mediscopeJun 2009

Discovery +Development

Manchester Medical School’s Student Magazine

Through the Keyhole

Interview with Dr Chris Steele

Cranial Nerve Exam Poster

Academic Medicine

Reviews

Andrew ChengYear: 4, MRIQ+A: Toilet paper... genius!

James GoodmanYear: 4, MRIQ+A: The wheel

Ahmed HankirYear: 4, WythenshaweQ+A: Gutenberg’s printing press

Lucy HollingworthYear: 4, WythenshaweQ+A: High heeled shoes

Khimara NaidooYear: Intercalating - PathologyQ+A: The microscope

Prizzi ZarsadiasYear: 4, MRIQ+A: 1,3,7-trimethylxanthine aka caffeine

n Puiu Cristian - Computer Sciences, Romania n Justin Healy - MBChB Year 4, Wythenshawe n Christopher Jacobs - MBChB Year 3, Wythenshawe n Loralie Rodrigues - MBChB Year 3, MRI

Q+A What is the best discovery/invention the world has ever known?

What’s Inside

12interview with dr chris

20a career in academic medicine

EDITORIAL TEAM

COnTRIbuTORs

06.09mediscope

Issue 5 Chief Editor: Ahmed Hankir

Web: www.mediscopeonline.com

Editors: editor@mediscopeonline.com

Article Submissions: articles@mediscopeonline.com

Competition Entries: competitions@mediscopeonline.com

Production & Layout: Andrew Cheng n Front, Editorial, Education,

Poster, Careers, YourScope, Society Prizzi Zarsadias n Info, Features, Careers, Reviews

Dedication: The Mediscope Editorial Team respectfully dedicate

this issue to Tom Donaldson who sadly passed away in February 2009 while on his elective.

28manchester medics Football club

16cranial nerve exam

26medical blogging

T he theme for issue fi ve of Mediscope is Discovery and Development. We hope that this humble eff ort acknowledges and pays tribute to the women and men, in the words of Professor Diczfalusy, “who dream of things that cannot be and ask why not?” In their tireless endeavour

the audacious few, some overt but most obscure in their labour, aim to push the frontiers of humankind. We salute their determination and persistence to unravel the mysteries of the universe.

Th is Mediscope issue includes an array of articles for a diverse readership. Introspection can breed internal discovery as is made apparent in the One Week article by Ben Amies in YourScope. Reuben Roy carries the fl ag for the Manchester Medics in University Challenge and elaborates on his adventures in our Beyond the Call of Medicine feature.

Compiling this issue of Mediscope has been extremely challenging for the team as a whole. Our hard work has not gone unnoticed, however, and we are very pleased to announce that Medicope Magazine were awarded the fi rst prize in the 2009 Student Team Working Awards in the extracurricular category sponsored by PricewaterhouseCoopers. We would like to say a big thank you to all of those who have made this project possible, particularly the Medical School.

Mediscope Editorial Team 08-09

4 Val Wass Providing insight into the world of Academic Medicine

5 Nothing to Lose, Much to Gain Applying for academia

6 Diabetes Virus A trigger for childhood diabetes?

6 Also in the News Health news from around the world

7 Malaria Vaccine An answer to an epidemic

8 Through the Keyhole Laparoscopic surgery

9 Under Construction A DIY surgical simulator

10 University Challenge Beyond The Call of Medicine

11 Time to Get Personal The future of personalised treatment

12 Interview with Dr Chris Steele From This Morning

16 Poster How to do a Cranial Nerve Examination

18 Surgical Checklist Ticking off patient safety

19 Competition Winners

19 How Not to Get Struck Off Advice from the MPS

20 A Career in Academic Medicine An indepth analysis

21 Hypothetical Holiday Working in the Summer

22 Neonatology Caring for the tiniest of patients

23 Interview with the Orthopods Not just brains, brawn and bones

24 One Week An eye opener for Ben Amies at Christie Hospital

25 The International Medical Student From Qatar

25 YourScope Mediscope asks the Medics

26 Medical Blogging A virtual soapbox for the anonymous?

28 Scalpel Manchester’s surgical society

28 Manchester Medics Mens FC Top of their game

29 Manchester Medics Womens FC Narrowly pipped

29 Serenity Project In Tanzania Helping abroad

30 So You Want To Be A Brain Surgeon? Careers book

30 Series: Clinical Cases Uncovered The PBL companion

31 Cuckoo Crazy A different way to spend your Friday night

31 The Last King of Scotland Zheng vs McAvoy

06.09

EDuCATIOn

CAREERs

YOuRsCOPE

sOCIETIEs

REVIEws

FEATuREs

InFO COnTEnTs

EDITORs’ LETTER

infoscope

mediscope 06/094

infoscope4 Valerie Wass - Academic Medicine6 Diabetes Virus7 Malaria Vaccine

Academic Career Pathways:

MissedOpportunitiesnot to be

Professor Val Wass (Professor of Medical Education) understands that on entering medical school it is hard to identify where you want to be in twenty years time. For those who can imagine themselves as a future professor or hospital dean, she assures us that the goal is really worthwhile but students should start planning ahead.

scopeinfo

5 06/09 mediscope

“ exciti ng possibiliti es now exist but are open to

nati onal competi ti on ”

For those of you interested in making groundbreaking

medical discoveries and being paid to travel the world to

present them, Academic Foundati on training is the logical

next step aft er medical school.

Each UK deanery allocates a small number of academic

foundati on training positi ons every year. Recruitment

takes place between May and September; clinical MTAS

applicati ons begin aft er.

Those who recruit for the academic foundati on training

positi ons seek candidates who they expect to capitalize

on the opportuniti es that the programmes provide to

augment academic skills. They will expect you to be aware

of ongoing research acti viti es at the specifi c insti tuti on(s)

relevant to your fi eld of interest. Some interview panels

will expect you to have made contact with the appropriate

academics.

A strong applicant will demonstrate through their appli-

The changes introduced by Modernising Medical Careers(www.mmc.nhs.uk) have made

it increasingly important to plan ahead. If you are keen to include research and aca-demic education activities in your future clinical role then it can be use-ful to recognise this now. The pathway is often competitive. A well structured CV is very advantageous. Those of us enjoying the challenges and rewards of Academic posts would really encourage you to think ahead and make use of opportunities available to you.

Why is this important? The NHS is keen to foster and develop high qual-ity clinical researchers. A working party was set up in 2005 (The Walport Report htt p://www.nccrcd.nhs.uk). The Report made recommendations for specifi c train-ing programmes to encourage young doc-tors to develop the qualifi cations needed to compete and progress in the academic arena.

The pathway off ers opportunities at all stages of your career. Manchester was particularly successful in bidding for these posts. Academic Foundation jobs are avail-

able at all the Manchester teaching hos-pitals and off er a four month Academic rotation within the two year programme. These rotations are devoted to pursuing research (clinical or in medical education). We have nineteen Academic Clinical Fel-

lowships across a range of specialties which of-fer 25% protected time to develop proposals for PhDs and take a training fellowship. For

those with PhDs there are fi fteen clini-cal lectureships which enable doctors to continue their research alongside clinical training. A wide range of support and ex-citing possibilities now exist but are open to national competition. It is important to be prepared.

What should you do to set yourself up in a good position for an academic career? Intercalation to achieve a second degree, in addition to an MBChB, is undoubt-edly important. A fi rst or upper second class Bachelors or a Masters degree gain important points on application forms for these posts. There are many opportunities to intercalate either between phase 1 and 2 or in the clinical years. We are also for-tunate at Manchester to have the Masters in Medical Sciences Research programme

supported by the Medical School and available between Year 4 and 5. This is a relatively unique opportunity compared to other medical schools.

You may be aware that, across the UK, many medical students intercalate after the fi rst two years. Therefore, having a second degree can really help if you are seeking a career in a competitive special-ity. Intercalation here in Manchester is becoming more popular. The number of students doing so has almost trebled over the last three years. The advantages of intercalation are becoming increasingly recognised. So consider this carefully and don’t overlook opportunities at the end of Phase 1.

We ask at Academic interviews, “Where do you see yourself in ten years time?” Don’t be modest. If you feel your future lies in a highly competitive spe-cialty, as a lead in medical education or doing some research alongside clinical medicine start building your CV now. You will not regret tak-ing the opportu-nity even if you ultimately change your mind. Aim high!

cati on form and interview(s) some evidence of academic

achievement (undergraduate examinati ons, presentati ons,

publicati ons, essay prizes etc), a sense of career focus and

ambiti on, and equally important, a generous show of enthu-

siasm.

There is no limit to how many deaneries you can apply

to, with no detrimental consequences to future MTAS

applicati ons. Much in common with research itself, if you

don’t try, you won’t fi nd out – but if you are successful, the

rewards and further opportuniti es are considerable.

Resist conceding to any sense of self-doubt or whispers

of the scale of the competi ti on – both are oft en overstated.

In applying for academic foundati on jobs there is litt le to

lose and much to gain, and if you are interested, I would

strongly encourage you to apply.

Good luck!

infoscope

NOTHING TO LOSE

USEFUL LINKS:

www.medicine.manchester.ac.uk/postgraduate/mres/medicalsciences

www.medicine.manchester.ac.uk/academicclinicians/northwest/

www.nccrcd.nhs.uk/intetacatrain/

www.acmedsci.ac.uk

MU

CH

TO

GA

INIMRAN YUSUF ACADEMIC FOUNDATION TRAINEE OXFORD,

COMMENCING AUGUST

ACADEMIC FOUNDATION APPLICATIONS:

By John Moore

infoscope

mediscope 06/096

local InternatIonal

also

In t

he n

eWs J

AMES

GOO

DMAN

natIonalManchester

In January 2009, a woman n

became the fi rst in the UK

to give birth to a baby who is

free from the BRCA1 ‘breast cancer gene’. The

private clinic at University College Hospital used

the technique known as pre-implantati on geneti c

diagnosis to select embryos free from the gene.

Elizaabeth Adeney, aged 66, has become n

Britain’s oldest mother, beati ng the previous

record by four years. She was forced to undergo

IVF treatment in the Ukraine as most Briti sh clinics

do not treat pati ents above the age of 50.

The 500,000th pacemaker operati on in the UK n

has taken place at St George’s Hospital, London.

The fi rst pacemaker, the size of a pram wheel, was

fi tt ed in 1958 and had to be plugged into mains

electricity leaving pati ents stuck in hospital and at

the mercy of the electricity supply.

The NHS confederati on (which represents 95% n

of NHS organisati ons) has released a report saying

the NHS faces its biggest fi nancial challenge in its

history. It forecasts a funding shortf all of £15 bil-

lion over the next decade.

The incidence of type 1 diabetes is

increasing every year and there

is currently no way to prevent

its onset. Genetics play a substantial role

in the development of diabetes; however

environmental factors may also be

involved. More specifi cally, the theory

that viruses could be one of the potential

causes of diabetes has been hypothesized

for decades.

Recent UK research does suggest that

a common virus may be the trigger for

the development of type 1

diabetes. Pancreatic tissue

samples were collected

during autopsy from 72

children across the UK who had died less

than 12 months after being diagnosed

with type 1 diabetes. The samples were

compared with those of 50 children

without the condition. Research leader Dr

Alan Foulis suspected that enteroviruses

would be detected in the type 1

diabetic samples, owing to the improved

sensitivity of new techniques and highly

sophisticated equipment. In keeping with

Dr Foulis’ expectations, approximately

60% of the children with type 1 diabetes

showed the presence of enteroviruses. It

was also found that 40% of adults with

type 2 diabetes had signs of the infection

in insulin-producing cells. Researchers

speculate that the infection aff ects the

ability of the cells to make insulin, which

in combination with the greater demand

for insulin in obese people, is enough to

trigger the onset of the disease.

Professor Noel Morgan told the

BBC, “The next stages of research are

to identify which enteroviruses are

involved, how the beta-cells are changed

by infection and... to develop an eff ective

vaccine... which we hope will drastically

reduce the number of people around the

world who develop type 1 diabetes, and

potentially type 2 diabetes also.”

President Obama has vowed n

to seek, “a cure for cancer in our

ti me.” His $10 billion economic

sti mulus package echoes Richard Nixon’s ‘war on

cancer’ in 1971. Obama said, “It will launch a new

eff ort to conquer a disease that has touched the

life of nearly every American, including me, by

seeking a cure for cancer in our ti me.” Both his

mother and grandmother died of cancer.

GlaxoSmithKline (GSK) n has started fi nal phase

trials on its groundbreaking anti -malarial vaccine,

Mosquirix, which will be tested on 16,000 African

children. If successful, the vaccine, which is 50%-

55% eff ecti ve, will be fi led for regulatory approval

in 2011. GSK has also just made their ‘diet pill,’ Alli

(Orlistat) available over the counter to people in

the UK with a BMI greater than 28.

French surgeon Professor Laurent Lanti eri has n

performed the world’s fi rst full face transplant in

Paris on a man who was severely burned in 2004.

Professor Ian Hutchinson, a surgeon at Barts and

the London hospital said, “The issue here remains

that this is a huge operati on – but not a life-saving

one.”

The peti ti on by The n

Christi e Hospital, which

was handed to Gordon

Brown requesti ng the return of £6.5m in dona-

ti ons, lost when the Icelandic bank Kaupthing

Singer and Friedlander collapsed in October 2008,

has been granted.

Sir Alex Ferguson has backed a campaign by n

one of his former players to increase awareness of

multi ple sclerosis (MS). A nati onal survey by the

MS Society found the North-West had the worst

knowledge of the disease in the country with

almost half unable to name a single symptom and

a third thinking there was a cure for MS.

A pioneering safety device – the safety can- n

nula, which features a self-acti vati ng safety clip,

has been introduced in the A&E department at

Manchester Royal Infi rmary. Mr Stewart, clinical

director of emergency services says, “Before we

introduced this safety device we were running

at around 19 needle-sti ck injuries a year in this

department. In the year aft er its introducti on, we

had not had a single incident...”

children across the UK who had died less in combination with the greater demand involved, how the beta-cells are changed

“ 60% of the children with type 1 diabetes showed the presence

of enteroviruses ”

vIral trIgger for chIldhood dIabetes

scopeinfo

7 06/09 mediscope

The twenty-fifth of March 2009 marked the second World Malaria Day. It coincided with the news that Sanaria, a Maryland-based company in collaboration with

the PATH Malaria Vaccine Initiative (MVI) is to launch Phase 1 clinical trials of a unique vaccine candidate. Although there are several malaria vaccines already in advanced clinical develop-ment, most consist of recombinant or genetically engineered antigens or epitopes of malaria parasites, and have shown only partial effectiveness. Sanaria’s vaccine candidate, an attenuated form of the Plasmodium falciparum sporozoite (the most deadly malaria parasite), is the first of its kind in the malaria vaccine field.

“Initiation of this trial expands the spectrum of malaria vac-cines in clinical development today,” said Dr Christian Loucq, the Director of MVI. There is hope that evidence from previous studies, which suggests that Sanaria’s vaccine has the potential to confer high levels of protection against malaria, will be repro-duced in the present trial, which will involve 104 volunteers and began in mid-May.

Malaria kills one million people every year, mainly young children and pregnant women in sub-Saharan Africa. The last three decades have seen the burden of malaria rebound dramatically following the unsuccessful Malaria Eradication Programme of the mid-fifties, in part due to the failing efficacy of affordable antimalarials and insecticides. In the 1990s the Roll Back Malaria Initiative responded to this alarming trend by promoting malaria control strategies, such as indoor residual spraying and insecticide treated bed-nets for vector control, intermittent preventative therapy in pregnancy, and early and effective treatment for children. These strategies have made gains in reducing the malaria burden in many countries. However, the need for a malaria vaccine has become more pressing in recent months following reports of a new malaria strain in western Cambodia that is resistant to even the most effective chemotherapeutic treatment (a combination of antimalarials including the drug artemesinin).

In recent years, there has been a renewed focus on malaria eradication as a long-term goal. In 2007, the Bill & Malinda Gates Foundation thrust malaria eradication to the forefront of the global health agenda. This was endorsed by the World Health Organisation, but if the goal of eradication is to be realised, a constant pipeline of new tools to fight malaria would be crucial.

In a recent conference, Dr Loucq commented that, “History has shown that vaccines are the most powerful tool to control and eliminate infectious disease.” Professor Michael Good, the Director of the Queensland Institute of Medical Research has de-scribed Sanaria’s recent announcement as a “watershed event” in the realisation of this ultimate goal.

malarIa vaccIneto begIn trIals

Malaria is a major global health problem, affecting the ninhabitants of tropical and sub-tropical regions of the world, particularly sub-Saharan Africa

It is caused by the parasitic infection of one of four nPlasmodium species, of which P. falciparum is the deadliest and the focus of most research

The vector for the malaria parasites is the female Anophelene nmosquito, which transmits the infection between humans

The clinical features of malaria depend on the malaria nparasite but usually include swinging fever and rigors, accompanied by non-specific symptoms such as abdominal pain, headache and diarrhoea

Complications include hepatomegaly, encephalopathy, severe nanaemia, jaundice, hypoglycaemia and convulsions

Diagnosis is by identification of the parasites in the red blood ncells or parasite antigens in the blood

Treatment depends on the malaria parasite, but is assumed nto be P. falciparum until proven otherwise. The most effective antimalarials are currently the artemesinins-combinations

THE FACTS

By Ambrose Boles

mediscope 06/098

featurescope

“There was a standing ovati on as the gallbladder was delivered

through the pati ent’s umbilicus!”

I qualifi ed as a doctor from Manchester University in 1977.

With the fi rst phase of my lifelong ambiti on to be a surgeon

achieved, there followed several years of ongoing training and

examinati ons and in 1989 an appointment as Senior Lecturer in

Surgery in the department headed by Professor Sir Miles Irving. Now

reti red, he remains an inspirati on to many, a charismati c man of razor

sharp intelligence, boundless energy, and has a knack of predicti ng

future developments. Soon aft er I joined his unit, he summoned me

into his offi ce, having returned from one of his many trips abroad,

and described how he had witnessed a laparoscopic cholecystectomy.

I had only ever heard of a diagnosti c laparoscopy, a procedure that

was mainly in the domain of gynaecologists, but could not envisage

how a surgical procedure could be performed laparoscopically. On

Tuesday 12th June 1990, I joined a number of surgeons at the Leeds

General Infi rmary to watch Joe Petelin, a surgeon from the USA,

perform this operati on. We could not believe what we saw. We

watched in awe at the television images of the operati on in progress

and there was a standing ovati on as the gallbladder was delivered

through the pati ent’s umbilicus!

I was charged by Professor Irving to develop laparoscopic surgery

at Hope Hospital and he arranged for me to visit Professor Dubois

in Paris, an early pioneer. I returned from my visit a convert, and set

about drawing up a shopping list of instruments. Getti ng hold of the

kit was incredibly diffi cult, since there was just one company that

manufactured the instruments and it could not sati sfy the demand.

The second hurdle was training, since there were no more than a

handful of individuals who had any experience of this new surgery

in the U.K. I decided to make a simulator so that I could practi ce

with my colleagues and theatre team. A trip to the local B&Q to

purchase the materials and a few hours work in my garage resulted

in the simulator show in Fig 1, that sti ll survives to this day, 19 years

aft er its inventi on! A few hours practi ce and I was ready to perform

my fi rst operati on in 1990, assisted by a senior colleague. It took us

four hours, but the pati ent was up and about the next day and ready

for home. The traditi onal open operati on would have taken me 40

minutes, but the pati ent would have stayed in hospital for 5 to 7 days.

Laparoscopic surgery had come to Hope Hospital. My descripti on of

the trainer was published in 1991.

This year, it will be twenty years since I was appointed a consult-

ant and fi rst heard of laparoscopic surgery. The practi ce of surgery has

been transformed by advances in laparoscopic surgery. High resolu-

ti on imaging means that we can see bett er than the naked eye in con-

venti onal open surgery. Instruments have been developed to execute

every acti on, such as dissecti on, suturing, stapling, sealing and divi-

sion of large blood vessels. There is virtually no operati on that hasn’t

been carried out laparoscopically, and in many cases, the laparoscopic

operati on is the norm. Robot assisted surgery, of which robots such as

the Da Vinci robot are employed, is now common practi ce. Originally

developed to facilitate remote surgery, such robots have found a

niche where surgery is required in limited space, such as the pelvis

and in the paedatric age group. Robots can also be programmed to

scale down the operators movements and reduce tremor.

All this has resulted in an enormous benefi t to the pati ent, such

as smaller scars, less adhesions and shorter hospital stays. Pati ents

have accepted and oft en demand keyhole surgery. It wasn’t always so.

In the early nineti es, many surgeons launched into this fi eld without

adequate training, fearing that if they did not do so, pati ents would

desert them. This resulted in a dramati c rise in complicati on rates and

mortality in safe, common operati ons such as cholecystectomy. The

situati on is quite diff erent now, with proper training programmes,

mentoring and accreditati on.

What about the future? Undoubtedly there will be further devel-

opments in technology, to make operati ons easier and safer. Surgeons

are also beginning to explore novel concepts, such as natural orifi ce

transluminal endoscopic surgery or ‘NOTES’. The idea is to gain ac-

cess to the abdominal cavity through the gastrointesti nal tract or the

genital tract in women, to enable scarless surgery. Cholecystectomy,

appendicectomy and splenectomy through the vagina or the stomach

have already been described!

featurescope8 Laparoscopic Surgery10 Beyond the Call of Medicine11 Personalised Medicine12 Dr Chris Interview

through the Keyhole

Consultant Surgeon Mr Muntzer Mughal, Consultant in General and Upper GI Surgery, reminisces on his innovative invention and paves the way for future practioners of this Art

9 06/09 mediscope

scopefeaturescopescopefeature

When you consider the term ‘laparoscopic simulator’, what is the fi rst image that

comes to mind? Perhaps it is a complex and expensive virtual reality machine. Regardless of what image your mind has conjured up, it is unlikely to be that of two cheap plasti c boxes with a web-cam att ached with blue-tack!

The idea for such a contrapti on oc-curred to me during a laparoscopic skills day organised by Scalpel (The University of Manchester’s surgical society) in Preston. Hearing of Mr Mughal’s £75 DIY simulator from the early 1990s prompt-ed the following thought: why can’t you use a plasti c box, webcam and laptop?

While such a basic simulator could not provide a realisti c environment, it would nonetheless facilitate the learning of basic laparoscopic techniques, such as knot tying. The benefi ts of such training would not be restricted to laparoscopic surgery as many specialti es uti lise an endoscopic approach and thus require such skills. Hence, developing their dex-terity and visual-spati al coordinati on is going to be a key aim for many aspiring surgeons.

Rather predictably however, such a set-up was not a novel idea and several authors have published details of similar devices. Compared to commercially available simulators, the devices already in print are cheap, costi ng approximately £40-100 to construct. However, this generates a new challenge: how to build a laparoscopic simulator on a medical student’s budget!

A fi gure of £15 pounds was suggest-ed. This sum was only for materials, as most students already possess a compu-ter and web-cam. Two black boxes were obtained (£2.99 each) from a local DIY superstore. Opaque boxes consisti ng of thin, malleable plasti c were selected as this makes allowance for modifi cati on.

Two batt ery-powered LED lights were obtained at £3.99 each to provide a suit-able light source. Other essenti al items were sti cky tape, blue-tack, A4 paper and elasti c bands. Suture material and catheters may be obtained from those fabulously helpful folk known as skills technicians!

Building the simula-tor (total cost approx £14) was essenti ally a case of experimentati on. The total ti me required is less than an hour, but the featured design is constantly in development.

The implements pictured are reti red instruments borrowed from Mr Mughal, which are inserted through holes in the plasti c. Many hospitals use ‘disposable’ instruments that once cleaned, are very handy for practi ce at home. Thus, most students should be able to lay their hands on laparoscopic instruments, pro-viding they speak nicely to the correct person!

Alternati vely, manual manipulati on of conventi onal surgical instruments under camera vision can be achieved by cutti ng two large holes into the side of the box. Although this may seem rather pointless, by using the web-cam soft ware, it is pos-sible to fl ip and/or mirror the image.

Anyone has the ability to build their own DIY surgical simulator and devise suitable tasks. Although there is not yet evidence that this simulator improves surgical skills, it surely cannot hurt to try and improve these valuable skills.

featurescope Under Construction...

Standing on the Shoulders of Giants. Alisdair Gilmour, a fourth year medical student, experiments with DIY medicine and discovers the rewards that can be reaped by tapping into the creative potential of the human mind.

then and Now:

Fig1 (above) - Photos

of Mr Mughal’s

simulator.

Fig2 (left ) - Alisdair’s

updated version, complete with

a screen shot of the acti on!

CoNGRAtULAtIoNs to second year medical stu-

dent Andrew McMaster who successfully completed the 24th Marathon Des Sables featured

in the last issue. The 202 Kilometre event (126 miles) took place over fi ve days in the Sahara Desert. Andrew completed

the course in a fantasti c ti me of 30 hours 11 minutes 43 sec-onds and came 206th out of 812 internati onal competi tors. Full report to follow in next issue.

*sw

ord-

shap

ed

“each team enters the stage to the Rocky theme tune!”

do you know what xiphoid means in Lati n* (were you even at that anatomy demonstrati on)? Or that triage is

derived from French (to sort, to separate)? Medical knowledge can be quite handy for a University Challenge quiz team, so it is not surprising that medics oft en seem to make up part of the oppositi on. Before our win this year, The University of Manchester last triumphed in 2006. However, we cannot help but feel disap-pointed with the recent result, since we won as a consequence of the oppositi on’s misconduct and the BBC’s eff orts to protect themselves from yet another quiz scandal, rather than from a true winning performance.

The selecti on process for the team takes place in March each year and is organised by Stephen Pearson, a librarian based at the John Rylands University Library (JRUL). The fi rst round of selecti on involves a writt en quiz cover-ing a very broad range of topics, from science and history, to politi cs, literature and geogra-phy. The 12 highest scoring applicants are then invited back to the second round of selecti on, which takes the form of a buzzer quiz consisti ng of old University Challenge starter questi ons and lasti ng for around 45 minutes. Stephen is very careful in the selecti on process, ensuring a balance of knowledge between the sciences and humaniti es. Thus, the highest score in the two quizzes does not ensure automati c selecti on; it is the questi ons answered which matt er the most. Having selected a team, we then formally apply to enter the show.

Following our applicati on to the show, we were invited to an auditi on/interview in order to determine our suitability. This

consisted of a 20 minute chat with the produc-ers of the show. Apparently, they like to ensure that the teams are not too old (following com-plaints in previous years) and that we are not secret quiz champions! Earlier series have had teams with ‘professional’ quizzers (Mastermind, Brain of Britain etc.) on them, which is now fi rmly discouraged.

Manchester has a very good reputati on for quizzing, thanks to the work of Stephen, a quiz enthusiast. We have weekly practi ce sessions in JRUL, which increase to twice a week as recording draws nearer. An oppositi on team is drawn from former Univer-sity Challenge contestants, the quality of which is consistently high. From my experience as a contestant, I now appreciate that you can never really prepare for a show like University Chal-lenge and that the practi ce sessions are invalu-able for the development of the team; initi ally we were not aware of when to buzz or which topics each member was strongest. Somewhat helpfully, the sessions also also provide a good opportunity to learn new facts! Regarding the development of ‘tacti cs’, we were just mindful to slow our answering of the bonus questi ons (in which the team confers), as this consumes quizzing ti me, so is benefi cial when ahead.

Filming of an episode takes around 45 minutes. The producers try and make it as enjoyable as possible; each team is formally announced to the audience and enter the stage to the Rocky

theme

tune! The quiz requires around 25 minutes of fi lming ti me. Aft erwards, retakes are fi lmed (even Paxman fl uff s his questi ons - with some regularity). Shots are taken of the audience ap-plauding, and the closing shots are fi lmed many ti mes. The intense fi lming of the quiz, followed by the much more relaxed audience shots, all contribute to this somewhat surreal experience.

In terms of my medical educati on, I cannot say that having a broad general knowledge has been especially useful, though it is someti mes

handy on a ward round when the oc-casional consultant enjoys testi ng the

rest of the team with odd questi ons. However, an in depth knowledge of the speciality would probably be more useful, for both the ward round and in the long term!

It would be safe to say that although the team members have good general knowledge, I do not think any of us are parti cularly brilliant when it comes to our own course subjects. Whether our brains have made a sacrifi ce to re-tain this (mostly rubbish) knowledge instead of that related to our degrees is open to debate...

In this issue’s regular feature, Reuben Roy, an intercalati ng medical student, sheds light on brain training, quiz scandal and show biz entrances. Left to right: Stephen Pearson, Henry

Perti nez, matt hew Yeo, Simon Baker and Reuben Roy

Beyond the Call of Medicine:Reuben Roy Rises up to the

CHALLENGE

11 06/09 mediscope

scopefeature

Time to get

a recent report issued by the United States Department of Health and Human Services, ‘Personalised Health Care: pioneers, part-nerships and progress,’ pinpoints personalised medicine as an integral part of healthcare systems of the future. Mark Hawthorne, intercalating medical student asks what exactly is personalised medicine and will it ever be possible to achieve?

Personalised medicine is defi ned as “the manage-ment of a patient’s disease or disposition by using molecular knowledge to achieve the best

possible medical outcome for that individual.” Un-doubtedly, the 20th century’s so-called ‘blockbuster’ era of drug discovery has brought us a long way. However, it is no myth that most drugs now prescribed exhibit diff erent effi cacy between patients. Furthermore, there are also safety issues: some people experience severe adverse eff ects whilst others do not. The reality is that patients are all diff erent and the great hope is that dis-covering the diff erences in their genetic profi les will take healthcare away from the ‘one size fi ts all’ approach into a new era of personalized medicine.

Since the completion of the Human Genome Project at the turn of the century, research has started to focus on the genetic components of individual diseases. Perhaps the most promising area is the ‘genome-wide association studies’ utilising Microarray technology. A sample of DNA from a patient can be added to a Micro-array and the genes being over- or under-expressed can be detected by scanning it into a computer. The patt erns of gene expression subsequently identifi ed could lead on to the discovery of crucial biomarkers.

A biomarker is a biological substance that can be used as an indicator of either a normal physiological process, pathological process or a pharmacological response to a therapy. The BCR/ABL gene (or the Phila-delphia Chromosome) is an important biomarker found in some patients with Chronic Myeloid Leukaemia. The eventual goal following biomarker discovery is the development of a targeted therapy, as was the case with Gleevec™, which is now used to inhibit the BCR/ABL gene in these patients.

There are clearly huge challenges along the road to personalized medicine including technical issues. Although an increasing number of Microarray studies are being performed, their impact to clinical medicine remains relatively subtle. One of the main reasons is that each experiment generates a huge volume of data and researchers often encounter ‘data overload’.

If researchers become more adept at translating experimental data into more clinically relevant informa-tion, personalized medicine will start to become a more feasible option but the challenge then is likely to be overcoming the cost of the new drugs. To put things in perspective, Gleevec™ currently costs around £50,000 per year. Thus, as more targeted therapies become available, healthcare budgets will be put under an ever increasing strain.

Personal

mediscope 06/0912

featurescope

Holly Merrick

meets

Dr Chris

Unfortunately, gone are the days when I can

lounge in bed watching This Morning. Today,

however, I actually get to see it being filmed

in London…

Dr. Steele, who prefers the more relaxed ‘Dr. Chris’,

is letting me shadow him for the day. I want to learn

about the impact the media can have on health aware-

ness (and maybe do some celebrity spotting at the same

time!)

On the 6.10 train from Manchester Piccadilly to

London Euston the man across from me looks pretty sur-

prised when Dr. Chris comes to sit next to me! My first

impression of the nation’s favourite GP is just how nice

he is. His calm and composed manner soon puts me at

ease and makes me ponder on what a great family doc-

tor he must be as we chat about the day’s proceedings.

From the train station we take his chauffer-driven

car to the studio. We are given a tour around the set

which is surprisingly quite small in real life. Unfortunate-

ly, no one has arrived just yet…

Dr. Chris has been appearing on This Morning since

1988 whilst also working as a GP in South Manchester.

He specialised in smoking cessation, a special interest

which found him locking horns with the Secretary of

State to get nicotine gum put on NHS prescription.

He had been ‘breaking the rules’ and prescribing it

at his Smoking Cessation Clinics because the NHS did not recognise smoking as

a dependency, or nicotine as having any therapeutic effect to treat it. A tribunal

vindicated Dr. Steele and he then travelled worldwide lecturing on the subject and

making many media appearances. This gave him experience for his role on This

Morning. He has pioneered the use of the TV medium, and now the internet, to

inform and educate the public on health matters. His most notable health matter

on This Morning was the controversial live breast and testicular examinations. The

examinations received just a few complaints which were then followed by hundreds

of letters of thanks for saving the lives of viewers who, on performing the exams on

themselves, found lumps and consequently went early to their doctors.

Chris has to do a lot of homework. He gets a brief the night before the program

on what he will be consulted on. This can, however, change at a moment’s notice

if there is breaking news on a medical matter that the viewers would be interested

in. In today’s show he is talking about bowel cancer because it’s Beat Bowel Cancer

Week. There is a patient on the show who is telling her own cancer survival story

and the message that Dr. Chris wants to convey to the audience is, ‘Don’t die of em-

barrassment’. Sometimes Dr. Chris talks about what’s new in health care in an item

called, ‘What’s New, Doc’, but the most nerve-racking part of his job are the live

phone-ins, where viewers call in to speak to Chris about their ailments on national

television.

As I watch Dr. Chris describe the red-flag symptoms of bowel cancer I can’t

help but think that someone, somewhere, is watching the TV and thinking, “that

sounds like my symptoms?” This is practicing medicine on a national scale. Mixed in

with the other items on fashion, celebrities and makeovers is a piece of life-saving

journalism.

Dr Chris comes through the door to do our interview while he is removing the

last smudges of foundation on his face...

Holly Merrick, intercalating medical

student, interviews Dr Chris Steele on the set of This Morning where

he has worked for over twenty years

Inte

rv

IeW

13 06/09 mediscope

scopefeatureme: so where did you train and what was

it like?

Dr. Chris: I trained in Manchester

actually at the MRI, very enjoy-

able, great days. It was obviously

diff erent to the course now,

the structure has completely

changed. I didn’t work too

hard; I was more inter-

ested in the social side of

medical school life. I was

social secretary of the

MSRC. I was also in a

rock band.

me: What was the

band called?

Dr. Chris: Man Fri-

day... we did a lot

of gigs and we had

a mobile disco too. We

used to organise parti es for the medics and

bring the mobile disco to them. I didn’t

necessarily att end all the lectures or the

ward rounds, but I got through in the end.

me: Why did you choose to become a GP?

Dr. Chris: For the independance. I didn’t

want to climb the ladder. I just wanted to

get out and do my own thing.

me: So how did you make the transiti on

to This morning?

Dr. Chris: It’s a long story but the short

answer is I was Richard and Judy’s GP. The

long answer is, many years ago I started

taking an

inter-

est in

smoking

cessati on

and I

opened clinics in Withington and Wythen-

shawe which were very popular. No one

knew about using nicoti ne as a treatment

then. Then Nicorett e gum came out and

I had 60 to 200 pati ents in a clinic com-

ing along each week for six weeks. So, if I

had 100 pati ents coming to a clinic for 6

weeks and gave them all Nicorett e that’s

600 pati ent weeks experience. That’s a

lot of experience. So I became an expert

in nicoti ne gum because no one had had

the experience I had. When Nicorett e was

launched they invited me out to

Canada. I was lecturing to doctors

but that was a front. The real

reason was to publicize the gum

to the public and the media. I

went to Toronto in Canada and

they asked me to speak to the

media. They got me a media

trainer from New York. She told

me what to say and what not

to say. We spent all day media

training and when she showed me the fi rst

take and the last take of the day they were

totally diff erent. So then I went off around

Canada doing about 15 to 20 interviews a

day. I got a lot of experience in two weeks.

Aft er Canada I went all over the place.

When This Morning was created they

couldn’t fi nd a suitable doctor. They said

to Richard and Judy we are dropping the

medical arti cle and they said, “Have you

tried our doctor?”

me: do you think the work that you have

done has raised the public’s awareness

about their health?

Dr. Chris: Oh yes. Quite a few years back I

did the fi rst breast examinati on live on air.

I argued for years to get that put on the

show but ITV wouldn’t allow bare breasts

on mid-morning television. Eventually

they said yes, as long as it is done in the

best possible taste. I showed the viewers

how to examine their breasts. There was a

huge response from women saying thank

you to This Morn-

ing for saving their

lives. There were

hundreds of cases

like that. I then did a

testi cular examina-

ti on live on air.

me: So do you have any infl uence

on what items make it on to the

show.

Dr. Chris: Oh yeah. The

shows been going for

20 years and I was

on the fi rst

one. I used to

decide every

week about that part of the shows content

but now we are very news reacti ve. Today

though I did suggest talking about bowel

cancer because it is ‘Beat Bowel Cancer’

week and they accepted that idea. It is

mainly a team decision however.

me: Is there anything that’s come up that

you have

not wanted

to comment

on?

Dr. Chris: I am careful about what I say

regarding aborti on and euthanasia. I will

talk clinically about these issues but I won’t

give my personal opinions on them.

me: When you were speaking to the

pati ent on the show about their bowel

cancer you didn’t want to focus too much

on her age (she was only in her 30s and

suff ered from ulcerati ve coliti s) because

it might cause panic. do you worry about

this?

Dr. Chris: Yes you have to give a balanced

view. I did say it is more common in the

over fi ft ies but one in ten are under. If we

focused on her age too much people might

think that bowel cancer is very common in

young peopleI have never managed to get

all the points I want to get across in any of

my shows so far

me: Has being in the public eye left you

open to a lot of criti cism?

Dr. Chris: Yes. At fi rst it upset me. I

spend a lot of ti me doing my

homework. People think I just

walk on set. I spend about 4 or 5

hours researching each piece. So

I know whatever I say is scien-

ti fi cally correct. You can’t please

everyone all the ti me and you get

complaints from medics as well as

the laypeople. There was more of

that in the early days though.

me: What’s your most memora-

ble moment on this

morning?

Dr. Chris: I

think

prob-

Are you Dr Chris from This Morning?

I did the fi rst breast exam on air...there was a huge response from

women saying thank for

saving their lives

mediscope 06/0914

featurescope

A unique week of educational and social events aimed at all levels of medical students, offering knowledge and

insight into a selection of competitive medical specialties, putting you one step ahead of your peers.

16th - 23rd August 09Manchester

£155 per person

Future Excellence

Further information and applications: www.doctorsacademy org

Closing date for applications 17th July 09

International Medical Summer School

Highlights of the event

Provide insight and enhance understanding of the most competitive surgical and medical specialties

Endow with a taster of basic clinical and surgical skills in the specialty

Empower the student with guidance on developing a strong portfolio in their chosen career

Exciting social activities and programmes in the evening

SATURdAY 7th noVemBeR 2009

scalpel Undergraduate surgical Conferencescalpel Undergraduate surgical Conferencescalpel Undergraduate surgical Conferencescalpel Undergraduate surgical Conference

noW ACCePTInG ABSTRACTS: for posters and/or oral presentations on surgical case studies, audits and original research.

Submission deadline is Thursday, 1st October 2009.

PRIZes: will be given for the best oral presentations and posters.

WHAT? An opportunity for any UK medical undergraduate to present their work at a national conference, hear

prestigious keynote speakers and attend unique skills sessions.

WHen? Saturday, 7th November 2009

WHeRe? University Hospital of South Manchester, Wythenshawe

INteRested? Visit our website for further information...

www.scalpelmanchester.co.uk

ably the breast examinati on and testi cular

examinati on because when we did it we

saved lives. The guys who wrote in about

fi nding a lump in there testi cle were young

men you know.

me: What’s it like having

celebrity status?

Dr. Chris: (Modestly) Oh

it’s all right. I don’t have

great celebrity status. The

program isn’t peak viewing

at mid-morning, so not

everyone has seen it. The

program is an insti tuti on

though because it has been

going on for so long. Its part

of some people’s morning

routi ne. When it started the

plan was only to run for 3

months and here we are 20 years later.

me: do you feel like your pati ents treat

you any diff erently?

Dr. Chris: The big eff ect is from new

pati ents. My old practi ce was in Fallowfi eld

in Manchester so a majority of pati ents

were students. When the new term starts

they ask me, “Are you Dr. Chris from This

Morning?” Then in the evening they go

home and boast to

their friends!

me: As you say it’s

quite chaoti c how

do you balance your

work and home

life?

Dr. Chris: Now I

have left general

practi ce all I do

is media work. I

write for a few

magazines and

do radio work.

At home the top

fl oor of the house is

offi ces. So I mainly work from home. That

can have its drawbacks. I tend to work late;

I am a bit of a night owl.

me: What do you do to combat your

stress?

Dr. Chris: I like gardening and I play the

piano and the electric organ.

me: do you sti ll have the band going?

Dr. Chris: No, well in the band I played bass

guitar but then I progressed to the electric

organ. I have four kids and the eldest is a

musician from the Brand New Heavies.

Me: How do you communicate eff ecti vely

with pati ents?

Dr. Chris: Smile! Find out what the pati ent

is really concerned about and what they

are thinking.

me: finally, what ti ps do you have to give

to medical students so they can become

good doctors?

Dr. Chris: I would just say work hard and

play hard.

From my interview with Dr. Chris I

concluded that he is a very down to earth

and genuine chap, despite his well-

deserved star status. He left the fi rst-class

carriage to sit in standard class with me

and we spent the rest of the return journey

talking about medicine and how the

course has changed.

II - Optic

VISUAL ACUITY - sharpness and clarity of vision.Place standard sized Snellen chart 6m in front of patient.• Ask the patient to cover one eye and read out loud the lowest line they can clearly see.• Repeat with the other eye.•

+ Ask them to read out loud text from a novel or newspaper to assess near vision.

VISUAL fIeLdS - area of vision of each eye. Confrontation method:Sit facing the patient 1m in front of you.•

+ Ask the patient, “Is any part of my face missing or blurred” to test for central vision loss.Ask them to cover one eye whilst you cover your own eye which is directly opposite, i.e. • if patient covers their left eye, you cover your right.Ask them to keep their head still and maintain focus on your open eye.• Compare the patient’s visual field with your own by using small finger movements or a red • tipped pin, coming in diagonally from each of the four outer quadrants.

+ Test the blind spot. Compare the patient’s blind spot with your own by using a red tipped pin, coming in horizontally towards the centre from the temporal side. The blind spot is normally located 15° to the temporal side.

RefLexeS - tests optic (afferent) and oculomotor (efferent). Warn patient about bright light!Accomodation

Ask the patient to look over your shoulder into the corner of the room.• Place your finger 30cm in front of patients face and ask patient to refocus onto your finger.• In a normal response, their eyes should converge and pupils should constrict.•

Direct light reflexShine a light from the side into patient’s eye. Look for pupil constriction in that eye.•

Consensual light reflexShine a light from the side into patient’s eye. Look for pupil constriction in the opposite eye.• Repeat direct and consensual reflexes with the patient’s other eye.•

+ Relative Afferent Pupillary Defect (RAPD)Shine a light into the patient’s eye. Pupils of both eyes should constrict.• Move the light to the other eye. Normally both pupils should remain constricted.• If one eye’s optic nerve is damaged, both pupils would dilate instead of remain constricted • because the brain interprets this as a decrease in light being presented.

+ CoLoUR VISIon - Test colour vision using Ishihara test plates.

+ fUndoSCoPY - The eye examination is not complete without visualising the internal eye.

S

I - Olfactory

+ Check if the nasal passages are clear.Ask the patient if they can identify common • smells from scent bottles (usually coffee, vinegar, vanilla). Test each nostril separately. Alternatively, ask patient if they have had • recent problems with smelling food.

S

III, IV, VI - Oculomotor, Trochlear, Abducens

INsPeCtIoNAsk the patient to look straight at you. Note common abnormalities: strabismus • (squinting), ptosis (drooping eyelids) and proptosis/exophthalmos (protruding eyes).

oCULAR moVemenTSSit facing the patient 1m in front of you.• Place your index finger equidistant between yourself • and the patient and ask them to focus on it.Ask the patient to follow your index finger without • moving their head. Check vertical, horizontal and oblique planes. Drawing an ‘H’ is ideal. Look for nystagmus (jittering to-and-fro movements).

+ Ask the patient if they see double during any time (diplopia).

+ Place your finger at the top of the patient’s vision. Rapidly move your finger towards the floor and look for lid lag. Normally there is perfect coordination of eyelid movement.

+ Ask the patient to focus onto one point on your face and maintain this focus. Cover one of their eyes. Their uncovered eye should remain stationary and fixed in focus. If the patient has strabismus and their uncovered eye moves to refix focus, that eye was squinting. Repeat test with other eye.

M

V - Trigeminal

seNsoRYAsk the patient to close their eyes and to respond if they feel sensation on their face.• Use a cotton wool ball to assess and compare the left and right side of ophthalmic • (forehead), maxillary (cheek) and mandibular (midway along jaw) branches.

moToR - Muscles of mastication.Ask the patient to clench their teeth. Feel both sides for contraction of the • masseter and temporalis muscles.Ask them to open their mouth wide and resist, whilst you try to close it.•

RefLexeSJaw jerk

Warn and explain procedure to the patient beforehand.• Ask them to let their mouth open loosely.• Place your finger horizontally across their chin and tap lightly with tendon hammer.• The normal response is either a slight closure of the jaw or more commonly, no response at all!•

Corneal reflexYou would not elicit this is an OSCE, but just be aware of it.• It is elicited by touching the patient’s cornea using a fine tip of cotton wool. Blinking is the normal • response. Tests V1 (afferent) and VII (efferent).

SM

Poster Design by Andrew Cheng

III

IV

VI

IX, X - Glossopharyngeal, Vagus

Ask the patient to open mouth and say ‘Ahhh’. Inspect palate and uvula with torch • and note any deviation of the uvula.Ask them to cough. Assess the character of the cough and their speech.• If you suspect swallowing is normal, ask the patient to swallow a small amount of • water. + If you have concerns about safety, you would ask Speech And Language Therapists (SALT) to perform a swallowing assessment.Test taste if you have not already done so. The glossopharyngeal nerve innervates the •

posterior 1/3 of the tongue.

SM

VII - Facial

seNsoRY - The facial nerve innervates the anterior 2/3 of the tongue.Ask the patient to identify common tastes from tasting bottles (sweet, salty, bitter, sour).• Test each side of the tongue in turn.•

moToRAsk the patient to raise eyebrows, smile and show teeth.• Ask them to close their eyes and blow out their cheeks against resistance supplied by you.•

+ Note: In a unilateral upper motor neurone lesion, function in the upper part of the face is preserved because there is bilateral cortical innervation of the upper facial muscles. However, in a unilateral lower motor neurone lesion (e.g. Bell’s Palsy), the upper facial weakness is unilateral.

SM

XI - Accessory

+ Inspect the sternocleidomastoid and trapezius muscles for wasting and asymmetry.

Assess SCM muscle power against resistance by asking the • patient to turn their head to one side and press against your hand. Repeat on other side.

Assess trapezius muscle power against resistance by asking the • patient to shrug shoulders whilst your push downwards on them.

M

XII - Hypoglossal

Ask the patient to open their mouth to inspect the • tongue. Look for deviation and fasciculation.Ask them to stick their tongue out and move it • from side to side.Assess tongue power against resistance by asking • the patient to use their tongue to push out their cheek, whilst you press your hand against it.

M

V - Trigeminal

seNsoRYAsk the patient to close their eyes and to respond if they feel sensation on their face.• Use a cotton wool ball to assess and compare the left and right side of ophthalmic • (forehead), maxillary (cheek) and mandibular (midway along jaw) branches.

moToR - Muscles of mastication.Ask the patient to clench their teeth. Feel both sides for contraction of the • masseter and temporalis muscles.Ask them to open their mouth wide and resist, whilst you try to close it.•

RefLexeSJaw jerk

Warn and explain procedure to the patient beforehand.• Ask them to let their mouth open loosely.• Place your finger horizontally across their chin and tap lightly with tendon hammer.• The normal response is either a slight closure of the jaw or more commonly, no response at all!•

Corneal reflexYou would not elicit this is an OSCE, but just be aware of it.• It is elicited by touching the patient’s cornea using a fine tip of cotton wool. Blinking is the normal • response. Tests V1 (afferent) and VII (efferent).

SM

VIII - Vestibulocochlear

BASIC TeSTSAsk the patient to close their eyes and to respond if they hear a noise.• Starting on one side, rub/click your fingers away from the patient’s head • and bring the noise closer towards their ear. Repeat on the other side.Alternatively, whisper numbers into their ears and ask them to repeat.• Ask them to walk in a straight line, stand still and close eyes.•

WeBeR’S TeSTTap a 512Hz tuning fork and place base on patient’s forehead in the midline.• In conductive deafness, the tone is heard loudest in the affected ear • because external sounds are depressed, amplifying bone conduction.In neural deafness, the tone is heard loudest in the unaffected ear.•

RInne’S TeST - testing for conductive deafness.Tap a 512Hz tuning fork and place next to the patient’s ear to test air • conduction. Then apply the base of the tuning fork to the mastoid process to test bone conduction. Ask them which sound was louder to them.Normally, air conduction > bone conduction (Rinne’s +ve). However, in • conductive deafness, bone conduction > air conduction (Rinne’s –ve). In neural deafness, Rinne’s test remains positive.

S

Cranial nerve exaMinationby Andrew Cheng

How to Do a...

IX

X

educationscope

mediscope 06/0918

Pre-Anaesthesia:* Has patient confi rmed Identity, procedure, site, consent?* Are all safety checks complete?* Site marked?* Specifi c patient risks; allergies, aspiration diffi culties, drugs, blood loss. Contingencies in place

Pre- Incision:* All team members introduced by name and role* All confi rm patient, site, procedure* Anticipated critical events and timeline: review by surgeon, anaesthesia professional, nursing team leader* Antibiotic and drug review* Critical imaging available / displayed* Back-up procedures and equipment

Post-surgery | Prior to patient leaving theatre: * Name of patient, procedure correctly recorded* Instrument, sponge, needle count all correct* Specimen labelling correct* Instrument and equipment shortfalls correctly logged* Whole team review key concerns for post-op care and recovery* Correct hand-over of patient confi rmed

The WHO surgical checklist

m

Having been involved in all aspects of fl ight operations for around 30 years I have witnessed the development of CRM (Crew, or Team Resource Management),

SOP’s (Standard Operating Procedures for aircraft operations), decision making techniques and checklists. These develop-ments, and many more, have had one core focus and this has been to improve overall fl ight safety; in particular, the reduction of error that may lead to an aircraft incident or accident.

It is plain to see that these changes have actually worked; globally, the number of passenger aircraft lost or destroyed and the number of deaths and injuries from aircraft accidents has reduced markedly since the 1970’s.

The civilian aviation industry and medicine (surgery in particular) have much in common. For instance both, quite obviously, involve professionals making safety and perform-ance-critical decisions often under challenging circumstances; both involve work within large, multi-cultural organisations. The Human Factors in both working ‘societies’ are huge….and when human beings interact with increasingly complex technol-ogy (and with each other), there is always room for error. It is interesting to witness therefore that clinical organisations are now beginning to use versions of techniques and procedures that aviators regard as the norm. At the same time, the way in which clinicians work together as a team is also being chal-lenged. This, in turn, opens up a myriad of new questions on best practice.

Checklists are fundamental to a safe airline operation; from the moment that a pilot reports for work right until leaving the aircraft, he or she is checklist driven.

Above, I have illustrated a potential framework checklist for surgery; I am sure that you could add considerable detail.

Much of this clearly mirrors the way the professional fl ight crew accept an aircraft for service and then brief all team members prior to departure. Risks and threats are constantly re-evaluated throughout the fl ight regime until all passengers are safely disembarked and the aircraft is handed onto the next crew or licensed engineer.

If you haven’t yet used a checklist, my guess is that they will become increasingly common, perhaps mandatory, as your career progresses.

educationscope18 Surgical Checklists19 Competition Winners19 How to Avoid Being Struck Off

Ian Hollingworth is a fl ight crew instructor at Emirates

Airline, having previously fl own as a Captain with

Briti sh Airways on Boeing 747 and Boeing 737. Prior

to this he was a pilot instructor on fast jets in the RAF.

Surgical checklistsan aviation-based perspective

scopeeducation

19 06/09 mediscope

IGnoRInG YoUR PRofeSSIonAL 1. ReSPonSIBILITIeS To YoUR PAtIeNtsdRs – Your fi rst duty is to your dRs – Your fi rst duty is to your dRs –pati ents, this may mean that you have to occasionally work beyond the end of your shift .

ALTeRInG oR noT mAKInG 2. AdeQUAte ReCoRds dRs – Your notes will form the basis dRs – Your notes will form the basis dRs –of any potenti al defence case. Clearly state the date and ti me the note was made and do not tamper with the original notes (remember computer notes are audit trailed). Make sure any forms that you complete are factually correct and, where relevant, the informati on can be corroborated by the medical records.

IndeCenT BeHAVIoUR ToWARdS 3. PAtIeNts oR CoLLeAGUes (InCLUdInG ImPRoPeR SexUAL ReLATIonS WITH PATIenTS).dRs – Be aware that pati ents may dRs – Be aware that pati ents may dRs –mistake inadvertent touching as being improper; e.g., when performing fundoscopy, beware of any loose clothing touching the pati ent and when applying/removing a blood pressure cuff , be careful not to inadvertently touch the chest area. You must follow the Trust’s chaperone policy. Always explain what you are going to do and why.

BReACH of ConfIdenTIALITY4. dRs – Be aware of inadvertent dRs – Be aware of inadvertent dRs –breaches of confi denti ality (e.g. ‘corridor talk’). It is your responsibility to remain professional at all ti mes, even when off duty.

mAKe fALSe CLAImS ABoUT YoUR 5. QUALIfICATIonS oR exPeRIenCedRs – You should complete all dRs – You should complete all dRs –applicati on forms in a factually

accurate way and be able to provide copies of documentati on when requested.

dISHoneSTY, InCLUdInG THefT 6. And fRAUdULenT ReSeARCH ResULtsdRs – You should be careful when dRs – You should be careful when dRs –completi ng expense forms, provide original receipts and keep copies for your records. Do not be tempted to forge signatures on any document and ensure that any submitt ed work is either your own or thoroughly referenced and att ributed.

IRReSPonSIBLe PReSCRIBInG And 7. mISUSe of dRUGSdRs – Avoid prescribing for yourself dRs – Avoid prescribing for yourself dRs –or for anyone with whom you have a close personal relati onship. Do not use illegal substances.

ImPRoPeR deLeGATIon8. dRs – You must not delegate tasks dRs – You must not delegate tasks dRs –to people with inadequate skills and training. Equally you should not work outside your fi eld of competence - always take advice from a colleague if you are unsure.

TReATmenT WITHoUT ConSenT9. dRs – You should follow Trust dRs – You should follow Trust dRs –guidelines in terms of taking consent and only take consent if you have a good understanding of the risks and benefi ts of the proposed procedure. Document everything.

PRACTISInG WHen A CARRIeR of 10. InfeCTIoUS dISeASedRs – If you know that you have or dRs – If you know that you have or dRs –think you may have a serious infecti ous disease or a conditi on that may aff ect your performance, you should consult your GP and/or the Trust Occupati onal Health Department without delay and follow their advice.

mn semonic

Wherever you are in the world the chance of being removed from the medical register is a

clear and present danger. Sara Williams chats to MPS Medicolegal Adviser Dr Richard Stacey about how to avoid being struck off .

Here is a list of the ten most likely ways to be erased from the medical regis-ter. Cases like these involve students and junior doctors on a daily basis and are a recurring theme for Dr Richard Stacey (DRS) who deals with such incidents.

Always remember, the Medical Act (1983) allows the GMC to consider mat-ters that occurred before a practitioner was registered, including those as a student.

If you have any queries about the is-sues raised in this article contact MPS on 0845 605 4000 or querydoc@mps.org.uk

one of eC’s psych-related mnemonics to help you take an anorexia history:d: Dieti ng increasee: Exercise increaseA: Appeti te supplements? Laxati ve use?d: Diureti cs use

f: Fear of wt gainA: Amenhorrhoeat: Thin BMI < 17.5/ ti red/ troubled/ tooth decay?

AP’s helpful hint to remember Crohn’s diseaseTreatmentC: Change lifestyleA: Anti bioti css: Surgerys: SteroidsI: Immunosuppressantse: Elemental diets

Signs/Symptoms (3 for each)C: Cardiovascular [Anaemia, DVT, blood in faeces]L: Limbs [Clubbing, arthriti s, osteoporosis]o: Occular [Iriti s, conjuncti viti s, episcleriti s]G: GI [Diarrhoea, SI obstructi on, malnutriti on]G: General [Weight loss, malaise, aphthous ulcerati on]s: Skin [erythema nodosum, pyoderma gangrenosum]

loralie rodrigues won last issue’s competition with her Lettuce Sandwich for insomnia:

“I’m not sure of the mechanism of action here; apparently lettuce has very sedative properties! My theory is that it’s probably the most boring thing you will ever eat so having concluded that being asleep is more interesting, one would be likely to surrender to the latter!”

educationscope

How to avoid being struck off

winners!Congratulati ons to Aaron Poppleton

and Emma Crewe, the winners of our mnemonics competi ti on

careerscope

mediscope 06/0920

SOTONYETOLOFARITOLOFARI

The unprecedented advances in basic and clinical science have been extraordinary over the past

century, with the UK playing a leading role in the world arena. The contribution of academic medicine to these develop-ments has, undoubtedly, been beyond compare. So what exactly is academic medicine and why would you want a career in it?

Academic medicine traditionally is a term encompassing three major roles that have been coined as the ‘three pillars’ of academia. These roles include; educating medical students and junior colleagues, standard clinical practice and novel scientifi c research.

WHY do IT?

Academics are responsible for educating the next generation of medics and this can be very

rewarding. An academic career also provides lifelong prospects of intellectual challenge and autonomy. A common mis-conception is that academics are poorly remunerated; however recent literature demonstrates that apart from private practice, academics and clinicians have fi nancial parity.

Many authors have referred to academic medicine being in ‘crisis,’ as illustrated by the number of clinical academics in the UK falling by up to 27% since 2001. Despite this, there are

now more medical students than ever, with a 28% rise since 2000. Fortunately, these changes have not gone unnoticed and in 2004, the government set up a number of organizations, such as the UK Clinical Research Collaboration (UKCRC) that have provided recommendations for change to recruitment, training and career progression of young academics.

Changes to the career pathway of aca-demics are perhaps the most substantial recommendation made by the UKCRC. So what are these new career pathways and how can you get involved?

GeTTInG InTo ACAdemIA

Perhaps the fi rst exposure to any sort of scholastic activity at medical school would be an

intercalated degree, as it allows you to explore research in a lab based or clinical manner. Some universities also off er MB-PhD schemes, which are essentially an intercalated PhD (Doctor of Philosophy) off ered to those who have done a

previous BSc or MSc. Publications in any peer-review journal are obviously great, although hard to come by, but you’d be surprised how many consultants are willing to take on medical students for research.

Dr Jon Miles, Academic lead of the North-West deanery said that prior to the career pathway introduced in 2007, “There was no formalized structure to academic training and many aspiring academics were encouraged to, or op-portunistically took up academic training prospects”. Under the new system, students can apply directly for academic posts at foundation level. The F2 year will contain a four month academic rotation providing opportunities for teaching and research. Thorough training pathways will continue in specialist training. There will be an estimated three years of clinical training in your specialty (e.g. Surgery, Pathology, Radiology) as an academic clinical fellow. Here, approximately a quarter of your time will be dedicated to teaching and research roles. Upon completion of this phase, there will be opportunities to apply for a training

careerscope20 Academic Medicine21 Working Summer22 Neonatology23 Interview with the Orthopods

IN DEPTHA CAREER IN

HYPOTHETICA

LHOLIDAY

Academic MedicineWhat exactly is it, where does it stand in the realm of clinical medicine and who is it for? Intercalating medical student Sotonye Tolofari provides answers to all your questions about this dynamic fi eld.

scopecareer

21 06/09 mediscope

WANT TO LEARN ABOUT ACADEMIC MEDICINE? THEN READ PROFESSOR VAL WASS’ ARTICLE IF YOU HAVEN’T ALREADY!

fellowship, which will extend a further three years providing opportunities for full-time research resulting in a PhD and/or publications. The clinical lectureship period is for those with a PhD or MD (Medical Doctorate) and may extend up to fi ve years. This period gives time

to obtain grants and continue research before completing clinical training. Upon completion of training, senior clinical fel-lowships, lectureships and professorships are available.

A career in academic medicine that encompasses the ‘three pillars’ (teach-

ing, research, practice) appears to be an invaluable discipline within medicine, which is essential for both the continuity of the medical profession and its growth and development.

Adapted from; medically and dentally qualifi ed academic staff : Recommendati ons for training the researchers and educators of the future UK Clinical Research Collaborati on Academic Careers Sub-Committ ee of modernising medical Careers and the UK Clinical Research Collaborati on.

So where can you fi nd a research project that takes students for the

summer period? One opti on is to fi nd summer research placements with

organisati ons that off er short projects in their fi eld of interest. Successful candidates

could also be off ered a maintenance grant of up to £180 a week. Another opti on is to

independently search for one of the ongoing research projects at any UK based university. You

then need to write to the senior research supervisor to see if they are willing to take you on for the summer

period.Several organisati ons off er awards to undergraduate

students every year which are specifi cally aimed at supporti ng students on their vacati on research projects. However the

student must have agreed upon a suitable project with their supervisor in advance of applying. Awards usually have terms and

conditi ons and thorough research is recommended. Why limit yourself to the UK?! Many other countries (especially the

US) have a variety of similar research and funding opportuniti es and a large number of them are open to Briti sh students as well.

Undertaking a research project

over the summer can be a fun

and challenging way to spend

your holidays while at the same

ti me giving you an exposure to

the forefront of research.

Some organisati ons that provide placements:

- Cancer Research UK LRI Summer student

scheme in Greater London

- The Imperial College London off ers the UROP

program

List of some of the funding organisati ons:

- The Wellcome Trust- awards up to 250 awards

every summer and is highly recommended

- The Nuffi eld Foundati on- awards up to 400 awards

every year

careerscope

HYPOTHETICA

LHOLIDAY

Have we managed to tempt you into academic medicine?

Vinit shah has some tips on how to boost your academic medicine CV and enjoy a taste of things to come...all during your summer holidays!

careerscope

mediscope 06/0922

The word ‘neonatology’ basically means the ‘science of the newborn’. A neonatologist

is a doctor specialising in this fi eld. Neonatology is a relatively new subspeciality of paediatrics, which off ers diverse challenges such as providing

ethical dilemmas surrounding life and death decisions. It is a very ‘hands on’ specialty with opportunities to learn and develop diff erent advancements in the medical fi eld e.g. Use of High Frequency Oscillation as a mode of ventilation.

WoRK of A neonAToLoGISTThe day to day work of a neonatologist entails looking after babies in the Neonatal Intensive Care Unit (NICU), a special area devoted to the care of critically ill babies. Babies born prematurely need to be in NICU to provide support to various organs until they are mature enough to manage without. For example, they are often nursed in incubators to keep them warm, need ventilatory support for immature lungs and need parenteral nutrition to help them grow and tolerate gentle increments of milk feeds. To provide these they must have arterial line and central venous catheters and need regular

intensive care to very young and fragile patients.

It is diffi cult to gain experience in this fi eld unless you elect to do a SSC in neonatology. For many junior doctors doing neonatology as a part of their Paediatric rotation, it reminds them of the long hours and routine baby checks. If you can see beyond this, then it is one of the most exciting and rewarding specialties in medicine and is quickly advancing its training, research and technology.

WHAT mAKeS neonAToLoGY exCITInG And CHALLenGInG?The main factor which drives most neonatologists to pursue this profession is the challenge of looking after extremely ill infants; some on the borderline of viability. Caring for a 500 gram baby and seeing them achieve normal to near normal development a few years later is

monitoring of their blood gases, serum electrolytes, infection status and blood glucose.

Neonatologists need to be profi cient in basic practical skills, including managing delivery room emergencies, assisted ventilation, ultrasound examinations of the head and echocardiography.

Good communication is extremely important as it involves perinatal counselling, having to break bad news to parents and supporting them through the bereavement process.

Central to being a good neonatologist is to possess personal qualities such as empathy, kindness and humility, combined with a dedicated commitment to the specialty.

tRAINING IN NeoNAtoLoGYTo be trained as a neonatologist one needs to complete basic paediatric training and post graduate examinations in paediatrics (MRCPCH). During the fi rst three years of ST training in paediatrics, it would be expected that the trainee would spend at least six months in a tertiary neonatal unit. The next stage would be to apply for National Training Numbers (NTN) in Neonatology to pursue a career as a tertiary neonatologist in year six of ST training. This requires having done neonatology at ST4/5 level and either tertiary neonates or specialties allied to neonatology in ST year six (these can include cardiology, genetics, PICU, neurodevelopment).

JoB PRoSPeCTS In UK And ABRoAdThis is a fast growing fi eld with fi erce competition for places. There are many opportunities for neonatologists to work abroad, especially in Australia, New Zealand and Canada. Opportunities also exist in developing countries although resources are limited.

extremely rewarding. There is also the challenge of caring for or helping babies with complex surgical, cardiac, metabolic and neurological conditions to simply survive. It often poses some strong

Dr Srabani Samanta, a consultant neonatologist at Saint Mary’s Hospital, sheds light on this rapidly advancing speciality. Neonatal Medicine

scopecareerNAME: Mr Lindsay Muir

SPECIALTY: Consultant Hand Surgeon

WHERE DID YOU TRAIN?I graduated from the University of Glasgow and then I did my House

Offi cer jobs in Glasgow Royal Infi rmary. I went on to do my fellowship

training in Liverpool before starti ng as a Registrar in Orthopaedics. I

then went to France for 6 months to study hand surgery. Aft er that,

I came back to the UK and conti nued as a hand fellow in Withington,

followed by a shoulder surgery placement at Wrighti ngton Hospital.

Then in 1996, I applied for the post of Consultant Orthopaedic

surgeon at Hope Hospital and have been there ever since.

WHY HAVE YOU CHOSEN THE HAND?It off ers a great combinati on of trauma and electi ve surgery. I also

fi nd hand anatomy fascinati ng, beauti ful and versati le. I

marvel at the way such a small organ can do so much

from picking up a pin to stroking a baby’s cheek to

hammering a fence post.

WHEN AND WHAT MADE YOU DECIDE TO SPECIALIZE IN ORTHOPAEDICS?I decided in my third year of medicine that

I wanted to do surgery. In my fourth year,

aft er having enjoyed my Orthopaedic

placement, I decided to pursue

Orthopaedics. Just goes to show you that

these placements do have an impact on

how you choose your specialty.

WHAT ARE THE BEST ASPECTS OF ORTHOPAEDICS?It’s very grati fying and interesti ng.

Pati ents get bett er quicker.

AND THE WORSE ASPECTS?Paperwork.

DOES GENDER AND SIZE MATTER?No. We have several female Orthopaedic surgeons

on the rotati on. For size, perhaps a heavier-built

person may be bett er suited to the heavy-duty surgery.

WHAT ADVICE WOULD YOU GIVE TO MEDICAL STUDENTS INTERESTED IN A CAREER IN ORTHOPAEDICS? Practi cal apti tude. Especially with surgery, one must have good hand

skills and being able to do hand-related craft s tend to help. CV-wise,

we’ll be looking at publicati ons, audits and Orthopaedic placements,

for example SSCs.

ARE THE JOKES ABOUT ORTHOPAEDIC SURGEONS TRUE?(Laughs) in the past, it did att ract larger-built people, but it’s now

more science-based and not so much pure mechanics.

OUR THEME IS ‘DISCOVERY AND DEVELOPMENT’. IS THERE ANYTHING YOU’D LIKE TO ADVISE STUDENTS REGARDING THAT?“Ars longa, Vite Brevis”. (The art is long; the life is short. –Hippocrates)

NAME: Mr Hassan Dashti

SPECIALTY: Consultant Spinal Surgeon

WHERE DID YOU TRAIN?I graduated from Dundee University in 1991. During my postgraduate

training I was allocated to various diff erent posti ngs. I worked as a

House offi cer, Anatomy demonstrator, Research Registrar and then as

an Orthopaedics Registrar in Dundee unti l 2002.

WHY THE SPINE?I found it challenging, interesti ng and intriguing,

more so than the other specialti es.

WHEN AND WHY DID YOU DECIDE TO DO MEDICINE, THEN ORTHOPAEDICS?

I did my pre-med in the States,

intending to become a chemical

engineer. During a research

placement, the professor

discouraged me from

engineering and advised me

to study medicine. Since

my fi rst year as a medical

student I’ve wanted to do

Orthopaedics, from knowing

other Orthopods.

WHAT ARE THE BEST ASPECTS?The challenge of diagnosis.

WORSE ASPECTS?Time constraints.

IF YOU WERE ON AN INTERVIEWING PANEL LOOKING TO HIRE, WHAT KIND OF

CHARACTERISTICS WOULD YOU BE LOOKING FOR?

Someone intelligent, interesti ng and interested to

learn. Someone with whom you can interact easily. Also,

someone with good hand-eye coordinati on.

WHAT ADVICE COULD YOU GIVE MEDICAL STUDENTS FOR THEIR CV?CVs are misleading; someone with a good CV may not necessarily be

good in the work, from personal experience. But it should be varied,

with outside interests and one should write honestly.

OUR THEME IS ‘DISCOVERY AND DEVELOPMENT’. WHAT ADVICE COULD YOU GIVE STUDENTS WITH REGARDS TO THAT?

Growth is lifelong; when faced with a disappointment you must look

for the silver lining that will allow you to grow and develop more than

you would have if you hadn’t come against this parti cular problem.

Interview with the orthopodsby Michelle Ting

yourscope

mediscope 06/0924

MON

TUE

WED

THU

FRI

By the end of year three I had become disillusioned with Medical School altogether. My SSC at Christie cancer hospital changed all of that. The first week was one week to change my perspective on illness and medicine, life and death, and the strength and fragility of a human being. This was one week to remind me why I loved medicine and why I wanted to be a doctor in the first place.

The first patient I saw was an abrupt introduction to

cancer. Seeing patients near death wasn’t all that familiar

to me; most patients in hospital aren’t terminally ill after all. Weakness had made her almost incapacitated. ‘She’s obviously dying from cancer’ I thought. But it’s not so simple. The reasons people are admitted with cancer aren’t all that obvious. It’s not usually because they’re dying of cancer but because they are dying from sepsis. Chemotherapy is poisonous to all tissues; it works by being more toxic to the cancer cells than normal ones. It also has a propensity to destroy bone marrow making infection a constant threat. This woman, like many others in the hospital, wasn’t dying from cancer, she was dying from chemo.

It’s inspiring to see how people cope with their

disease. A diagnosis of ‘the C word’ evokes a real terror

in people. How would you feel if it were you or someone close to you? It quickly struck me that this fear was surmounted by the belief that they were going to beat this. Even the patients in their final weeks weren’t frightened. There’s something in having cancer that makes people fight through the exhaustion and vomiting, the

pain and the uncertainty for however long it takes. They have the will to get up every day and to carry on with life, and carry on with their battle.

Nothing strips someone of their identity like being

in hospital. Any ward is the same; full of motionless and

silent patients, dressed in the same hospital gowns, sharing the same fear and solitude. Everyone has their own life story; looking around, they lay stripped of their stories. Immediately it becomes apparent how much patients would rather talk about anything but being ill. All they want from us is to take an interest in who they are, and take their mind off where they are.

In medicine we usually think of death as the one outcome

we must never allow, beyond all others. An unforgettable

experience was to see for the first time a patient for whom death was the cure, for to prolong life was to prolong the pain and morbidity. ‘Do not resuscitate’ the form read in her notes. Can treatment really be worse than death? Surely treatment can give her and her family a few more precious hours? But for some there is nothing left but waiting. A slow death in pain, powerlessness, and indignity stains someone’s most sacred moment, when they finally succumb to their illness, when the fight just wasn’t enough.

Today was an extraordinary day. After what was not an

unexpectedly difficult week, I saw a very diff erent side

to cancer. The clinic was for testicular cancers. I stood silenced in the waiting room full of men my age with cancer. Most other patients I’d seen this week were at least over 50; I hadn’t thought of cancer as something as an immediate threat to my own health – as I’m sure these guys hadn’t either. One tragedy is to be taken from the family and life you have built for yourself, but another altogether to be deprived of the opportunity for those things altogether. These men were still so young. Most amazing was how wrong my assumption was. Not only were some walking into clinic with cancer, there were others walking in without cancer, cured. These men were given a second chance to get on with their lives.

What a vision for the future, imagine if we could one day do this for all cancers? For now, we can give support and hope to our patients and the strength to continue with their ongoing battle.

We all go into medicine for diff erent reasons. For me it was for exactly what I’d seen this week; to provide a better outcome and to alleviate a burden, and, if we can, to cure. Since then I’ve held onto these ideals, as dear to me as my parents, to remind me of why I’m studying medicine at all.

one weeKby Ben Amies

yourscope24 One Week25 The International Medical Student25 YourScope Q&A26 Medical Blogging

And

rew

Che

ng

25 06/09 mediscope

scopeyour

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???? ???Kirstin mcGregor - Year 1, MRI

“Meeting some of the friendly (and very good looking) foundation students on a recent placement and realising clinical years may be a whole lot more fun than I’d originally thought they would be...”

Sophie mylan - Year 4, Wythenshawe“For me, it is the undergraduate staff that make South so unique. They are friendly, approachable and never fail to do their best to support their students. They make a fantastic, dedicated team.”

John Patrick Byars - Year 3, Preston“Preston is the best because of our undergraduate department who dedicate the time and resources to ensure full commit-ment of the medical staff in our teaching. It may not have the night life of Manchester but compared to other base hospitals we do socialise more as a whole year, if not all 3rd to 5th years.”

Laura derbyshire - Year 4, Hope“I’m based at Hope Hospital and really enjoy having my placements there. The staff are enthusiastic to teach students and are among the best in their specialities. The Salford community is extremely diverse, making history taking very interesting!”

Country of Origin: QatarCapital City: DohaOfficial Language: Arabic

Official religion: IslamCurrency: RiyalPopulation: 1,541,130

When I was accepted into Manchester medical school,

I was both pleased and afraid. I was aware that this was a golden opportunity for me, but by the same token, was going to be a momentous change. When I first arrived in Manchester, I had no friends at all and had never interacted with non-Arabs before. It was a shocking experience. I did not know what to say in class (I was the only non-British student), I did not have anyone to talk to outside of class and frankly, I was totally lost. I always felt like I was a stranger and I was afraid of being judged as an outsider because I was not British. I did not breathe a word in class for the first three weeks. After that, all I could muster up was a sentence or two related to the PBL case. I did not know how to prepare for PBL and I had no one from which to seek advice. These were challenging times for me, but I never considered quitting medicine, as it was, is, and always will be my passion. I barely passed my first year exams, but was relieved nonetheless.

In my second year, I decided to change my lifestyle and try to become more sociable and interact with as many students as possible. I did not care about whether I would find someone with a similar

background to me or not; I just wanted to integrate no matter what. With my new found confidence, I spoke with more students and I realized that my thoughts of others perceiving me as an unwelcome stranger were actually wrong. Almost everyone reciprocated my overtures of friendship; some were even willing to help me with PBL. This was reflected by a dramatic improvement in my exam grades.

Now in my third year, my self esteem has increased so much so that I am now more confident than ever! I am loving my clinical years and am working as I hard as I can in order to become a good doctor.

The take home message here is that, as an international student, it is understandable to be afraid and feel like a complete stranger. However, it is important and indeed possible to overcome those fears (most of which are unfounded), and to make an effort with others. I also hope that this article increases awareness about how daunting it can be for international students to adapt to life in England.

Special thanks to mom and dad who were supportive in every step I’ve taken.

Third year medical student Ayda Al-Hammadi shares her experiences with mediscope and reveals to all the ambivalence of her odyssey so far.

yourscope

YourscopeQ+a Why is your base hospital the best base hospital?

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yourscope

mediscope 06/0926

incite change, outrage or just plain vent frustration, these blogs are often both informative and entertaining to read.

The other major genre of blog is what I call the ‘docu-diary’. These writers essentially dive into a goldfish bowl to be gawked at by readers. From medical student to fully fledged doctor, the access to insight has never been easier; particularly useful if you are just about to step into similar territory. Manchester Medic is one such docu-diarist. Admittedly, he writes the blog primarily for himself, using it in much the same as a portfolio to reflect on his clinical experience. He admits “it is reassuring for me to know that people aren’t able to associate what they read on my blog with me personally”. This blogger also reads other blogs which he says “give me a wider picture of what life is like working for the NHS in the various sectors, and what to expect upon qualification”.

There is an increasing number of blogs whose sole purpose is to inform readers. Institutions in particular, are utilising blogs to update the masses including the University of Manchester, the Student BMJ and the NHS (which also maintains a twitter feed for staff). Alex Langhorn is a careers consultant for the University and has been writing

an unofficial careers advice blog since August last year. It is aimed at final year medical students, but also provides advice to all students. Alex has found that blogs are “dynamic and informal, [they] are ideal to get quick messages out. The ability to put content out quickly meant that I could answer specific questions that I was receiving about the foundation recruitment process”.

Be it ‘soap box’ blog or ‘docu-diary’, over enthusiastic writers can trip up and land in a whole heap of litigious

trouble. Many well established medical bloggers do not blog anonymously and recommend that others shed their pseudonyms. Langhorn explains that “being accountable for what you write is an important part of the integrity of the blog which is why I do not keep my identity anonymous”. Langhorn highlights Lord Darzi’s blog as a good example of blogging without a disguise. Anonymity can give you a false sense of security to make comments from which there have been repercussions in certain documented cases. Anonymous blogger, Manchester medic, concedes that “there is always a risk that blogging anonymously can cause the blogger to

Over the past decade medics have posted millions of terabytes of words about

anything and everything on virtual internet diaries, better known as web blogs. Under aliases, they pour out their innermost thoughts for the readers’ dissection and delectation. Micro-blogging or twittering is a more concise method which has recently seen a burst of popularity. Tweets are limited to 140 characters, enough for two or three sentences (or four if you abandon the laws of grammar!) Tweets can even be texted to the site and as it takes only seconds to tweet, it has accelerated the speed at which news or trends are spread.

There are a variety of flavours of blogs, which is dependent on the agenda of the author. With pseudonyms like Dr Rant and Dr Shock, you’d be correct in thinking that many blogs are written by disgruntled hands. Blogging offers the writer a virtual soapbox to clamber onto and preach, rant or berate with a convenient mixture of exposure and anonymity. Whether their aim is to

Blogging offers the writer a virtual soapBox to clamBer onto and preach, rant or Berate with a

convenient mixture of exposure and anonymity

Med

ical

Blog

ging

PRIZZIZARsAdIAs

wwwwww27 06/09 mediscope

scopeyourbecome over confident and write in an inappropriate manner”.

Responsible blogging should obviously maintain confidentiality. Unfortunately, a study published last year in the US by the Journal of Internal Medicine found that after analysing 271 blogs, 56.8% contained information that could potentially indentify patients discussed in their blogs. The MDU published a fictitious case in its legal clinic in 2006 about a doctor whose blog contained details which a patient felt was sufficient to identify him by a third party.

There are currently no UK cases that demonstrate a breach of patient confidentiality on blogs that the MPS or the MDU could discuss publicly. However, breach of confidentiality of colleagues rather than that of patients has proved to be the greater problem. The MPS highlighted that there are cases of medics facing disciplinary action for their comments about colleagues on public forums such as message boards and social networking sites. One such high profile case was the suspension of a junior doctor after they posted critical comments about Dame Carol Black on the Doctors.net message boards.

A medico-legal advisor from the MPS highlighted relevant GMC guidance on the matter of respect for colleagues (Good Medical Practice paragraphs 46-47).

It appears that medical blogging is a trend that is bound to continue to grow, but with this comes concerns over confidentiality for both patients and peers. There is a growing demand that best practice on the web may need to be as closely monitored as it is clinically. However, concerns were raised over how this will encroach our freedom of speech. It appears that the line between freedom of speech and censorship will inevitably have to be drawn soon, but the question is, who will step up to the keyboard?

A stigma was originally a scar in the skin of ancient Greek criminals. It was a sign to all that these people

were unclean, unsafe and unwanted. Stigma persists today in society’s attitudes towards those with mental illness. It is a stigma which can see people unemployed and homeless, cut off from family and friends. It is a stigma which can delay diagnosis, exacerbate symptoms and hamper recovery.

Unlike meningitis or Crohn’s disease, we make judgements about a person’s character if they’re diagnosed with depression or schizophrenia. We see weak personalities or deranged minds rather than medical conditions that need understanding and care. It is this false division, this idea of a fundamental difference between the

asthmatic lung and the psychotic mind, that gives rise to much of the stigma that surrounds mental illness.

These stigmatising beliefs lead to people being pushed to the periphery of society. Though they are sick, they are not offered sympathy and compassion but rather ridicule and abuse. These attitudes are internalised and manifest themselves as ‘self-stigma’ - low self-esteem and negative feelings of self-worth that are independent of the mental illness they suffer from. People may think that they’re ‘going mad’ or just need to ‘pull themselves together’, they don’t believe that they have a real disease and will often blame themselves for how they feel. This leads to people hesitating before seeking help and needlessly suffering in silence.

The most successful anti-stigma campaign is the ‘see me’ campaign in Scotland. The campaign seeks to challenge media stories that perpetuate myths and preconceptions about those with mental illness. There are also national adverts which give factual information about the nature and realities of mental illnesses. The campaign also encourages the public to talk to patients and sufferers, to show that these conditions need not define an individual, that they are not the result of personal foibles and weaknesses but rather are real and debilitating diseases.

Challenging stigma is neither easy nor quick. It is, however, essential if we want to weaken the hold that disease can have on people’s lives.

At time of going to press The Times unmasked popular blogger NighJack as

Detective Constable Richard Horton. In his award winning blog he criticised police activity and detailed disciplinary infringements. In a bid to preserve his anonymity Horton sought an injuction stopping the papers from revealing his

identity. He failed. The High Court ruled blogging was in the public domain and therefore, under British law, authors of such blogs have no right to anonymity.

Horton has since deleted his blog.

BLOGS MENTIONED IN THIS ARTICLE:

http://manchestermedic.blogspot.com•

http://manchestermedicalcareers.•

wordpress.com

In the September 2008 issue of Mediscope, we launched the Dr Neel Halder Undergraduate Essay Prize For Psychiatry. Congratulations to Justin Healy, who took home the top prize of £400. Runners up were Bryony Clarke (£100) and Caroline Charlsworth (£50). Below is a brief extract of the winning essay. The full essay can be found at http://www.mediscopeonline.com/stigma.pdf“

”

COMPETITIONWINNER

societyscope

back at photos of how hospitals used

to look, hear about the life of house

officers in the 1950s and appreciate

just how much medicine and surgery

have evolved.. He went on to talk about

how surgery is now based around a

different disease spectrum and that it

is becoming extremely sub-specialised.

He was diplomatic in his predictions for

the future and explained that he thought

things could never go back to how they

were, but integral to this change was

advancement that could only have been

dreamt of when he was a junior house

officer.

This prestigious event was the start

of another busy Scalpel calendar, which

includes more lectures, surgical skills

training, speciality study days and much

more.

Scalpel members are entitled to

certain privileges, such as priority to

popular lectures and discounts on

events. For further information please

visit:

www.scalpelmanchester.co.uk

scalpel is the University of

Manchester’s student surgical

society. With the help of

surgical trainees and consultants, it

aims to provide medical students with

a deeper insight into the different

surgical specialities and provides them

with guidance on how to pursue a

career in surgery.

Last year Scalpel organised many

exciting events including a trauma

day, suturing workshops, laparoscopic

skills sessions, a research presentation

evening, numerous informative lectures,

an audience with Professor Gunther

von Hagen and a trip to the Bodyworks

exhibition in the Museum of Science and

Industry.

The first event for this year’s calendar

was a cheese and wine evening with

Professor Harold Ellis, who spoke about

his extensive surgical career within

the NHS. It was fascinating to look

The 2008/2009 season has been another successful year in the history of Manchester Medics Football Club. This year witnessed the achievement of not

only one, but two league titles for the club. The first team secured the premier league for the second year running with a 3-0 victory over History. Throughout the tournament, the Medics First Team comprehensively outclassed the competition, who struggled to keep up with the pace set by the Medics. A key part of the league triumph was the consistency shown by the defence: centre backs Jamie Weber-McCartney and captain Chris Newark, and goalkeepers Steve Broome and Graham Finlayson.

Dynamo Medics defied their tag of ‘third team’ by securing the second division title and with it, promotion to the first division. There, they will face an AC side who were bravely led out of relegation by captain Ben Darwent and centre-half Fraser MacNicoll, to climb to mid-table position, following a season where they were hampered by the loss of key players in a number of positions.

The season saw still more success, with the Manchester Medics Old Boys winning the Manchester Amateur League for the first time in their history, with four games in hand. In addition, the annual NAMS tournament, which was hosted in Manchester this April, saw the first team retain their crown as the best medics team in the country, despite stiff opposition from Sheffield in the final. We believe that this was a first for NAMS, having achieved the title without a single penalty shootout in the knockout stages!

societyscope28 Scalpel28 Manchester Medics Mens Football Club29 Manchester Medics Womens Football Club29 SPIT

scalpel - Laura Derbyshire

MAnChEsTER MEDICs FOOTbALL CLub

ME

ns

grah

aM F

inla

yson

scopesociety

sPIT is registered nationally in

Tanzania. I visited the remote

and extremely poor village of

Pommerin, South Tanzania this past

summer to capture the desperate plight

of its residents. This region not only

has the highest incidence of HIV/AIDS

transmission in the whole of Tanzania,

but after some local research and

communication with local government

officials, I was also staggered by the

other seemingly insurmountable

obstacles that this region faces. The

increasing numbers of street orphans,

the problem of poverty and the

workload of one qualified doctor, who

strives to cater for the needs of 27000

locals, are just a few.

It was a great privilege to be so

warmly welcomed and taken care of

by such a high spirited neighbourhood.

Free from exaggeration, they were

truly some of the kindest and happiest

people I have encountered. The main

take home message from my experience

in Pommerin was that health is wealth,

and what better than to promote this

sentiment by creating a lasting legacy,

which will hopefully help transform the

lives of a whole community and future

generations thereafter.

Currently over £500 has been

raised and will help towards building

an orphanage and hospital, which are

absent and urgently needed. Some of

this money has been used effectively to

build 3 new wells last October, providing

safe and clean water. Recently the

‘Karaoke Night’ function proved very

popular and successful. Get actively

involved and make a real difference.

MMWFC has gone from strength to strength this season. Not only have we come top of our league, but have also had our most successful

NAMS tournament in recent history, reaching the quarter finals without a single goal scored against us, only to be knocked out in a dramatic penalty shoot-out by Edinburgh.

The club has seen the injection of new talent; Emily Cant up-front with her fancy footwork; our pocket-rockets Ellie Wood and Becky KW in midfield running rings around

the opposition and Lucy Halliday and Kate Armstrong keeping an impenetrable defence. Our coaches have been pivotal to our success with their ambition, dedication and occasional nagging!

We’ve had some memorable socials in an array of fancy-dress, culminating in an invasion of Brighton and Birmingham, dressed as pom-pom wielding cheer-leaders on tour.

We’re extremely proud of the club’s achievements and we hope next year will be equally, if not more prosperous!

societyscope

MAnChEsTER MEDICs FOOTbALL CLub wO

ME

ns

sitara KuruvillaJess Foster

spit - Tabish Shah

Serenity Project in Tanzania

reviewscope

mediscope 06/0930

5/5£24.99 isbn:9781904842590

coMpetitionthe space available to review this

book does not give it justice, but

here are a few facts you need

to know. It answers almost every

question, from the simple “how do

I become a consultant?” to “how

do I become an expedition doctor

on Everest?” It lets you know all

about Modernising Medical Careers,

everything your crusty old “back when I was

a house officer” consultant can’t answer. For

each speciality (over 100), there is a graphical

clinical Skills for OSCEs covers

virtually all the possible OSCE

stations you will ever encounter

at medical school. It is a brightly colour-

coded book, which makes browsing and

locating particular topics a simple task. The

quality of this book is impressive, conveying

information in absorbable English and

in well presented diagrams. Each topic

is explained as a structured OSCE

station. It takes the reader through

the station step-by-step, in a concise and

comprehensive manner, concluding with top

exam tips. The tips include the conditions

most commonly examined and related

questions that may be asked. My only

qualm is despite a systematic explanation

in every station, it does not actually give

examples on how you can phrase history

taking questions. To summarize, this is a

very concise yet informative book, making

it a very effective tool for revision.

representation of all you need to accomplish

to move from FY1 to consultant. Every

speciality is compared by competitiveness,

salary, work-life balance, on-call activity, and

boredom/burnout ratio. It also mentions

amusing myths such as “arrogant, divorced,

Porsche driving, wannabe surgeons” for

cardiology and then gives the reality “a

pleasant surprise, some… are still

married!”

It also includes alternative

careers to the traditional clinical

medicine, such as forensic medicine,

entrepreneurship, law, and journalism. To

finish, there is an excellent section on getting

a job and staying competitive during your

career. I heartily recommend this book to

Problem based learning. Whether

you love it or hate it, the Gener-

al Medical Council have decided

that it’s here to stay. There is no deny-

ing that a case-based

curriculum will create

better prepared doctors.

However, many people struggle to en-

gage with PBL, having come from force

fed systems of sixth form. Students

often fail to identify the

depth of knowledge

that they must possess.

Furthermore, once objec-

tives are made, we quickly fall back into

the list-ticking techniques of learning that

we’re all so familiar with. Clinical Cases

Uncovered (CCU) is a new se-

ries of books designed to tackle

these pitfalls.

Rather than

present clinical medicine as lists of symp-

toms and management plans, the CCU

editors take the advantages of

PBL to create easily digestible

textbooks. Each chapter contains

a patient orientated case designed

to explore a specific topic.

Whereas other textbooks fire information

into our brains in a brute force manner, these

books make you think thoroughly about spe-

cific conditions. Instead of list learning, read-

ers are better equipped to appreciate and

form their own understanding of a disease.

There are currently thirteen books in the

series covering core material from cardiology

to paediatrics, to more obscure topics such as

radiology and infectious diseases. With each

book containing roughly twenty cases, there

are no bases left uncovered.

CCU’s lack of diagrams and snappy

summaries are its main downfall, and was

clearly not designed for those needing the

‘final cram’ before exams. However provided

they are used wisely, CCU may become an

invaluable PBL companion for clinical medical

students.

any medic. If you don’t know what you want

to do, this book is a great start. If you do, be

prepared to change your mind.

We have three copies of SYWTBABS to give

away! To be in with a chance send in the

best career advice you’ve ever received.

If Neel Burton’s Clinical Skills for OSCES has

caught your eye, you’re in luck, we’ve got

two copies up for grabs. Simply send in the

worst thing you have said/heard in an OSCE!

Submit your entries by September 30th to competitions@mediscopeonline.com!

By siMon eccles and

stephan sanders - Tom Hansen, Year 3, Hope Hospital

reviewscope30 SYWTBABS & Clinical Cases Uncovered30 Clinical Skills & Competition31 Crazy Kings and Cuckoos

clinical sKills For osces By neel Burton - Lisley Salimin, Year 4, Mancester Royal Infirmary

clinical cases uncovered - Andrew Cheng, Year 4, Mancester Royal Infirmary

4/5£19.99 each blackwell wiley

other toPics in this series:

4/5£16.99 isbn:9780199231966

31 06/09 mediscope

scopereview

“move aside for the old school renditions of thai

transvestite crazy wendy”

Going for a beverage was done most nights this week

- reference only to phase 1 students here – the post

second year medic is far too sensible a species

for mid-week drinking! Have PBL gatherings saturated your

love for the deliciously (non) daring dansak and delights of

the curry mile? they maybe light on the

wallet but not light on the lipase needed

for digestion. Robinskis… really? Again?

or do something with a little va va voom

this saturday...

Not meaning sweet loving (though if you are lucky enough to have

found someone then by all means enjoy the sweet act of love making

under the moonlight this Saturday evening)! For everyone else, give

Crazy Wendy’s a try…

Located on Burton Road, West Didsbury, the little gem known as

Thai E Sarn can be found buzzing and boisterous on a Saturday night.

Coined as a “unique dining experience” it genuinely is like nothing

experienced before.

Diners are allocated less space per metre squared than that of

a multiparity fetus. Chairs are stacked on top of each other, room

for your dinner plate is negligible... and attempting to work

your way towards the bathroom is undoubtedly not worth

the effort of any relief eventually obtained. It’s also

quite a way from the 41/42 bus route and invariably

the food does not quite resemble what was originally

ordered.

Yet, this is an absolutely fantastic evening out. Despite

paying your fair share for food and drink here, they are only

a minute part of what this restaurant actually has to offer.

Once the last chili is chewed and final fork replaced -

tables, chairs and people alike move aside for the old

school musical renditions of Thai transvestite Crazy

Wendy.

Wendy is definitely not admired for her singing

ability. In fact, her ability to hold a note is somewhat

questionable. Thankfully, she generously offers around the

microphone to willing customers.

Dance on chairs, hog the microphone and agonize over how

unfair it is for a man to have such an enviable woman’s figure.

Take away is at 15% discount, but why don’t you sacrifice the

space and comfort of eating in your own home for the cramped,

rowdy and hilariously entertaining environment of the restaurant?

it’s a saturday night, you’re ready to let your hair down...but what do you

do? JENNA BURTON thinks the answer might be to pay crazy Wendy a visit at thai e sarn

since the list of medically related films

churned out by Hollywood can be

written on a post-it note, Mediscope

is literally scraping the barrel for appropriate

films to review. The Last King of Scotland was

released in 2006 with James McAvoy in the

lead role as Nicholas Garrigan. He’s young,

he’s a Scot, he’s in Africa and he’s a medical

student. But that’s not all…Idi Amin (Forest

Whitaker) is in the neighbourhood; and ac-

cording to Wikipedia he “was a (sic) Ugandan

military dictator and the president of Uganda

from 1971 to 1979.” He is the “Last King of

Scotland”.

Garrigan is a fictional character, being

fortunate enough to be placed into the time

Amin was in power. He is an idealist at first,

searching for excitement and the chance to

do good, but he is unexpectedly given the

role of personal physician to the leader and

witness to the madness of King Amin.

Like most “based on a true story” films,

liberties are taken to “sex up” a potentially

boring story. It glues together a mish-mash

of news stories and urban myths of the

time to create its compelling

story. You get a real sense

of McAvoy’s uncertainty of

his role in Amin’s life and

see everything through his

innocent eyes. Whitaker’s

portrayal of Amin is impres-

sive. He is imposing, unpredict-

able, but charming. OSCAR got it right

and he carries the film and makes you

question whether this man is a victim of

circumstance or just a monster.

It’s a great story with great direc-

tion, but there’s nothing that

leaves me wanting to see it

again. The film will keep

you enthralled through-

out its running time;

a good tense drama/

thriller that builds up

momentum until the

end, reaches its climax

and then makes you

wonder what the point

of the two hours was.

reviewscope cucKoo craZyyu

ran

Zhen

g’s

Mov

ie r

evie

w

the last kIng of scotland3/5

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