want their players
an orthopaedic surgeon. On Tuesdays I work at a fracture
to be available. Sports people are high achievers and see
clinic followed by a knee clinic. OnWednesdays I do a
the injury as a massive block. There are lots of non-clinical
cardiology clinic, where I treat a lot of arrhythmias and
skills that come into this – for example communication
see patients with chronic cardiac problems and explain the
skills, being honest and dealing with people.
“ REGULAR MODERATE PHYSICAL ACTIVITY CAN REDUCE BLOOD PRESSURE BY 12/5 WHICH IS A BIT BETTER THAN MOST SINGLE THERAPY ANTIHYPERTENSIVE TREATMENTS. ”
benefits of physical activity to them. Then, on Wednesday afternoons, we have our specialist registrar teaching. On
Could you give an example of a hot topic in sports and
Thursday I do a rheumatology clinic and in the evenings
exercise medicine?
I practice at the Isokinetic clinic which is a private sports
Currently, concussion is a hot topic in SEM. There was a
medicine clinic on Harley Street, where I do some phys-
lot of talk about it during the Rugby World Cup. In foot-
iological testing. This includes maximum threshold tests
ball you must remove the player from the field of play if
and isokinetic tests. Friday mornings are spent at Reading
they have a concussion. The risks of concussion are high –
FC, where my role is a lot more focused around General
it’s a brain injury and it’s something that is not visible un-
Practice.
like a broken leg. It can be subtle but the risks are danger-
“ I ALSO LIKE THAT YOU ARE USUALLY WORKING WITH
PATIENTS WHO WANT TO RECOVER QUICKLY. RUNNING ON A
PITCH IN FRONT OF 40,000 PEOPLE IS UNUSUAL – WE ARE CERTAINLY NOT TRAINED TO DEAL WITH THIS IN MEDICAL SCHOOL.”
ous. There’s been some reported evidence in the NFL that Would you agree that Sports and Exercise Medicine is a
repeated head injuries could increase your risk of chronic
very varied specialty?
traumatic encephalopathy, which is a degenerative neuro-
Absolutely. For example, the female athlete triad is a health
logical disorder, so concussion must be treated properly.
concern for active women who are driven to excel in sports
You must give the athlete time off work to recover.
such as athletics and gymnastics. It involves three distinct and interrelated conditions: disordered eating, irregular
What’s the single best thing that we can do for our
or absent menstrual periods and end stage osteoporosis
heath?
which leads to low bone mass and risk of fractures. We
There’s a great video on YouTube by Dr Mike Evans which
work alongside rheumatologists to improve bone health.
talks about the importance of physical activity. It’s called
However, you are a specialist in treating musculoskeletal
23.5 hours and describes how we should only be sedentary
injuries and using exercise to treat them. The cardiologists
for 23.5 hours a day as there is great evidence that physical
take the lead on the cardio problems but we still carry out
activity helps in physical, mental and sexual health.
“ YOU GET PRESSURE FROM THE PLAYERS THEMSELVES WHO
WANT TO RETURN BACK TO SPORT AND FROM THE COACHES WHO WANT THEIR PLAYERS TO BE AVAILABLE. ”
cardiac screenings. What advice would you give to medical students interWhat is the best thing about working in Sports and Ex-
ested in SEM?
ercise Medicine?
Get involved. Think about doing your elective in SEM.
I like that it’s a small but important specialty. I am grateful
When you’re a junior doctor you could volunteer at the
that I am able to work for the FA and travel and see things
London Marathon. Email people that are involved in
that the average doctor would not. For example, I recently
SEM, put yourself out there. Go to the meetings arranged
went with the England under-17 team to the World Cup
by the London Sport and Exercise Medicine society. At-
in Chile and we visited local schools in the area. I also like
tend conferences. Join the British Society of Sport & Exer-
that you are usually working with patients who want to
cise Medicine. My advice to any medical student would be
recover quickly. Running on a pitch in front of 40,000
to enjoy medical school and to remember that there is no
people is unusual – we are certainly not trained to deal
such thing as a silly question.
with this in Medical School.
25
vol.
I,
no.
III
article by dr patrice baptiste
articles
DR. PA
-
life after
TRICE
BAPT ISTE medical school
After 6 or more years of long, hard study, our finalists have taken their exams, passed, and been judged fit for practise. Whilst an exhilarating and exciting time, for some, it can be daunting. Dr. Patrice Baptiste, UCL 2013 graduate, tells us about her time after medical school and what they should expect.
During the year 2013 I graduated from UCL, and it was one of the best days of my life. I always wanted to be a doctor and I worked so hard, day in and day out, to ensure it happened. After numerous exams and assessments I could finally say I was Dr. Baptiste; no more “Hi my name is Patrice, I’m a medical student”.
shouldering
responsibility
I was placed at Whipps Cross Hospital for my first year and I couldn’t wait to start; I was typically eager and enthusiastic. Coupled with this was the apprehension and fear of being ‘let loose’ on patients and responsible for their care. It was not until I started working as a doctor that I realised how much responsibility the role carried. I still remember my first week working in the Coronary Care Unit (CCU) - patients, nurses and other staff would ask me questions and it would take me a while to realise they were asking me. Oh, so now I’m the doctor? I’m meant to make decisions? It takes a while to get used to and as the FY1 you are the most junior person on your team and more often taking orders than giving them out! But unlike a student the patients on your ward are your responsibility, if they need investigations you have to request them, ensure they are carried out and check the results ensuring you feed back to your team and ask for help when necessary. If your patient develops a new symptom - for example chest pain, it is your responsibility to ask them more, examine them, request an ECG, a troponin level etc. It can be very scary but no matter how busy or short-staffed the hospital was, I have always been able to find someone senior to help. Whether that was my SHO, registrar, a registrar from a different team, or even the consultant, help has been there when I most needed it. So don’t worry!
rums
review
26
journey
&
articles
my
development
I think it is fair to say that as a junior you often have moments where you feel like you have absolutely no idea what is going on - lost in a heap of investigations and multi disciplinary team meetings, running to cardiac arrests, unsure what you will encounter, or worse - that you will be the first one there not knowing what to do! You may think, when will I actually feel like I know something? After almost three years I still have moments where I am unsure. It is important to remember that there is much to learn and as long as you stick to your basics, you truly will be fine. I look back at all those ward rounds I attended as a student, not being able to keep up with the various patients on the ward, lost in all the medical jargon. Then, I look back at my first day on CCU - surrounded by all the cardiac monitors beeping and the numerous jobs piling up on the ward round. I look at today, when I can confidently manage a ward, knowing what to do and how to construct a clear plan in most situations, and in the times that I don’t, knowing where and how to get help. There are so many useful resources and people to help you on your journey and it is crucial that you use them. Not sure which antibiotics to use - what about the guidelines on the intranet, what about the pharmacist or the microbiologist? I have learnt so much but I have also forgotten many of the things I used to know as a medical student. It can also be frustrating because somewhere like UCL is so academic and the wards are so clinical. I can run a ward but there are loads of things that would pop up on a ward round or in teaching and I would just think “I actually used to know that!” You spend hours revising and a few months after finals you’ve forgotten all the causes of hypokalaemia!
the
future
I spent my second year working in Southend and, whilst everyone was busy submitting applications, I decided to take a year out. There were many reasons for this: I felt that I needed a break; I had left school only to enter medical school and then started working unsociable hours which did take a toll. I also felt that I never really had enough time to fully pursue my interests outside of medicine like writing, playing the piano and long-distance running. I also was very unsure about what specialty I wanted to commit to and with the junior doctors’ contract dispute I was even more unsure about what the future had to offer. I am glad that I have taken a year out and know many other doctors who I have met along the way who are taking a year or even two out of training. Taking a break is a good thing; it allows you time to think about your next step and future choices. It also allows you to enjoy life and explore so many opportunities. I enjoy writing various articles and I have written for the BMA, BMJ, MPS, Support for Doctors Network, Medic Footprints and The Canary websites among others. I am also looking forward to a taster week at the BMJ in June. In addition, I publish content on my blog and I am working on publishing a collection of poems this year. I dedicate a proportion of my time to helping students understand more about medicine and applying to medical school and at present I am working on delivering courses for such students (if you want to know more and are interested in helping then please email me - see below). I still remain connected to UCL by being a part of the Black and Minority Ethnic (BME) alumni committee here. After my year out I plan to re-commence medical training in August via the GP programme.
do
what
is
right
for
you
There are a lot of changes going on in the NHS, and medicine is a very demanding but also a very rewarding profession. Some of you will start work and won’t enjoy it - perhaps you were ‘pushed’ into medicine or perhaps you always wanted to be a doctor but the politics, the system or other factors like moving frequently to different hospitals means you do not think it is right for you. Rather than the end of the road, this could just mean that a change of direction is in order. Some of you will love it, you’ll love the adrenaline rush, you’ll love helping people and putting a smile on their face and you will go on to be amazing doctors. I want to end by saying that our profession of choice can ultimately consume us, if we let it. As medics we are highly skilled individuals and we must not let the voices of others, or medicine itself, institutionalise or define us. We are more than just doctors and we have so much to offer whatever we choose to do with our lives!
For Patrice’s tutoring website, please visit www.dreamsmarttutors.com If you would like to get in touch with Patrice you can email her at drpatriceb@gmail.com or to read more, please visit www.infinitypages.wordpress. com for Patrice’s blog.
27
vol.
I,
no.
III
articles
dr. farah jawad Dr Farrah Jawad is a registrar in Sport and Exercise Medicine. She currently works at the Institute of Sport, Exercise and Health in London and co-ordinates the British Journal of Sports Medicine Trainee Perspective blog. Here, she outlines the considerable benefits of exercise, and why both doctors and medical schools should be talking about it more.
PRESCRIBING
PREVENTION
It has been said that exercise, if it were a pill, would be prescribed for almost
as hypertension or diabetes. Doctors, whilst knowing wide range of benefits
everyone and would be one of the most cost effective interventions available.
of exercise, perhaps do not always realise the opportunities they have in
Low cardiorespiratory fitness has been shown to be a more important risk
clinic to propagate the physical activity message and offer advice on physical
factor for all-cause mortality than hypertension, high cholesterol and smok-
activity and being less sedentary. The focus tends to be that of a disease
ing. One systematic review and meta-analysis has shown that self-reported
service rather than a health service, and perhaps that is a reason why exercise
physical activity reduced all-cause mortality by 29%. To put this into per-
prescription does not feature in many medical school curricula.
spective, the commonly prescribed ACE-inhibitor reduces all-cause mortality by 10%. Low fitness has been shown to kill more people than smoking,
Part of the problem with designing such curricula is that they are packed to
diabetes and obesity combined. Individuals exercising just 15 minutes a day
the rafters because there is so much to cover; there is always a feeling that
live approximately 3 years longer than inactive individuals.
one topic has to come out in order to fit another topic in. Perhaps the way to solve this is for lecturers to incorporate physical activity in each of their
rums
Prolonged sitting time is strongly associated with obesity, metabolic syn-
lectures on various diseases; the effects of physical activity are far-reaching.
drome and type 2 diabeties, as well as cardiovascular disease and cancer.
Physical activity is beneficial in a number of diseases and normal physiolog-
It is also associated with total mortality independent of daily moderate to
ical states, including: fibromyalgia and chronic pain syndromes, osteoarthri-
vigorous intense physical activity. What this means is that it is better to be
tis, pregnancy, obesity, mild to moderate depression, diabetes mellitus types
frequently active throughout the day rather than to exercise once a day for
I and II, cardiovascular disease and chronic obstructive pulmonary disease.
an hour and spent 16-hour days sitting. This message is important to get
Being more physically active does not mean being sporty, and does not re-
across to patients as it has significant health implications.
quire special equipment or expensive gym memberships. People can make
Most people presenting to their GP have a non-communicable disease, such
even the smallest changes to their lifestyle – taking the stairs instead of the
review
28
articles
words by dr. farah jawad
photo by jessica nash
lift, getting off the bus a stop earlier and walking, for
of exercise as they have different positive effects, for
example – which can help to contribute to an overall
example, aerobic exercise for cardiovascular fitness
increased level of physical activity.
and muscular strength for mobility and falls preven-
The UK Physical Activity Guidelines advice for adults
tion. When tailoring advice regarding a specific pro-
(19-65) states:
gramme of exercise for a patient, you can discuss the
“THE FOCUS TENDS TO BE THAT OF A
DISEASE SERVICE RATHER THAN A HEALTH
SERVICE, AND PERHAPS THAT IS A REASON WHY EXERCISE PRESCRIPTION DOES NOT FEATURE IN MANY MEDICAL SCHOOL CURRICULA.”
FITT principles:
• Aim to be active daily. Activity should add up to over 150 minutes per week by participating,
Frequency - How many times a week to do
in at least 30 minutes of moderate intensity
the activity
physical activity on 5 or more days a week, or
Intensity – How hard to exert oneself during
in multiple bouts of 10 minutes or more.
the activity
• Comparable benefits can be achieved through
Type – The type of activity agreed with the
vigorous activity of 75 minutes a week or in
patient
a combination of moderate and Wvigorous
Time - How long the patient might partici-
activity.
pate in the activity in minutes
• Adults should also undertake physical activity to improve muscle strength on at least two
The FITT principles can help a clinician make sure
days a week.
all the bases are covered when discussing exercise pre-
• All adults should minimise extended sedentary (sitting) periods.
scription. One example of how the FITT principles can be applied is if a patient, when prompted about any particular activity they might like to do more of,
The guidance for children aged 5 to 18 is that they
mentions walking, the clinician may then suggest that
should participate in a minimum of 60 minutes a
the patient walks at a moderate intensity, so they feel
day and up to several hours every day of moderate
slightly sweaty and short of breath, for 30 minutes a
to vigorous intensity physical activity. Three days a
day, five times a week as a goal. But that they might
week should include vigorous intensity activities that
start with a lower intensity, time and frequency ini-
strengthen muscle and bone. This age group should
tially so that they can build up their fitness in time.
also minimise the amount of time spent being sedentary (sitting) for extended periods. For under 5s
In summary, exercise can be a cheap and effective way
capable of walking, they should spend a minimum
of reducing morbidity and mortality, and we need to
of 180 minutes a day playing and being active, and
address potential barriers to exercise and the reduc-
those that cannot should be encouraged to play in
tion of sedentary behaviour. Even a short discussion
safe environments and minimise time spent sitting or
with patients on the benefits of exercise is a start.
restrained.
Active children grow up to be active adults and so
One way you can bring exercise into the consultation
intervening at a young age is important. The Active
is by asking “The Exercise Vital Sign”: “On average
Movement project aims to do this by integrating low
how many days/ week do you engage in moderate or
level activity into the normal day of schoolchildren.
FOR LINKS TO THE BRITISH JOURNAL OF SPORTS MEDICINE TRAINEE PERSPECTIVE BLOG, INSTITUTE OF SPORT, EXERCISE AND HEALTH’S 5 OR 10K RACE IN
REGENT’S PARK, MORE USEFUL LINKS AND REFERENCES, PLEASE VISIT: WWW.RUMSREVIEW.CO.UK
greater physical activity (like a brisk walk)?”, then, “On those days, how many minutes do you engage in
As clinicians, it is good to lead by example. On Sun-
activity at this level?”
day 26th June 2016, why not walk, jog or run the
This helps to start the discussion about physical ac-
Institute of Sport, Exercise and Health’s 5 or 10K race
tivity and being less sedentary with patients. It is
in Regent’s Park? Perhaps I will see you there!
important to extol the virtues of the different types For a full list of references, please visit www.rumsreview.co.uk
29
vol.
I,
no.
III
D E M Y S T I F Y I N G
M E D I C A L review
best
answers
( sbas )
cording to their global rating.
Our SBA papers pass marks are set using the modified Angoff Method. In the Angoff meth-
The pass mark is where the best fit line inter-
od, a panel of faculty members who are famil-
sects the halfway point between borderline
iar with the curriculum and the standard of
pass (3) and borderline fail (2). The OSCE
the student in that year reviews each question.
pass mark is the average of each stations score.
Each panellist then estimates the percentage
clinicians throwing their reckonings into the mix too.
year, the rumour mill manages to generate the same misconceptions, often cemented by some
summative assessments. Setting of the pass mark is probably the most frequent of these. Every
Perhaps one of the most common misconceptions I end up having correct are those relating to
summative our are
- how
S C H O O L
pass
marks
set ?
articles rums
single
of ‘just passing’ students that would answer
It is possible to pass the OSCE overall while
the question correctly. Each panellist does this
failing some stations provided you have
independently. There is then moderation on
enough marks. There is no threshold for the
questions that have a range of over 40% be-
number of stations failed, leading to a fail
tween predictions. Once the probability is set
overall.
for each question, the pass mark is calculated by averaging these scores.
what happens to poorly performing or osces ? Dr Alison Sturrock, academic lead for assbas
Thus there is a pre-test set standard. Contrary
sessment for UCL Medical School explains
to rumours, this means that there is no quota
what happens to poorly performing SBAs and
for passing or a set percentage of students des-
OSCEs.
tined to fail. ‘After each assessment the performance of objective exams
structured
clinical
( osces )
each SBA and OSCE station is reviewed. The question and answer for each poorly perform-
The borderline-regression method is used to set
ing SBA is checked to make sure the answer is
the pass mark for the OSCEs. To understand
correct. If there appears to be a question that
this, we first need to know how the OSCE is
is performing poorly we consider whether we
marked. The OSCE mark sheet consists of two
should remove this item from the assessment.
components, individual criteria (‘objectives’)
We remove the questions from that paper if
for the examiner to assess you against, and a
they are ambiguous, misleading or do not have
box for a ‘global’ rating.
a single correct answer. The remainder of poorly performing questions are removed from the
For each criterion, the examiner can indicate
bank so they are not available for future as-
to what degree you’ve satisfied it – on a scale
sessments.
of ‘pass’, ‘borderline’ or ‘fail’ for years 1-5 and ‘clear pass’, ‘pass’, ‘borderline’, ‘fail’ and ‘clear
We also review the statistics, as well as the
fail’ for final year. These determine your mark
candidate and examiner feedback from each
for that station. In years 1-5 and in the final
OSCE station. If there appears to be a station
year short station OSCE, a 5 minute station
in which there has been significant differences
has a total of 20 marks and a 10 minute sta-
between how the station has been run between
tion has 40 marks. In the final year long sta-
sites/days, then we discuss whether or not this
tion OSCE, 10 minute stations have a total
station should be withdrawn from the assess-
of 15 marks and the 30 minute history station
ment at the exam board. As we have enough
has 45 marks.
stations in the OSCE to ensure that the withdrawal of a station does not reduce the relia-
You may notice on the sample mark schemes
bility of the assessment, we believe it is fairer
provided online that there are fewer than 20
to students to withdraw a station if students
‘objectives’. This means that different objec-
have been assessed differently between differ-
tives have different weightings, for example
ent sites/circuits.’
you might get 3 marks for using appropriate you ?
communication skills throughout the station
what
and 4 marks for completing an appropriate
There are no quotas for the number of stu-
examination.
dents who pass/fail.
does
this
mean
for
- An entire cohort is able to pass. The examiner is also asked to rate you on a
- Standard setting methods used for the
global judgement. This is the overall impres-
SBA paper and OSCE station allow tricky
sion of your performance on the station and
questions to be included without unfairly
asks whether your overall performance was a
disadvantaging students.
‘clear pass’, ‘borderline pass’, ‘borderline fail’ or clear fail.’ There are no marks attached to this judgement. Instead it is used to plot a regression analysis. (see fig 1). Here, candidates’ mark for the station is plotted in groups ac-
30
ravi mistry
(y5) // rums
1
1
1
2
1 2 5 5 4 2 5 1 2 2 4
vice-president for education y4-6
articles
“contrary to rumours, this means that there is no quota for passing or a set percentage of students destined to fail.�
1
4 7 5 3 2 9 12 8 10 13 14 11 5 12 8 13 8 6
SPORTS + SOCIETIES ROUND-UP
mer carried through into their fantastic
tions. It was the first time this event
performance of Bedpans and Broom-
was run so hopefully it can become a
sticks (sports clubs really need to work
staple of the RUMS calendar.
on their heckling for next year though). March was on us in a flash. Sporting
ANDY WEBB MBBS YEAR 5 RUMS SPORTS & SOCIETIES VP
Photos: Leo Garbutt
We moved into December and the end
seasons came to a close, Sports Ball
of term rush began. First up we raised
preparations were well underway and
over £100 with our Red Sportsnight in
the MDs got us off to a winning start
support of HIVE. Then came the infa-
with their continued domination of
mous Naked Sportsnight: everyone got
the UH Comedy Revue!
naked, lots of people forgot to cover
The Rugby UH final, hockey and net-
themselves up, we deleted a lot of pho-
ball varsity, and the first ever women’s
tos, and playing cards and calendars
UH football final were next on the
will be out in the not so distant future.
schedule. Unfortunately results didn’t
The second years were victorious over
go our way, but they were great events
the Freshers in Bill Smith’s, with strong
and the RUMS support turned out
spectator turnout and port sales had
in force – a credit to all the teams in-
their annual spike in the Bloomsbury
volved.
area.
RUMS then celebrated with the new
The Boat Club got things moving
generation of doctors at Finalists’
again after Christmas with the very
Sports Night! It was a fitting end to the
first RUMS Pub Quiz. Apart from the
year of sport’s nights and an emotional
3-strong Exec team getting robbed, the
one with it potentially being Stu’s fare-
night was a great success. January also
well in charge of the security team who
saw the union threaten to withdraw
look after us so well.
Since RUMS ran Richmond in Sep-
travel reclaim for all sport within zones
tember, the schedule has been jam-
1-6. After a couple of strongly worded
The last week of term arrived. Lumsden
packed with activities and sporting
emails and some meetings with the rest
raised a shedload of money, the Fresh-
events. In late September we welcomed
of the UCLU Sports Panel, everything
ers won John’s cup to deny the second
our latest intake of Freshers. The Wel-
was cleared up and is set to continue
years quadruple winner status and
come Fair was packed out as usual and
for next year.
Sports Ball was the biggest it has ever
although the medical school did their
rums
review
been with 470 guests! It was a superb
best to scare Freshers away from extra-
February was host to LGBT Pride in
night and it reinforced how amazing
curricular activities, our sports clubs
Sport Week and RUMS Dine With
RUMS is and how proud I am to have
and societies worked hard to steadily
Me. All RUMS Sport Presidents signed
been a part of running it this year.
increase Fresher numbers throughout
the pledge and attended the ‘Tackling
the year.
LGBT-Phobia in Sport’ panel. RUMS
Thank you to all the Presidents and the
Rainbow Sportsnight also raised £120
rest of the Exec team for all the help
Trials and fixtures got underway and
for Stonewall. Next up was RUMS
this year. Congratulations and good
UH Sports Night was as big and cha-
Dine with me. Over 200 members of
luck to James Shuttleworth who is tak-
otic as always. Then the MDs’ success
RUMS Sport descended on Brick Lane
ing over as RUMS VP Sports & Socie-
from the Edinburgh Fringe in the sum-
and ULU to develop inter-club rela-
ties next year!
32
long you have been at ucl?
I’m in charge of security for the following UCLU Bars: the Huntley and Mully’s, where I work closely with all UCLU and RUMS clubs and societies to ensure that customers follow the venue’s rules and regulations. This means that they experience a safe, relaxing and enjoyable atmosphere, resulting in a close bond, friendship and mutual respect between myself and RUMS. I try and help out RUMS as much as I can to show my gratitude for their respect towards myself and my security team. I have been at UCL for nearly 8 years, I spent 4 years over at the UCLU Bar Phineas and I’m coming up to my fourth unforgettable year at the Huntley and Mully’s.
OF TIME IN MULLY’S, WILL KNOW STU ARRAND. HIS REPUTATION FOR RUNNING A SMOOTH SPORT’S NIGHT IS WELL NOTED AMONGST THE RUMS COMMUNITY, AND EVEN STRETCHES AS FAR AS CLUB DE FROMAGE (AS VERIFIED AT END OF SEASON DINNER). MANY OF YOU WILL ALSO KNOW THAT HE IS SADLY PLANNING TO LEAVE US LATER THIS YEAR. ON BEHALF OF RUMS AND THE RUMS REVIEW TEAM, WE WOULD LIKE TO THANK YOU FOR MANY ENJOYABLE EVENINGS - YOU WILL BE SORELY MISSED! HERE’S WHAT HAPPENED WHEN WE CAUGHT UP WITH HIM.
does
the
rums
community
sport’s night?
There are so many to choose from, but if I have to pick one, it would have to be this year’s finalist’s Sports Night; the atmosphere was unforgettable. We had all the final year medical students downstairs to raise a glass and congratulate them on finishing their exams and to give them a goodbye gift. As I called up the teams one by one, everyone in the room sang songs affiliated with their sports team and cheered them on. Also, with everyone’s emotions running high, you all made sure it was a sports night that they would never forget.
differ
so, what makes the rums community different?
is there any advice you would give to the rums students?
There are plenty of things that I can say for this. Part of university life is to find your own footing - everyone is different and will handle things in different ways. The only thing I can say is to make sure that you give whatever situation you are faced with everything you have and never feel afraid to ask for help from others. You are all surrounded by people that care for you and will be more than happy to help you out. Finally, please don’t let the fact that I might not be around UCL anymore deter those of you that usually come to me for advice or just to rant to get things off of your chest, you can always use Facebook or emails to contact me.
what’s next for you?
I have a few open doors for me when I finish my course, which involve me working in either marketing or graphic design. There might also be a position I am considering on applying for, without going into too much detail, which would see me still being around UCL.
33
+
what has been your most memorable
from other ucl communities, and if
The RUMS community stands out more to me than other UCLU communities because it seems to have more of a family connection between students, from the way you all look out for each other, especially after a sports night, to the way you allocate medical parents to the freshers. Every game, event, and show RUMS students hold, you can guarantee a massive turn out. But more importantly, you extend this family feeling and support towards non-medical students like myself and other students, for example, RUMS badminton and tennis who have non-medical student members.
sports
you are involved with rums, and how
SPORTS NIGHT, OR SPEND A SIZEABLE AMOUNT
societies
stu
please may you briefly explain how
farewell
MANY OF THOSE WHO MAKE THE WEEKLY TREK TO
are
there
any
rums
students
you
will miss in particular, and why?
I am going to miss all of you like mad - each and every RUMS student has left their own personal mark in my life that I will never forget. Both current and past RUMS students have a special place in my life and heart.
can we expect to see you at any sport’s nights next year?
I will still be around for the first few sport’s nights of the next academic year and, after that, no matter the outcome, I will still be based in London. This means that I will be able to pop in every now and then on a Wednesday to see all of your lovely faces and to make sure that you are behaving yourselves. Also, I promise that I am going to make sure I keep an eye out for RUMS events, shows and games so I can come along and show my support and catch up with everyone.
vol.
I,
no.
III
societies
and see you soon; we’ll always
isoc
sports
+
the
highlight
year in three words
time for everyone though!
save a seat for you in Mully’s.
of the year
Winning the UH Revue for a
biggest
achievement
this
Enjoyable, inspiring and like
record third time in a row by
notable
a family
a unanimous judges vote.
sults:
Getting a spot in London
An amazing Christmas show
Varsity Series for the first
with our biggest attendance
time! So great to see the 1sts
highlight
lowlight
of the year
of the year
end
of
year
re-
year
The night of the Charity
Not going to Centre Parcs on
to date, another fantastic per-
playing and have lots of sup-
Week Dinner, where we man-
Weekend Away for once.
formance at the Inspire Med-
port too.
aged to auction off a cake for
icine Conference, performing
£20,000 to a collective of
with the Cheese Graters at
message to graduates 2016
students. It wasn’t the sum
their joint comedy show in
GOOD LUCK! RUMS Net-
for which the cake sold for
February, winning the UH
ball wishes you all the best.
that made it special, rather it
revue for a record third year
You will all be sorely missed;
was the highlight of the year
in a row.
please come back and visit us
as it showed unity amongst
and stay in touch!
students in working towards
most improved member
a positive goal.
Charlie Hall. He started off
notable end of season re-
a little shy and rough around
sults
the edges but after six years
53 netball girls attending
year
with us he’s finally found his
Sports Ball this year! An im-
Attaining record membership
voice. He even gets a few lines
pressive turn out!
levels and increasing engage-
now and again when he’s real-
ment with the RUMS Islamic
ly on form, even a laugh once.
biggest
achievement
this
society cohort to the extent
most improved player
A difficult one with so many
where our members consider
most
memorable performance
teams and great players. A
us more as a family than anything else. message
to
graduates
2016 The final years have contrib-
and
uted so much to this society,
FOR A FULL LIST OF AGM RESULTS, PLEASE VISIT
www.rumsreview.co.uk
helping to get us to the level we are and giving us their precious time and advice to build
biggest
us from strength to strength.
year
We would like to thank them
Performing for the first time
for all their efforts, smiles
at the Edinburgh Fringe Fes-
and presence, and wish them
tival last August for 8 nights
the very best in the new chap-
to a sell out crowd every sin-
ter of their lives as doctors.
gle show.
achievement
this
sports
They are always welcome at RUMS Islamic Society and
most
we hope to see them again!
Jonathan Au, for being a
valued member
&
why
technical wizard with all things lighting and sound
Greg Dewar: “I’m sorry I’ve
few players that stand out are
sults:
related. Who needs a smoke
forgotten my lines everyone,
Sophie Parrock, Emma Beck,
We managed to hold a pleth-
machine when you’ve got Jau.
I’m really hungover.” 5 stars.
Alice Meredith and Beckie
ora of events such as a work-
message to graduates
shop on laparoscopic surgery,
The society has transformed
a conference on mental health
in the six years you’ve been
this year, and of course the
here and that change began
£20,000 cake! We also had
with your year. As a collec-
our annual AspireMed con-
tive, you ushered in a new era
highlight of the season
dlesex 1s to win by 2 goals. A
ference as well as many out-
of sketches that transformed
TOUR! Such a fun weekend
great show of determination
reach basic life support cours-
us into the most successful
of RUMS Netball doing what
and teamwork!
es and academic tutorials.
RUMS society competing
they do best!
notable
end
of
year
re-
mds the
year in three words
Just three words?
rums
review
2016
netball the season in three words
most memorable performance
Fun, feisty and friendships!
The 2nds pulling it back in the last quarter against Mid-
in UH competitions and inspired writers to produce
lowlight of the season
work we never could have
One week only 7 people were
imagined possible. Good luck
at training… it was a busy
34
Fisher.
been a blast!
ing pulled out of BUCS at AGM
the year in three words
message to graduates 2016
notable
Inspiring, fun and exciting.
Keep up the amazing fundraising
We end the year with two groups of
have gone unbeaten and done the
and hard work you've done to help
committed, lovely people making
double over UCL! What more could
highlight of the year
those who need it most around the
up RUMS Music. Choir is com-
you ask for!
Jailbreak of course, with new and
world!
posed mainly of freshers who I hope
societies
hours for Jailbreak)!
rag
last year and making their maiden
interesting adventures every year;
will continue to sing with us until
message to graduates 2016
their final year.
Thanks so much for all the hard
but also launching new trips to run
notable end of year results
the Athens Marathon and climb the
Raising £15000 for our 3 supported
Atlas Mountain range!
charities Teenage Cancer Trust, The
most
Cure Parkinson's Trust and Pump
Jordy – choir’s piano accompanist;
lowlight of the year
Aid; as well as over £60000 for our
thanks for sticking around and
Not being able to organise a cycling
trip abroad for Hope For Children!
keeping us in tune!
most developed member
most
Our lovely freshers who joined
(good
committee meetings in Term 2 after
All of the choir did really well car-
reclaiming the position as UCL 1st
being so enthusiastically involved in
olling at the Whittington at Christ-
XV from the UCL side.
our events.
mas and also at the Medic to Medic
+
voyage into the LUSL leagues, they
sports
end of year results:
graft you’ve put in over the last 6 years, best of luck and see you all for
improved member
another shot at UH next year! notable end of season results
trip abroad with our charity in time for Term 2; but we will definitely work on it for next year! biggest achievement this year
Recruiting the biggest team we've ever had for our trip to climb Mt. Kilimanjaro for the charity Hope For Children! most valued member
All the members of the RAG Commemorable
performance
or bad) and why?
societies
charity event.
mittee who have organised and
double over UCL. The 1st XV also
most improved player
John Partridge. Got himself fit and
most memorable contribution
Arthi; for getting us Chicken
Both the 1XV and 3XV doing the
is now a real force at prop in the
Cheques from Nando's as prizes for
rugby
our Jailbreak teams!
the season in three words
captaincy for next year, which he
Up and down
will do a wonderful job of.
highlight of the season
most memorable performance
Our plate victory at the Oktoberfest
Nick Cox gave the most memorable
7s competition in Munich with a
performance of the year, completely
RUMS vs RUMS final - nice to get a
missing the game in Paris because
bit of silverware! This only narrowly
he’d had a couple of strong French
beats (and although bittersweet) get-
lagers the night before. Him and
lowlight
ting to the UH final again and play-
Jack Webb were quite the double act
Being rudely kicked out of a rehears-
ing in front of a great RUMS crowd.
on tour as well…
music
the
year in three words
Fun, musical, laughter! highlight
of the year
Our Spring Concert
Boars. Earned himself the Piggies
al room by Pole Fitness!
hosted all the fundraising activities;
lowlight of the season
including tracking teams for 48
biggest
hours (12 hours for LOST and 36
Recruiting lots of new members
down to Chichester. 1x Refresher
(maybe it was the free pizza!)
Munich for Dennis the Menace
achievement this year
Leaving the 1XV kit on the train
Effiom. most
valued member
&
why
Lloyd Warren – our secretary, head
biggest achievement this year
of strings group and president next
Renewing our link with PSL and
year! Worked so hard for each group
travelling to Paris to play them once
of RUMS Music and recruited lots
again. We’re looking forward to wel-
of new members.
coming them back to London again next year!
message
to graduates
2016
Thanks for recruiting us older years
most valued team
to join originally; good luck, it’s
It has to be the Piggies. After be-
35
vol.
I,
no.
III
societies
bank captain by explaining
as you’ll undoubtedly be get-
year
the laws of cricket, or Cap-
ting call ups again when we
Everyone’s phenomenal indi-
the season in three words
tain Greenwood’s first over in
are short of players.
vidual improvement.
Preseason, Exceptional and
indoor cricket, recording 3+,
Exciting
3+, 3NB, 4+, 4, W… truly
most improved player
most valued team
dreadful.
Rover had a fantastic season.
Women’s – for excellent re-
Ever present and destroyed all
sults in their BUCS league
opposition he faced.
and for progressing the fur-
sports
+
cricket
highlight of the season
considered UCL’s 1st team
men’s football
indoor. We are especially
the season in three words
message to graduates 2016
proud of this considering our
Having a party.
Thank you so much for all
Having come above UCL 1s and 2s indoor, we are now
thest in the BUCS Cup.
team is made up of predominantly freshers. lowlight of the season
your contributions. We will highlight of the season
welcome you back as Alumni
Winning NAMS for the
with open arms!
351st time in Liverpool
Kit orders. Still not here.
notable end of season results biggest
achievement
Isaac
this
Aristidou
winning
year
RUMS Squash Individuals
year
To be able to bring home
Shield.
Managing to find two new
the coveted NAMS trophy
sponsors and we received a
for the 5683th time, simply
very impressive fresher intake
because it means so much to
this year.
all our fans to do well on a
biggest
achievement
this
national level – and with the message to graduates 2016
European
Thank you so much for all
coming up this summer it
Championships
the service you have given to
puts us in a good place.
put the club into the position it is in today. Also, please buy
message to graduates 2016
membership next year, we
Thank you – you will be sore-
squash
need the money…
ly missed and make sure you
the season in three words
still have your Saturdays free
Tight, deep and hard.
notable end of season re-
most improved player
Split between Samir Ab-
sults
highlight of the season
Beating UCL 1s by 29 runs
RUMS
to
dulkarim, Rebecca Heath,
and UCL 2s by 37 runs.
Brugge and playing against
Tom James, Louis Saada, and
semi-professionals.
Kieran Francis. Impossible to
Squash
tour
decide.
most improved player
Fresher Eggplant.
lowlight of the season
most memorable performance
Losing to Cardiff in the
most memorable performance
NAMS final 3-2.
Tom Western – beating the
Snail for being condescend-
RUMS Squash nemesis from
ing to the London South-
rums
review
biggest
36
achievement
this
Sheffield at NAMS 3-2.
on court. Sadly she only has 1 year
her hands (she’s a defender) and
Fun. Flirty. Fierce.
at UCL, so we have to say goodbye -
got red carded, I think a first in the
you will be sorely missed Anya.
club’s history. She did however earn herself the role as back-up keeper
highlight of the season
The final match of the season, end-
and actually surprised us all with her
and women’s teams! Emotions were
women’s football
running high as the finalists played
the season in three words
their last ever match for RUMS
Together anything’s possible.
tennis
ing in home wins for both the men’s
societies
Rowe saved the ball on the line with
the season in three words
+
about 15 minutes in when Charlotte
match she was annihilating everyone
sports
great natural ability, and by the final
badminton
Badminton. It was made better by
skills in goal.
the season in three words
the fact that the men’s team had
highlight of the season
won all of their league matches this
The first team beating Leyton Ori-
season!
ent against all odds!
biggest achievement this year
lowlight of the season
After the women’s victory last year at
Lack of commitment across the club
BUCS, there was a lot of pressure at
meaning many games got cancelled.
Middle middle middle!
the beginning of the season for the guys to match up to the girls’ suc-
biggest achievement this year
cess. However, thanks to a talented
The seconds team winning more
intake of freshers and the leadership
than half of their games to finish in
of men’s captain Tom Ngan, the
their highest league position for as
men’s have come away with great
long as we can remember!
success this season and will be promoted next season. Their killer per-
most valued team
formance has opened up talks to po-
My committee as they have been my
tentially set up another men’s team.
rock and their help has been incred-
highlight of the season
ible this year.
Lifting the United Hospitals League Cup at Wimbledon!
message to graduates 2016
It’s always sad to say goodbye to
message to graduates 2016
finalists, but this year will be par-
I literally cannot imagine the club
lowlight of the season
ticularly difficult. We are saying
without them. They are such a huge,
The Men’s 1sts being dumped out of
goodbye to perhaps one of the most
influential year and we would not be
their cup competition semi-final in
dedicated and talented intakes that
where we are today without them.
some dubious circumstances.
we have had as a club, as highlighted
They will be missed a ridiculous
by our four honorary-life members.
amount and I hope they come back
biggest achievement this year
It’s the end of an era and we’d just
to visit.
The Women’s team have really ex-
like to thank you all for your com-
celled this year, coming within a
mitment to the club and we wish
notable end of season results
whisker of promotion, and the
you the best of luck with your fu-
Actually winning multiple games on
Men’s 1sts almost went the dis-
ture careers!
NAMS (practically unheard of!) and
tance in their cup competition af-
our 2s finishing 4th out of 9 in their
ter a successful summer! As a club
most improved player
league, with some really impressive
for the first time we have secured
Aswin Suri - he has attended all so-
results throughout the season.
sponsorship, and grown in size to 90
cial and team practices this year and
members.
is a well-known figure in the club.
most improved player
The commitment to badminton has
I think I would have to say Lisanne
message to graduates 2016
shown in his continued improve-
Schoutens. She is a transfer who
Thank you for everything you have
ment this year.
joined us last year in the seconds
given the club over the time you
team but has improved so much in
have spent with us! Good luck in
most memorable performance
her time with us that she has be-
the future, please come and share a
We would like to give a special men-
come a very strong and valued first
pint with us again soon!
tion to Anya Chen, a non-medic
team player this year, with an in-
student who joined the club but
credible attitude and huge amount
most memorable performance
has become as much a part of the
of dedication to the club.
A notable mention to Richard Be-
team as any. It was obvious from the
koe, who thrashed his opponent so
start she was an outstanding player,
most memorable performance
hard that he went and complained
always dedicated to training and
It was the match where we played
to the union (he was eligible by the
matches. She started off very wary
against the top of the league team in
way, sorry Roehampton).
at singles but soon realised she had
horrifically windy conditions. It was
37
vol.
I,
no.
III
societies
+ sports
men’s hockey
message to graduates 2016
The 1s beating UCL and rele-
lowlight of the season
message to graduates 2016
We are saying goodbye to 6
gating them out of the league.
The captains having to read
Thank you for your years of
the riot out over support at
service to the club, you won’t
Novice Sprints…
be forgotten soon and see you
the season in three words
finalists this year who have
What a year!
all given a lot to the club over
biggest
their years of service. We will
year
highlight of the season
miss them all, both on and
Being able to maintain 3
biggest
Our Varsity match with
off the pitch. I wish them all
teams playing every Wednes-
year
notable end of season re-
GKT, like previous years,
good luck in their futures as
day and Sunday - excellent
BUCS Head! A lot of logisti-
sults:
didn’t disappoint. Addition-
doctors and hope they will
commitment from the whole
cal planning and working out
M1: 21/48 in BUCS, UH
ally, our club-wide tour is al-
stay in contact with us for a
club.
how on earth UCLU actual-
Head winners; W1: 19/33
ways well anticipated by club
long time to come!
ly works culminating in all
in BUCS; M4+: UH Head
message to graduates 2016
6 crews racing at BUCS in
winners; Women’s 4+: Allom
members and this year’s one
achievement
this
all at VPs! achievement
this
to Leeds was a particularly
notable end of season re-
We’ll miss you! have a fabu-
Newcastle for the first time
Cup & UH Head winners;
enjoyable one. A tough act to
sults
lous time on elective and have
ever - and nobody came last!
M2: Novice Regatta, Winter
follow for next season.
The 2nd XI had a very im-
fun starting your new jobs.
pressive result against UCL
Please come back and visit!
Sprints and UH Head winmost valued team
ners; W2: Novice Regatta
The Men’s Second VIII.
& UH Head winners; MN
lowlight of the season
3s earlier in the season win-
The loss at Varsity was disap-
ning 9-0 against the team
notable end of season re-
Close competitors for the
and WN: not coming last at
pointing after we performed
that finished above them in
sults
overall RUMS Team of the
BUCS
so well on the night, but the
the league last year. They have
Canterbury 1s v RUMS 1s =
Year (Congratulations ten-
support from everyone who
narrowly missed out on pro-
1-1 allowing the 1s to main-
made it to the Olympic pitch
motion this year and will be
tain their position in the
and the night out afterwards
pushing hard for it next year!
league and relegating UCL 1s
made the loss that much more bearable.
out of it! most improved player
Luke Hailston was our most
most improved player
improved player this year. It
Speaking on behalf of all the
year
was difficult to pick out an
captains I think every player
Reaching out to alumni
individual player for this ac-
has shown a great improve-
and hosting our first alumni
colade as many players have
ment this term, without
drinks at the beginning of
upped their game this year.
which our club wouldn’t have
this term - welcoming back
Luke, however, has improved
been so successful!
some faces from RUMS
greatly on the pitch and de-
most improved member
Men’s Hockey’s past. This is
serves the praise he has been
Gracie Sutton - coming into
set to continue later this year
getting for it.
this year as a novice cox, she
biggest
achievement
this
with our Old Boy’s match
now has a race win to her
against the alumni at South-
most memorable performance
name and an established
gate.
I feel Hamish Miller has had
crew in the women’s seconds
a storming season this year
and has come on leaps and
most valued team
and a highlight of this would
bounds this year.
Our 3rd team is a vital part of
be his performance in our
the club. With many people
Varsity match. This was a
most memorable performance
joining the hockey club who
high stakes match and with-
Greg Gibson - for being the
have never picked up a stick
out him running the game
cox of the novice women and
before, a welcoming 3rd XI is
at times in the middle of the
very important for allowing
field it would have been a
rumsbc
these players to develop on
very different score line.
the season in three words
the pitch and keep them in-
being bigger than all of them, just to increase the challenge.
Medal Medal Medal! highlight of the season
3rd team which shows just
women’s hockey
Winning 5 of the 8 categories
nis...) these guys have won
how important it is. A special
the season in three words
at UH Head and the whole
everything in UH this year.
mention should go out to our
Exciting, challenging, suc-
club losing it when the men’s
They
3rd team captain Ollie Toth-
cessful.
first VIII won their first event
‘A’ game on race day and
for four years!
Wednesday evenings!
terested in the sport. Many of our 1st XI started out in the
am who has been excellent this year. rums
review
highlight of the season
38
always
bring
their
societies sports
+
TY VA R S I T Y darshni pandya
//
After weeks of blood, sweat and tears (believe what you want), Varsity day was
netball mbbs tear
3 //rums
finally upon us! Bright-eyed and bushy-tailed, we began our trek to East London
netball fixtures secretary
at 8am, decked head to toe in RUMS stash there was no mistaking who we were representing. With our new fave anthem (Work by Rihanna, big tune) blasting in the background, we had an early morning bonding session (involving many a braid) and began warming up.
Jennifer Westwood, Ria Mehta, Hannah James, Darshni Pandya, Robyn Brown, Corrina Horran, Emily Irwin, Sahana Gnanasampanthan, Elen Roblin, Roohi Bhatti
- women ’ s
As we approached 10:30am, the stands began to fill with our sign-bearing fans, and we readied ourselves to be called on to court by our president, Anna. The cheers were deafening, the banners were waving, our hearts were pounding, and as Roohi stepped into the circle, the battle began. The first quarter was fast and both teams showed skilled play. The first centre alone was intercepted multiple times by both teams, but it was ultimately RUMS who sank the first shot. As the quarter progressed, GKT settled into their rhythm more quickly and their shooting accuracy allowed them to start pulling away. After leading the first half of the first quarter, we finished on the back foot at 2-12. After a couple of substitutions, we were eager to close down the gap during the next quarter. We started out strong and immediately turned over a GKT centre, putting us in the driving seat for this quarter. Although we still had issues getting the ball up to our shooters and faced a lot of congestion in the centre third, the defensive team of Issy, Maddy and Ria was solid and we managed to hold the majority of possession. We made life very difficult for GKT and this was our best quarter – both teams scored 3 goals each. The third quarter saw the introduction of a new shooting combination by GKT. We maintained position for the first few minutes but soon enough, there were more long balls being passed straight into the circle. This was difficult to defend and GKT started to increase their lead again. Our own opportunities at goal also increased as we created more space and had greater movement around the circle. We went into the final quarter with a score of 8-32. With our final cry of ‘RUMS!’ we stepped onto court for the last time. GKT took the first centre and we immediately responded with a number of interceptions up to goal. We kept up the pressure and earned the majority of possession. With some excellent support play in midcourt, we brought the ball up well and created lots of chances at goal. We kept pushing until the final whistle, where the score was called at 11-39 to GKT. We might have lost this round, but we had an amazing time and played very well as a team. We’re so proud of each and every player for giving it their all and we’ll see what happens next year!
39
vol.
I,
no.
III
ITY
VA R S I SITY
The time of year was upon us once again, where RUMS would don their stash and go head to head against GKT in the annual varsity series. With the exciting addition of Medic’s Netball to the series this year, RUMS Review caught up on all the action…
- men ’ s harry bamber
As part of the London Varity Series, the first team once again had their match
hockey //
mbbs year
4 //
against GKT at Lee Valley. We knew it was going to be a tough game, and I feel we gave a very good account of ourselves out on the pitch.
first team captain
RUMS went 1-0 down after an early penalty corner conversion, but created several chances and were unlucky at the break. Forward Tom Chambers had a good Henry Sergeant, Henry Hill, Ben Miles, Josh Gardener, Hamish Miller, Harry bamber, Tom Chambers, James Shuttleworth, Sam Price, Ryan Nolan, Alex Maidwell-Smith, Will Southall, Harry Goss, Adam Muse, Adam Blackstock, Christopher Bu
opportunity to level the scores after a Hamish Miller flick could only be parried,
rums
review
but he was unlucky not to strike the resulting shot cleanly. Buoyed by an inspirational team talk, RUMS started the second half the stronger of the two teams. GKT went 2-0 up against the run of play with another well taken penalty corner but RUMS were able to mount a swift response via Hamish Miller’s goal from an acute angle. It was then that the talking point of the game occurred. The ball struck a GKT foot in the circle and was subsequently missed by the umpire leaving for an easy finish at the near post. RUMS were able to peg one back a minute later through a well struck Sam Price shot, leaving GKT to run down the clock in the final few minutes to hold onto the lead and take the win. Thank you to the members of other RUMS sports teams for supporting us - the support we received was fantastic. See you all again next year! Man of the Match : Sam Price Dick of the Day : Alex Maidwell-Smith
40
societies sports
+
TY VA R chloe hall
//
With RUMS and GKT Women each holding 1 victory from the London Varsity
hockey
mbbs year
3 //
Series, 2016 came around with everything to play for. A BUCS reshuffle awarded both teams with a promotion into South-Eastern 1A, so the rivalries had been
first team captain
building throughout the season; both home and away matches cumulating in tense 0-0 draws. The 5th March dawned breezy and cold, and after a team carb-load we embarked Frankie Bügg, Issy Norris, Iram Hassan, Cara Rocks, Elin Hughes, Josh (coach), Brogan Rudge, Phoebe Verbeeten, Annie Mosley, Alice Dewsnip, Amy Foulkes. Sitting down L-R: Rachael Sprio, Aisha Damerell, Chloe Hall, Charlotte Griffiths, Maddy Bangham
- women ’ s
on our journey to the Olympic Pitches. We were informed just prior to pushback that all seating had sold-out, and the atmosphere heightened as captain Chloe Hall’s team warmed-up and prepared to begin. RUMS took a while to settle into our rhythm, before the transfers between seasoned centre-back Lotty Griffiths and fresher Amy Foulkes began to flow. After 20 minutes of battling in midfield and some great attacking from inner Iram Hasan, GKT won a short corner where a flairy deflection managed to sneak the ball over the line. Not to be disheartened, RUMS retaliated with some great running and leads from forwards Annie Mosley, Izzy Norris and Alice Dewsnip, and some fantastic shots and nail-biting near misses in the GKT circle. Unfortunately, before the first half drew to a close, GKT managed another 2 goals from opportunistic breaks at RUMS short corners. However, after a rejuvenating team-talk and wine gums, inner Aisha Damarell ran the ball from the halfway line into the GKT circle, and a quick one-two allowed her to put the ball in the net. Tensions built in the second half with RUMS beginning to claw back, and some fantastic runs from right midfield Brogan Rudge up the line began to anger GKT as Brog continued to draw fouls against them. More chances arose with some sneaky balls up the line to speedy Maddy Bangham, but RUMS were unable to convert. A brief interlude as a GKT player took a hit to the head gave some time to re-group, but RUMS were shaken by this and let in a goal shortly after play resumed. A knee injury to defender Elin Hughes saw more GKT insults brought upon keeper Frankie Bugg, which she countered with some fierce saves to prevent further assaults on our score line. Some confusion in the RUMS circle saw a penalty flick awarded to GKT, which they slickly put between the posts, bringing the score to 5-1. As the full-time whistle blew, RUMS were awarded a short corner – a final chance at redemption. A fast-paced ball from fresher Cara Rocks was saved by the GKT keeper, but the rebound was caught by Rachel Spiro who put the ball back into the goalmouth for Phoebe Verbeeten to convert, drawing the match to an exciting close and a final score of 5-2. Player of the match was awarded to Brogan Rudge for some amazing runs up the line, and DOD went to coach Josh for the slowest boat race anyone has ever witnessed. We were immensely thankful to everyone who came to watch and joined us in Walkabout afterwards – despite our loss it was an amazing night and the RUMS support was much appreciated!
41
vol.
I,
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AND THERE IS, IN MY EXPERIENCE, A STRONG PRESSURE NOT TO STRAY FROM THE GIVEN PATH.
I wasn’t lying. I was in awe of the healthcare professionals I shadowed, and I did want to follow in their footsteps. I did want to understand human perception and identity. However, I hadn’t fully considered the emotional impact of medicine because my decision was already made. I had done the right subjects, I had the right grades and medicine was the only way I could have a positive impact in the world. When I shadowed my mother’s neurologist, I was devastated by a sixteen-year-old’s Multiple Sclerosis diagnosis. I brushed this off, MS was always going to be a soft spot, especially in girls my age. I was drained every day I came back from working at the nursing home and ignored it because I felt this was simply a consequence of my inexperience. When I came to medical school, I couldn’t seem to learn how to develop the necessary professional distance. I shadowed a cardiothoracic surgeon, and his patient nearly died on the table in front of my eyes, which left me confused for many days. I could only cope with the dissection through extreme abstraction. Each experience added to my doubts. I dreaded leaving medical school to be the UCL doctor.
rums
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42
Last summer, I weighed all my options and decided to apply for law, which would be a good foundation for a career in policy, whilst continuing my medical degree. After consulting several law firms and the UCL careers service, I entered second year and rounded off my application. When I received my offers, I decided I would defer them to finish my BSc in History and Philosophy of Science and Medicine. So far, the reaction from the medical school and my colleagues has been very positive. I am very happy with my decision, and astounded by the support and the opportunities I have been given. Of course, I will only know how this all turns out in a few years, but I feel like I am finally following my own vocation. I encourage everyone who feels a similar selfimposed pressure to release themselves of it, to own their own power, and to consider what future they truly dream of. After all, as I have seen during my time at medical school, a doctor is in the unique and privileged position to have an amazing positive impact during people’s darkest hour, but only when they are fully passionate and well suited to medicine. Should they not feel like they belong and still soldier on, they may end up depriving society of their true gift.
photographs by elliot nash
words by corlijn reijgwart, mbbs year
2
LOWEST DROP-OUT RATES,
f i n d y o u r v o c at i o n
THE COURSES WITH THE
:
MEDICINE IS ONE OF
Before I was entirely clear on the purpose and practice of tying shoe-laces, I had decided I wanted to be a doctor. I can’t even remember where this dream came from. In hindsight, I think the fact that I was a sickly child, and that I was around doctors often had something to do with it. I couldn’t admit to this on my personal statement, because it was, and still is, such an unconvincing cliché. It doesn’t show any reasoned decision making, or even any particular aptitude for medicine. In my actual personal statement, I described the study of medicine as an opportunity to better understand the basis of human perception and identity. I wanted to look into the link between matter and mind. I was impressed by the nurses at a home, who coped by cherishing the moments where they relieved some of their residents’ suffering. Then, I concluded my passion for medicine was rooted in my academic interest in the sciences, my will to challenge myself intellectually and most importantly in my wish to positively impact the lives of others.
At medical school I was gripped by medical law. The Clinical and Professional Practice course and the SSCs gave me some reprieve from the science in the horizontal modules. They gave me the opportunity to examine the mind from a philosophical perspective, and to learn more about medical policy. Soon, leaving became more of a positive choice to follow my passion and less of a flight from the challenges of science and medicine. I now feel like I no longer have to continue with a course, and later a profession, which will drain me emotionally and won’t allow me to tap into my true passion. The current situation with Jeremy Hunt has highlighted the fact that policy makers can have a massive impact on public health. Sadly, as in this case, sometimes a negative one.
comment
At school, my heart went out to the humanities. I loved to read and I excelled in essay subjects such as English, History and philosophy. My favourite extracurriculars involved debating and policy. However, I brushed my interest in these subjects and my slight distaste for the sciences aside. I felt that everybody knew the sciences were more difficult than the humanities. My logic was that things that are more valuable, tend to be more difficult. Giving up would be a sign of weakness.
words by katie hodgkinson
READ, LEARN,
RELAX. do no harm: stories of life, death and brain surgery Henry Marsh ‘First, do no harm.’ We’ve all heard it, all adopted it as a life motto, but none have truly considered it to the extent that neurosurgeon Henry Marsh has. Considering both the risks and benefits of treatment is something we will all have to do as clinicians, but we’ll never truly appreciate it the way he does. He is painfully honest about how medical intervention can cause more harm than good, how hospital bureaucracy has no place in modern medicine, and just how transient the bond between doctor and patient really is. This book is both elegant and brutal, describing every patient’s story - and his own career - in a truly reflective way, seen properly for the first time outside of the dreaded portfolio. His writing reassures you that no matter how much horror you see in your career, you will never lose that sense of humanity and feel for injustice which are so present in medical students today. His details around life and death decisions will make you think and certainly send you into clinical practice with a fresh sense of empathy. It’s all too easy to see neurosurgeons as the best of the best, but his sense of humility is evident and his care for his patients even more so. He is truly honest about what a career in the NHS and looking after people entails; it’s something so beautifully recorded that it’s a must-read.
i think you’ll find it’s a bit more complicated than that Ben Goldacre I’ve covered Ben Goldacre’s books before, but for a good reason. His writing style is beautiful - relaxed and digestible, yet it instils you with informed anger at just how science is portrayed in the media. This book is a collection of his writings on science and the lack of it, whether that’s pseudo-science, poor reporting, bad clinical trials or misinformation of the public. A perfect read for those wanting to understand just how the media represents both the medical and scientific communities, this will entertain you and cause outrage in equal measure. This book contains less of a linear narrative than Bad Pharma and Bad Science, but instead groups his writings by topic to make things clearer, and it also makes it much easier to read in small chunks. It’s a brilliant introduction to science writing and makes more sense if you read it before going on to read his other books, covering a massive range of topics and viewpoints easily. If you want to be informed on just about everything you’ve ever considered in terms of scientific writing, consider this book. It’s easy to read, well organised, funny and you can tell it’s written by a UCL medic, because it links beautifully with everything we’ve ever been taught in CPP.
43
trust me, i’m a junior doctor Max Pemberton One of three books written by Dr Pemberton on the subject of being a junior doctor, Trust Me is the first and details the very start of his medical career post-university. Max started writing weekly columns about being a junior doctor for The Telegraph and this book is a collation of those, presented in an easy-to-read diary format. Whilst the book was published in 2008 and Max now writes for the Daily Mail, the stories remain as pertinent and witty as ever. From run-ins with consultants, to making friends with the nurses - it’s all still relevant, still brilliant and definitely a more relaxed way to learn about post-medical school life than being on the ward all day. Dr Pemberton’s writing starts off as a very optimistic junior doctor ready to do the best by his patients, and ends ruminating on just how medicine changes you. An eye-opener to the reality that foundation years could be less about patients and more about paperwork and politics, this is a must-read for anyone looking for a more chilled way to learn just what the NHS is like for newcomers. It’ll make you laugh, it’ll make you cry, and it’ll make you angry at just how the NHS works- but most of all, it’ll make you excited to get out there and start making a difference, one patient at a time. vol.
I,
no.
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Yul Kahn Pascual
ending
? Professor Martin Elliott 16th March 2016 Museum of London
As the lecture theatre began to fill up, a very relevant quote was projected onto the first slide: ‘Hearts will never be practical until they can be made unbreakable’. Many will recognise this quote from a film featuring a Wizard and a character called Dorothy, but will never have thought about it’s underlying relevance.
the Pooh) and a well known ventriloquist, Paul Winchell, was in fact the first man to patent an artificial heart in 1956. After watching a surgeon lose a patient on the table, he was adamant that the patient could have survived had there been an artificial heart. His design patent very much resembles parts from some of the more recent successful ones.
The talk began by levelling the audience, with a detailed overview of the heart and the mechanics of the heart, highlighting what often goes wrong. In 2013, in the US, 5.8 million people were being treated for heart failure and each year over 650,000 new cases are being diagnosed. One in five of us will develop heart failure in the course of our lives with less than 10% of those diagnosed surviving the 10-year point. These figures are staggering and beg for a solution to what is an evident worldwide problem and a major factor in the plateau of lifespan.
In 1969 the Liotta heart, a double ventricle air-driven pump, was inserted in a patient for 64 hours, before a heart donor came forward and the artificial one was replaced by a much more reliable real heart. This was the beginning of artificial heart development. Soon many different companies released prototypes and while they were successful in their own way, no significant findings were made - the patients eventually died and their quality of life was often not great. In 2016, the artificial heart does have a place but in a ‘bridge to transplantation’ role. The Berlin Heart is one of the continuous flow pumps being used at Great Ormond Street, keeping the patient alive but restricting mobility as the child must move around with the machine. The success rates are staggeringly close to transplantation however, at 70% alive after 2 years compared with 80% in transplants.
Prof Elliott ran through the current management of heart failure, and went on to mention some early failed surgical attempts, such as Kantrowicz’s idea of using muscle from the latissimus dorsi to wrap around the heart in order to try and share the contraction load. Stem cells for muscular wall regeneration has been looked into by several groups but no effective solutions have come of it yet, since it is a relatively new emerging field.
Technologically may be progressing, but like most new treatments in modern medicine, they need to be evaluated for cost/benefit. The cost of each assistance device currently is around 1/4 of a million pounds per patient, and although this comes down to the manufacturer, high demand means it doesn’t look likely that companies will throw away this profitable opportunity. 100 were given out last year per 60 million people in the UK, so how do we decide who deserves it and who doesn’t? Do we give it to the sickest, or less poorly with a higher chance of accepting it? Do we give it to those contributing to society or have a lottery for it? Do we invest in cancer treatment and research, or artificial heart devices? An interesting question brought up by someone was that surely if the device didn’t work on someone it could be reused on another patient, but Prof Elliott ensured us
What naturally followed was the topic of transplantation - the next best solution for someone in last stages of heart failure. Since the turn of the 21st century, the number of heart transplants being performed worldwide has stayed around 3,750 whilst the number of people around the world suffering from heart failure is about 25 million. This means that we are able to attempt to help much less than 1% of people, 0.015% to be precise. Of these people only 16% are alive 30 years post op, bringing the figure even lower. Then came the greatly anticipated topic of artificial support. Now for another television reference, the man behind the voice of the Tigger(Winnie
rums
review
44
illustration by elva choi
words by yul kahn pascual
reviews
+ comment
the artificial heart: a new
LISTEN,
Yul Kahn Pascual
world suffering from heart failure is about 25 million.”
has stayed around 3,750 whilst the number of people around the
DO.
“the number of heart transplants being performed worldwide
WATCH, lets talk about aids Ms Lorna Benton 7th March 2016 LT2 Despite the small turnout, Ms Benton led a great discussion, covering her experiences in the HIV/AIDS field abroad and in the UK whilst encouraging us to add our thoughts. She stressed her fascination with HIV/ AIDS, saying this was down to its dependence on behavioural perspective and research. Thinking of different ways to approach the social campaigns in different countries is part of the thrill of working in this field. The most interesting part I found was how the virus developed in South Africa. The epidemic began to emerge during the time where president Mbeki turned his back on both the Western AR therapies that hit the market and the prominent scientific research at the time, and took the advice of AIDS denialists who said that AIDS was just a weak immune system and not a virus. He rejected offers of free drugs and grants, and was an obstacle to the treatment of many South African citizens at the time. It has been calculated that this misinformed decision led to the death of 300,000 people. Uganda, on the other hand, took all the advice and treatment on board and saw their AIDS rates decline substantially during the same period.
that the companies had made these devices for one-time use, £250,000 a go. The next topic was that if you put someone on a machine that could technically keep them going indefinitely until they become demented, how do you decide when to turn it off? It is part of their patient autonomy to decide and as a doctor you have a duty of care to the patient. Peter Laussen came up with the potential idea of these machines becoming a bridge to decision - so until family members or the patient come to terms with their family members’ death. How do you measure the futility of the machine, the doctors medical point of view may differ from that of that patient and would judges and courts need to get involved?
She addressed the lack of a HIV vaccine by stating that its absence isn’t actually much of a pressing issue. With the right prevention basket and constant engagement of behavioural interventions, we can slowly but surely reduce the figures of HIV sufferers in generations to come. She posed a question to the floor: who do we turn to when we have a problem? All of us answered peers or family. The conclusion she helped us visualise was that peer education is one of the key target areas of HIV prevention in generations to come. A new approach being tried is using behavioural approach models that are working out in Bangladesh, for Bangladeshi communities in London, to see if there is a cultural way of approaching targeted prevention.
He is a strong believer that the technology will keep evolving and that these ethical questions and dilemmas must be faced before an advanced version of the artificial heart becomes only available to certain members of the population and causes an uproar in the public health system. We must engage in a debate like in the 1984 debate about human fertilisation and embryology, before anarchy ensues and demand exceeds supply. He finished off by saying that 1% of the population holds 50% of the world’s wealth and if things continue in the direction they are going, what will we ever do with an everlasting Trump, Putin or Al Assad? This was a fascinating talk which was excellently delivered. I would very much advise going along to one of the upcoming Gresham talks at the Museum of London, especially Prof. Elliot’s next talk on the 25th of May!
medsoc and hive ucl:
It was a greatly informative talk covering both the past and current approaches to HIV. I would like to thank UCLU Medsoc and HIVE UCL for organising this talk and would encourage more of you to attend HIVE talks in the future!
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RUMS
Alumni Association
C O N G R AT U L AT I O N S to all of the new RUMS doctors! The RUMS Alumni Association are pleased to share in your celebrations by being proud sponsors of the
RUMS Finalists Ball 2016 We are also organising a Summer Event to allow the Class of 2016 to connect with other RUMS alumni! To receive the details of this, and for more information about the RUMS Alumni Association, please join the ‘RUMS Alumni’ Facebook group. Wishing you all a safe, enjoyable and rewarding elective, and we hope to see you soon!
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The RUMS Alumni Committee
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