Archive for the ‘Medical Students’ Category

The contribution of medical students to services in pandemic flu

Wednesday, November 25th, 2009

The Department of Health has released a guide to how medical students can help in the event of pandemic flu. It’s predominantly relevant with final year medics. There’s probably scope for expansion to other potential disasters, although this guidance applies explicitly to this particular disaster.

Examples of clinical activity that may be appropriate for a final year medical student to undertake include
• Clerking of patients in emergency or ward settings
• Ordering investigations under supervision
• Getting the results of investigations
• Venepuncture
• IV cannulation
• 12-lead ecg
• urinary catherisation
• arterial blood gases
• setting up an IV infusion
• manual handling, after specific training
These skills listed are taken from Tomorrow’s Doctors where it is stated what practical skills FY1s must be able to perform. The document may also set a precedent in stating that medical students should be paid a wage for work done outside of studying. Medical students will not be forced into doing this work, and must opt in to do it. They will be provided with immunisations. Many clinical medical students have already immunised as a matter of Trust policy around the country. It is unclear whether final year medical students or retired doctors will be called first if there insufficient doctors. It would make sense for the Department of Health to have policy on this. It seems unlikely that swine flu will overwhelm the NHS this winter, but it’s good to be prepared for the future. The document can be found here.

NPSA Medical Student Prize

Tuesday, November 3rd, 2009

The National Patient Safety Agency is running an essay competition for medical students. This is the first time that such an essay prize has been run in the UK. The essay title is as follows:

‘The world of patient safety through the eyes of a medical student.’
a. Three prizes will be awarded at the annual Patient Safety Congress.
b. The winner will receive £500 and the two runners-up £200 each.

The closing date for submission is 15th December 2009.

Please send all entries by email to:

Mrs Barbara Wilde,
PA to Dr. Kevin Cleary,
Medical Director, NPSA.
Telephone: 020 7927 9500
E-mail: barbara.wilde@npsa.nhs.uk

If you have any further queries please do not hesitate to contact Dr Vivian Tang, Clinical Adviser to the Medical Director on  vivian.tang@npsa.nhs.uk

Swine flu visualised

Tuesday, November 3rd, 2009

The visionary David McCandless at Information is Beautiful has taken some data and turned it into pictures. In this instance he has turned swine flu statistics into coloured-in maps and tables. Visualisation is the often the best way for people to understand things. Certainly claims that ‘the USA have had more deaths from swine flu than any other country’ can sound worrying until you think about them. I’d really like to see more information in this format, it’s a lot easier to remember bits of red and blue on maps than tables of text. If departments of health or the World Heath Organisation made information freely available in a standardised format it would be possible to develop application programming interfaces (APIs) to make maps automatically. Hans Rosling’s Gapminder.org developed software to turn global health statistics into graphs, which turned out to be so good it was bought by Google. As a consequence, lectures at schools of medicine and public health all around the world became more interesting. If someone could make software to make maps using this precedent that would be much appreciated by students and policy makers everywhere.

Elective grants from the British Medical and Dental Students Trust

Friday, October 16th, 2009

Elective scholarships are available through the British Medical and Dental Students Trust (BMDST), a charitable organisation. MDDUS members can apply for awards of £100 and £1000. The MDDUS is an independent organisation offering legal advice and professional indemnity for doctors, dentists and other healthcare professionals. The deadline for applications is 31st January for electives taking place between April and September.  Grants were in the past granted in March and September, but are now simply granted in March of every year.  Figures for the variation in applications and grants given can be found in this tableThe overall success rate is around 20%. The BMDST is working on its own website, but for now a page is hosted by the MDDUS. It is largely funded by the world’s biggest pharmaceutical company GlaxoSmithKline. This resource is underused at present, and is a great opportunity to find funding to make the most of a once-in-a-lifetime opportunity.

UKFPO questions 2010

Wednesday, October 14th, 2009

The UKFPO questions for 2010 application have been released. The deadline for filling them in online is next Friday 23rd. Get on it, final years. I still can’t believe they changed the West Midlands Foundation Schools at the last minute without any consultation. The following questions are scored at 10 points each and have a 200 word limit. They are numbered 2-6 as question 1 is simply filling in previous academic qualifications.

Question 2

Describe a case from your clinical experience that you have observed in the first 24 hours from hospital admission. How did members of different professional teams interact and how did this contribute to effective patient care? What did you learn from this that will influence your future practice as a new doctor?

Question 3

Describe a memorable experience of being taught and how this has shaped your thinking about teaching. Identify a particular situation in which you might be teaching as a doctor in the future. Describe how you might apply what you have learned to maximise the effectiveness of your teaching.

Question 4

You are one of two foundation doctors on a ward round. The registrar identifies a minor error made by your colleague and makes inappropriate critical comments in front of the patient and the healthcare team. Your colleague is visibly distressed. What actions would you take and how would you prioritise these? What actions do you believe your colleague should take in relation to these comments? How might you address a minor error made by a more junior colleague in the future?

Question 5

Describe one example from your medical training when you received feedback on an aspect of your performance. Explain how that feedback altered your subsequent practice. How will you use this experience to develop a specific aspect of your foundation training?

Question 6

At times, the patient and the medical team have different ideas on the management of the patient’s illness, because of personal, social or cultural views held by the patient. Describe a clinical case where you have observed this. Identify the factors that contributed to these differing views. Why is it important to understand these differences in your practice as a foundation doctor?

Medical students: professional values and fitness to practise

Tuesday, September 29th, 2009

Many UK medical students begin university as teenagers, go through five or six years of training and then come out the other end as doctors. Medical school is notoriously difficult and many will have to resit examinations of some sort. What is less widely known is that an increasing number of students go through “fitness to practise”procedures. Abbreviated to “FTP” (or “F2P” by the more trendy medical schools), fitness to practise is a much-feared buzz-phrase. Once it became widely adopted, lectures were able to casually drop into their talks that being late could potentially be a “fitness to practise issue”. University staff were able to mention off-hand that students not checking their email regularly enough could be casting doubts on their “fitness to practise” as doctors. Medics in older years would tell first-year students that not attending certain social events in welcome week (the re-branded freshers’ week) could constitute a “fitness to practise issue”. Such is the gravity these words are imbued with that some would believe these lies.

Which is why a booklet designed to point out what medical students shouldn’t do, when they should be punished and even when they should be ejected from the course is to be welcomed. Unintuitive though it may be, the body responsible for banning doctors from practising medicine ominously issuing guidelines on undergraduate behaviour is good news for medical students. The reason is simply that before there were no guidelines. The various medical schools have one pretty good incentive to fall in line with the General Medical Council (GMC) as their Quality Assurance of Basic Medical Education (QABME) cycles decide whether or not they can aware medical degrees. In the GMC’s own words, “Also, given that the GMC has to be satisfied that graduates applying for registration are fit to practise, it would be  surprising if a medical school thought it sensible to disregard this guidance.”
Completion of the medical degree in the UK leads to provisional registration with the GMC, followed by full registration one year later, and therefore recourse to proceedings which can lead to being “struck off” the medical register. It is very important that doctors remain publically accountable, in fact the British Medical Assocation (BMA) lobbied for the established of the GMC in the first place when the Medical Act of 1858 went through Parliament. This was to battle the quackery du jour, as at that time “doctor” was not a protected title, and so anyone could use this title.
With medical schools now more directly accountable to the GMC it is now easier for the student body to lobby on issues. Whereas previously local issues were local issues, and any students complaining about unfair fitness to practise procedures could potentially be subject to unfair fitness to practise procedures, now any discussions can be made centrally. The Student Fitness to Practise Working Group to develop this guidance was founded as a collaboration between the GMC and what is now the Medical Schools Council (MSC), the in which the Deans of all the UK medical schools make plans. This body co-opts one elected member of the BMA’s Medical Student Committee (also the MSC), who has the tough job of keeping an eye on what’s being said on behalf of medical students everywhere.
Fortunately, there are no big nasty surprises within this document. The key issue which is raised is just how “off-work” medical students are when they’re in their own time and outside of a clinical environment. The best predictor of future behaviour is past behaviour, it would clearly be unsafe to leave patients in the care of a doctor who had a criminal conviction for physical violence, who cheated in exams, who falsified research or who was too ill themselves to treat others. The controversial issue comes in the form of a disparity in the examples of concern between “Alcohol consumption which affects clinical work or the work environment” and “Dealing, possessing or misusing drugs even if there are no legal proceedings”. The government’s chief advisor on drugs Sir David Nutt found in the famous 2007 Lancet paper to no great surprise that many illegal drugs are less harmful than alcohol. Interpreted literally, these rules would mean that a first-year students experimenting with drugs once in her first term at university would automatically be a fitness to practise concern, but an alcoholic who managed to hold it together through finals would not be.

Historically, there have been great discrepancies between proceedings in different medical schools. What would be seen as a jolly prank at one institution would be seen as definitive proof that a young person was unsuitable to ever be a doctor at another. These discrepancies were sufficient to spur the GMC into action. Standardised procedures define the roles of the investigator, the fitness to practise panel and appeals process. The investigator decides whether or not there is sufficicent evidence to determine if a student’s fitness to practise is impaired on the balance of probabilities. This civil standard of proof means it is quite likely that students who are being investigated in the first place will make it to the full fitness to practise panel. The standard of proof in the fitness to practise hearing itself is also on the balance of probabilities, in the line with how doctors are now tried.

The only requirement for the composition of the fitness to practise panel is that it must contain one GMC-registered doctor. I suppose a medical school would find it difficult to argue that one doctor by themselves makes a panel. Recommendations are that the panel includes someone from outside the medical school, someone with legal knowledge and a student representative who does not know the student being investigated. Appeals themselves are less rigidly defined. There’s no new real advice for medical students to be garnered from this new document apart from the obvious: don’t do anything silly.

Students take over student society

Thursday, July 30th, 2009
The August 2009 edition of the Student Associate Newsletter of the Royal College of Psychiatrists is the first to be produced entirely by student associates themselves. Professor Robert Howard, the Dean of the RCPsych, gives advice on how to get published with some sensible advice including asking a senior if there’s anything they require help with. Neel Burton takes us through his atypical route into psychiatry via working in Paris as a strategy consultant and then an English language tutor. Vivek Datta summarises the anti-psychiatry movement by succinctly summarising the ideas of Michel Foucault, R.D. Laing and Thomas Szasz – no room for a mention of L. Ron Hubbard. R.D. Laing’s ninth child Benjamin Sunkel-Laing expands on some of the aforementioned ideas by pointing out that there are is lack of known neural correlates for different psychological phenomena. Leverne Mountany discusses her programme to use psychiatrists based in South Africa to train GPs in Botswana in diagnosis and management of psychiatric disease to supplement the five psychiatrists in the entire country. Stania Kamara interviews Steve Peters about his experiences of being the only psychiatrist in elite sports in his responsibilities for the Olympic team of Great Britain. Gemma Ward posits that fiction has a role in helping doctors empathise with their patients. Elsewhere, Georgina Fozard writes up a dinner held by King’s College London for members of psychiatry societies nationwide, Cheryl Bennett talks about the medical student workshop held at the RCPsych’s Annual Meeting, Philippa Aveyard writes freely on delirium and Rebecca Slack, Natalie Thomas, Katherine Townson and Shameel Khan share the most interesting moments from their psychiatric electives.
UK medical schools traditionally have undergraduate societies dedicated to medical specialties run by students themselves. The purpose of these seems not just to learn more about the speciality, to network with other students who are similarly inclined for tips and inspiration but also to give more consideration to whether the specialty in question is really what the student in question wants to spend an entire career doing. Decisions don’t come much more fundamental than that. However, these societies tend to have very variable levels of use depending on how much time students have and how much they are willing to invest. Recently, there seems to have been a wave of interest in psychiatry, which is really welcome at a time when only 6% trainees sitting MRCPsych Part 1 graduate from UK medical schools.

Which Foundation School 2010?

Thursday, July 30th, 2009

 

UKFPO have released the data detailing the first-choice applications to each foundation school . I have posted these here.  The figures for 2009 are for the vacancies advertised during the application period, not the final number of jobs available after many posts were removed from several foundation schools. The question for many final-year students around the country wondering which foundation school to apply to in the Autumn is, how much do past competition ratios predict future competition ratios? Competition varies depending on which schools other applicants list as their first choice, but as any psychiatrist will tell you, past behaviour is the best predictor of future behaviour.


It’s safe to say that South Thames will continue to be oversubscribed, especially with the changes in allocations this year. Applicants accepted to the Foundation School will no longer have to rank 808 jobs in order of preference. Instead they will go through a two-stage process where they will first rank  three groups within the Foundation School and be allocated to one of these groups based on score, then rank around 270 jobs within the region. This seems like a step forward as long as the programmes are split fairly between the three areas. The groups will be divided partially on the basis on geography, and partially on the basis of administering similar programmes. Specifically, each programme group will contain similar numbers of teaching hospital programmes and specialty programmes. This is similar to Birmingham Medical School’s plan for its future clinical undergraduate course when the 2014 Review comes in, splitting each year of medicine into three geographical areas.


It is difficult to extrapolate to next year from three year’s worth of figures, especially with changes being made to the boundaries of foundation schools. Birmingham, Staffordshire and Shropshire is amicably splitting into Birmingham Foundation School and Keele (Staffordshire and Shropshire) Foundation School. This is likely to increase applications to Birmingham as students wanting to stay within or near to West Midlands county were more likely to apply to Black Country so that they would definitely be working in Wolverhampton, Sandwell or Dudley. In previous years, several applicants from BIrmingham Medical School planning to work within Birmingham have ended up in the infamous Mid Staffordshire General Hospital in Stafford or University Hospital of North Staffordshire in Stoke-on-Trent, which is Keele Medical School’s main teaching hospital. I only know one person who is planning to commute from near the student area of South Birmingham to Stafford every day to work, and his life is not going to be as easy as it could be. Pre-UKFPO, Staffordshire & Shropshire was one foundation school, but was merged with Birmingham due to under-filling, so it will be interesting to see if this the case once more. Perhaps with Keele having now produced graduates for several years they will be more fond of the area.


Due to the chronic underfilling of North Yorkshire and East Coast, from 2010 it will be merging with West Yorkshire and South Yorkshire to form Yorkshire and the Humber. This could potentially have a negative effect on recruitment if applicants are more hesitant to apply as they are less sure of the geographical area in which they will be working.  Students at Sheffield Medical School are especially unhappy about this as they are no longer sure of a job in South Yorkshire. The main carrot for applying to North Yorkshire is that every single job is band 1B. Many Hull York Medical School students do apply to their home Foundation School of North Yorkshire and East Coast.

 

 

Banding is generally:

  • 37.5 hours or less per week is unbanded (basic pay – £21, 716)
  • 37.5 hours per week with unsociable hours is band 1C (basic pay x 1.2)
  • 37.5 – 48 hours a week is band 1B (basic pay x 1.4)
  • 37.5 – 48 hours a week with unsociable hours is band 1A (basic pay x 1.5)
  • 48 – 56 hours a week is band 2B  (basic pay x 1.5)
  • 48 – 56 hours per week with unsociable hours is band 2A (basic pay x 1.8)
  • 56 hours or more per week is band 3 (basic pay x 2)
Academic jobs are banded in exactly the same way, except if there is a separate education or research post that will be unbanded as hours worked are meant to be standard office hours.  Band 2A and above are now rare because the majority of jobs are now compliant with EWTD which limits working hours to less than 48 hours per week.  Rotations such as medicine and surgery are generally banded and rotations such as anaesthetics are generally unbanded.  Locum work is commonly available to junior doctors in additional to standard hours to increase up the salary, so even in an unbanded job there should be opportunities to make up the money.

Twitter in the medical literature

Thursday, July 30th, 2009

A medical student’s been published writing about Twitter. Should have been in 140 characters or less, really.

Intercalation in Disaster Medicine

Monday, July 20th, 2009

St. George’s, University of London is considering launching an intercalation in Disaster Medicine. Disaster Medicine is an emerging specialty that was introduced to many in an article in The Lancet Student last year. The chairman-founder of the American Board of Physician Specialties Dr Maurice A. Ramirez had a few words to contribute. One of the horrifying possibilities that would significantly impact healthcare provision he envisioned was an unwitting anticipation of the plot of The Dark Knight in the form of the deliberate destruction of a hospital. The textbook Disaster Medicine has had its first edition published in 2006, the same year the American Board announced board certification in the speciality.

The proposed Intercalated BSc in Leadership in Disaster Medicine aims to give students a solid grounding in the basics of safe and effective practice in humanitarian medicine in conflict and disaster scenarios at home and abroad. As well as being taught the fundamentals, students will be introduced to the agencies and organisations with major roles in the field and encouraged to address the key issues in order to develop potential leaders in Disaster Medicine for the future.

To anticipate potential demand for the course, UK medical students were invited to complete an online survey. The results of this study have are not yet released. If so this will be the first intercalation in Disaster Medicine,  which will help raise its profile in medical schools. Disaster Medicine may provide a useful set of skills, but I can’t help hoping these won’t be used very much in the future.