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Why we need to work to maintain a social life - A Darwinian Medical Training Programme

Book of the week (BotW) = The Darwin Economy by Prof Frank Being a medical student and wanna-be-surgeon, I am naturally very competitive. I know exactly where I want to end up in life. I want to be a surgeon at a major unit doing research, teaching and management, as well as many other things. To reach this goal in a rational way I, and many others like me, need to look at what is required and make sure that we tick the boxes. We must also out-compete every other budding surgeon with a similar interest. Medicine is also a dog-eat-dog world when it comes to getting the job you want. Luckily you can head off into almost any field you find interesting, as long as you have the points on your CV to get access to the training. In recent years, the number of med students has increased, but so has the competition for places. The number of FY1 jobs has increased but so has the competition for good rotations. The number of consultant posts has increased, but so has the competition for the jobs. To even be considered for an interview for a consultant surgeon post these days a candidate (hopefully my future self) will have to demonstrate an excellent knowledge of anatomy, physiology, pathology and demography. They will need to have competent surgical skills and have completed all of the hours and numbers of procedures. To further demonstrate this they will need to have gone on extra-curricular courses and fellowships. They will also need to show that they can teach and have been doing so regularly. They must now also have an understanding of medical leadership and have a portfolio of projects. Finally, they will have had to tick the research box, with posters, publications, oral presentations and research degrees. That’s a long list of tick boxes and guess what? It has been getting longer! I regularly attend a surgical research collaborative meeting in Birmingham. Many of those surgeons didn’t even get taught about research at medical school or publish anything until they were registrars. Now even to get onto a good Core Training post you need to have at the very least some posters in your chosen field and probably a minimum of a publication. That’s a pretty big jump in standards in just 15 years. In two generations the competition has increased exponentially. Why is that? Prof Frank explains economic competition in Darwinian terms. His insights apply equally well to the medical training programme. It’s all about your relative performance compared to your peers and the continual arms race for the best resources (training posts). However, the catch is, if everyone ups their performance by the same amount then you all work harder for no more advantage for anyone, except for the first few people who made the upgrade. The majority do not benefit but are in fact harmed by this continual arms race. I believe that this competition will only get worse as each new year of med students tries to keep up and surpass the previous cohort. This competition will inevitably lead to a greater time commitment from the students with no potential gain. Everything we do is relative to everyone else. If we up our game, we will outperform the competition, until they catch up with us and then relatively we are no better off but are working harder. Why is this relevant? I know everyone will want to select “the best” candidate, but in medicine the “best” candidate doesn’t really exist because we are all almost equally capable of doing the role, once we have had the training. So there is no point us all working ourselves into the ground for a future job, if all our hard work won’t pay off for most of us anyway. But we can’t make these choices as individuals because if one of us says that “I am not going to play the game. I am going to enjoy my free time with my friends and family”, that person won’t get the competitive job because everyone else will out-perform them. We have to tackle this issue as a cohort. How do we ensure that we don’t work ourselves into the ground for nothing? Collectively as medical students and trainees we should ask the BMA and Royal Collages to set out a strict application process that means once candidates have met the minimum requirements, there is no more points for additional effort. For instance, the application form for a surgical consultant post should only have space to include 5 peer-reviewed publications. That way it wouldn’t necessarily matter if you had 5 or 50 publications. This limit may seem counter-intuitive and will possibly work against the highly competitive high achievers, but it will have a positive effect on everyone else’s life. Imagine if you only had to write 5 papers in your career to guarantee a chance at a job, instead of having to write 25. All that extra time you would have had to invest in extra-curricular research can now be used more productively by you to achieve other life goals, like more time with your family or more patient contact or even more time in theatre perfecting your skills. If you were selecting candidates for senior clinicians, would you rather pick an all round doctor who has met all of the requirements and has a balanced work-life balance or a neurotic competitor who hasn’t slept in 8 years and is close to a breakdown? Being a doctor is more than a profession, it is a life-style choice but we should try to prevent it becoming our entire lives.  
jacob matthews
over 6 years ago
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3
92

Pathology - Sickle Cell Anemia

The online lecture series for medical students. On demand streaming video lectures. www.mdcrack.tv Owner: MD CRACK  
YouTube
over 6 years ago
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3
40

Health and medicine

The medical world can be a confusing place. Patients and their families might feel overwhelmed by the large vocabularies and complicated explanations they get from their health care providers. Students entering health care also struggle to grasp the complexity of health sciences, and are forced to memorize huge amounts of information. We hope to make understanding the medical world a bit easier. Look around! These videos do not provide medical advice and are for informational purposes only. The videos are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read or seen in any Khan Academy video.  
Khan Academy
over 6 years ago
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10
409

Pathology of Glomerulonephritis

Pathology of Glomerulonephritis.  
SlideShare
over 6 years ago
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1
8

National Pathology Week 2010 - The Naked Scientists

Naked Scientists - 2nd Jan 2011 - National Pathology Week 2010  
thenakedscientists.com
over 6 years ago
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1
43

Pathology images and text for medical education - WebPath

WebPath contains pathology images, text, examinations, and tutorials for medical education  
library.med.utah.edu
over 6 years ago
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1
131

Abdominal (GI) Examination OSCE Station Guide

The abdominal examination aims to pick up on any gastrointestinal pathology that may be causing a patient's symptoms e.g. abdominal pain or altered bowel habit.  
OSCE Skills
over 6 years ago
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1
96

Anaemia - Pathology / Disease | Fastbleep

Fastbleep offers the opportunity to support a growing social network of healthcare students and educators as they consider patient care, undertake professional development and share knowledge.  
fastbleep.com
almost 7 years ago
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34
2503

COPD (Emphysema) Explained Clearly

Understand the treatment of COPD (Emphysema) with this clear explanation by Dr. Roger Seheult.  
YouTube
almost 7 years ago
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11
274

Seizure classifications, types for neuroscience pathology student: Tonic Clonic etc

Seizures include tonic clonic, abscence and status epileptics. Simple partial and complex partial as well.  
YouTube
almost 7 years ago
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1
43

Diabetic Retinopathy

Most common cause of blind registration for patients in the UK between 15 and 65years.   Pathology When were they diagnosed with DM- the longer the duration the higher the chance of diabetic retinopathy (80% have retinopathy after 20 years) What is their HbA1c? (the worse the control of DM the higher the chance of retinopathy)  
almostadoctor.com - free medical student revision notes
almost 7 years ago
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2
57

Cataracts

  Cataract is the most common non-refractive cause of visual impairment worldwide   Pathology In simple terms=  Opacification of the lens.  
almostadoctor.com - free medical student revision notes
almost 7 years ago
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1
33

Subdural Haemorrhage

A haemorrhage between the arachnoid and dura mater. It can be acute, chronic, or acute on chronic. Most cases are chronic, and occur in the elderly after mild trauma (e.g. a fall). Usually a venous bleed.   Epidemiology and aetiology Elderly Hypertension Falls (e.g. in epilepsy and alcohol abuse) Anticoagulant therapy   Pathology Vast majority due to trauma, but sometimes can be caused by ↑ICP and brain mets.  
almostadoctor.com - free medical student revision notes
almost 7 years ago
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1
28

Duchenne’s Muscular Dystrophy

This is a severe form of muscular dystrophy, and most boys do not survive past adolescence. It is an X-linked recessive condition. Typically affects skeletal muscles initially, but may later go on to affect the heart, and sometimes diaphragm.   Epidemiology Affects 1 in 3500 male boys The most common muscular dystrophy   Pathology    
almostadoctor.com - free medical student revision notes
almost 7 years ago
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4
286

Diagnosis, Pathology and Management of Hypertension

All images in this article taken from the Nice guidelines on Hypertension, and reproduced in accordance with the terms on conditions of the author.   WHO criteria for defining hypertension: Under 50 – should try to get it under 140/90  
almostadoctor.com - free medical student revision notes
almost 7 years ago
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1
17

Extradural Haemorrhage

Extradural Haemorrhage aka Epidural Haemorrhage Blood collects between the dura mater and the bone of the skull. The dura is stripped away from the skull – indicating a high pressure bleed. On CT and MRI, it has a classical lentiform (lens) shaped appearance.   Pathology  
almostadoctor.com - free medical student revision notes
almost 7 years ago
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2
39

Human Papilloma Virus - HPV

Epidemiology The most common STI in the UK Estimated that 10-20% of the population have a genital HPV infection, but only 1% of the population are symptomatic at any one time   Pathology The result of HPV infection. There are >100 types of HPV, and only several cause warts. HPV types 6 and 11 account for >90% of cases   Spread  
almostadoctor.com - free medical student revision notes
almost 7 years ago
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26

Endometrial Carcinoma

Epidemiology The most common genital tract cancer Every year, about 4500 women in the UK develop endometrial cancer The majority (93%) of cases are diagnosed in women aged over 50 years Geographical variation exists - North American: Chinese ratio of about 7: 1   Pathology  
almostadoctor.com - free medical student revision notes
almost 7 years ago
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1
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Faecal Incontinence

Faecal incontinence Occurs in 15% aged >65Y, increasing incidence with age in men only. Causes include: Sphincter weakness (following childbirth/surgery); Anal/rectal pathology e.g. fistulae, Crohn’s, proctitis;  
almostadoctor.com - free medical student revision notes
almost 7 years ago