Choosing a career path is one of the hardest (non-clinical) decisions many doctors will face in their professional lives. With almost 100 specialties and sub-specialties available, settling on any one career can seem pretty daunting, particularly as in the majority of cases the choice will set a path you’re likely to be on for the next 30+ years. But, with only a very small range of these specialties and almost none of the sub-specialties available to undertake as rotations during any one foundation programme, finding out what actually working in different specialties is like can be difficult. It’s likely you’ll have at least identified an area you’re kind of/maybe interested in before starting the foundation programme but, to use a total cliché, you wouldn't buy a car without taking it for a test drive, right?
There is good evidence to show that any experience, even if only brief, can be very influential on career choice and this is why all deaneries offer new doctors to undertake a ‘taster week’ at some point during the Foundation Programme. This is usually from 2-5 days, taken as study leave, in a specialty of the doctor’s choosing which they haven’t and won’t work during their foundation programme. Most hospitals will allow doctors to do this at an external hospital or organisation if the desired specialty isn't available locally. Tasters are often organised by the trainee but deaneries are encouraged to provide a list or register of structured taster programmes to its trainees. A timetable split into half-day activities, including time for 1:1 discussion with both consultants and trainees, should be provided or agreed with a supervisor, which gives the doctor as broad an experience of the roles, responsibilities, highlights, challenges and lifestyle of the specialty as possible. This should then give the doctor plenty of food for thought and provide an opportunity for (you guessed it) reflection to confirm or exclude that specialty as a career choice and identify (if the former) what steps they need to take to get there. At the end of the experience the doctor should fill in a feedback form and formally reflect in their portfolio.
Taster weeks aren't limited to particular specialties and sub-specialties either; there are plenty of more over-arching opportunities such as experiencing leadership and management roles or getting involved in academia, research or medical education. As long as you can identify and describe what you’ll aim to learn or understand from the experience, almost any taster is possible.
So, how do you go about it? Each deanery should have a policy relating to taster weeks, or have an responsible administrator who can provide advice. Talking to your educational supervisor can also be really useful. Considering early on in FY1 which area or specialty you want to explore is important; time runs out scarily quickly and taking time out of rotations needs careful planning and co-ordination to make sure there is enough cover for your day job. You may already know or have identified an appropriate supervisor who will facilitate the experience but if not, your supervisor or administrator will almost certainly be able to point you in the right direction.
You’ll never get to experience every possible career path before starting out on one; the specialty or sub-specialty you eventually work in may not even exist yet. But getting an idea of what you’ll definitely consider, or definitely won’t, will give you a better chance of identifying something that will suit you personally and professionally, and, particularly in the more competitive and run-though specialties will give you another example of commitment to specialty. Don’t be afraid to think outside the box or look at something really niche – it may give you a taste for something unexpected that you’ll love for life.
During our antibiotics teaching at medical school we were told that a recent survey of junior doctors had revealed that a significant proportion didn't realise that augmentin, tazocin, and carbopenems were penicillins and as such should not be given to those with known allergies. I devised a "mind-map" summarising the main antibiotics in use using information from the BNF and my own lecture notes. For me, seeing the information laid out in this manner, pinned above my desk as I work, helps me remember the major classes, their relationships with one another, and their major side-effects.
The relationship between patients and doctors has long been based on face-to-face communication and complete confidentiality. Whilst these fundamentals still absolutely remain, the channels of communication across all sectors have changed monumentally, with social media at the forefront of these changes.
Increasingly patients are taking to the Internet to find recommendations for healthcare professionals and to self-diagnose. By having an online presence your business can positively influence these conversations – engaging with the public and colleagues both locally and globally and can facilitate public access to accurate health information. The reality is social media is here to stay, so in 2014 why not make it your resolution to become part of the conversation.
To get you started and so that social media isn’t seen as such a daunting place, SocialB are providing a free eBook containing lots of fantastic advice on how to use social media within the healthcare sector ‘Twitter for Healthcare Professionals’ please visit http://www.socialmedia-trainingcourses.com/top-10-twitter-tips-ebook/ to receive your free copy.
Here are 5 top tips on using social media in 2014:
1. Decide on your online image and adhere to it
Decide how you would like to be portrayed professionally and apply this to your online presence. Create a tone of voice and a company image – in line with your branding and values – and stick to it.
2. Be approachable, whilst maintain professional boundaries
Connecting with patients via social media can help to ease their concerns and develop a certain rapport or trust with you prior to their consultation. However, this must remain professional at all times, and individual advice should not be given. The general rule is that personal ‘friend requests’ should not be accepted; connection over corporate pages and accounts is encouraged to maintain a traditional doctor-patient relationship.
3. Contribute your knowledge, experience and industry information
Social media is a fantastic way to launch an online marketing campaign. Interaction with your patients and potential clients via social networks is an inexpensive way to engage with, and learn from your audience.
As a healthcare professional, you will inevitably take part in conferences, training days and possibly new research. Social media allows you to share your knowledge, enabling your market to be better informed about you and your work.
4. Treat others how you wish to be treated
By engaging with other means that they are more likely to take notice of, and share, your social media updates. Sharing is key and it is this action that will substantially grow your audiences. Maintain your professionalism and pre-agreed tone of voice whilst communicating with others. Make it easy for peers and patients to recommend your level of skill and service, and ensure you recommend fellow healthcare professionals for the same reasons.
5. Consider your audience
Whilst you may be astute at targeting a particular audience as a result of careful market research, always be aware who else can see your online presence. Governing bodies, competitors and the press are just a few examples. Whilst social media tends to be a more informal platform, by following the above points will ensure your professional reputation is upheld.
Thank you Katy Sutherland at SocialB for providing this blog post.
All stages of essay writing can be tricky, from the choice of a proper topic to the organization of the paper to the actual writing. Moreover, you also have to edit and proofread the paper in order to make sure it’s clean of all spelling errors and logical gaps. The content has to be free of plagiarism, and all sources you have used need to be properly referenced. When you have all those rules in mind, essay writing can become really confusing.
However, there are online resources that can help you through every stage of the process, and we will list some of the most useful ones in the continuation.
Help with your topic and thesis
The first stage of the process can often be the most troublesome one. However, there are online tools that offer great topic ideas, which you can later turn into thesis statements with the help of thesis generators.
Writinghouse is citation generator that will create the needed bibliography entries and in-text citations in your paper.
How to write a college application essay – 10 practical ninja tips by Ninja Essays. This simple guide offers practical tips for writing impressive application essays. Paying attention to this advice will relieve you from the stress of college applications.
Thesis Generator 1.0 is a great tool for drafting clear thesis statements for argumentative and persuasive essays. In order to get a suggestion for your thesis statement, you will need to enter the topic and main argument of your paper, along with two reasons that support the main argument.
Thesis Statement Creator is also requires you to enter all components of the thesis statement, after which you will get a suggestion for a thesis statement that you can directly use into your essay.
Understand the types of essays
All types of essays have different requirements, so you need guides that will help you understand their principles.
Roane State Online Writing Lab provides clear information about various types of essays, as well as samples that will help you get an impression of how great academic writing is done.
Writing Detective provides a useful online lesson that will teach you how compare/contrast essays are written, after which you can take a quiz to test your abilities.
The organization of your paper
Proper essay organization isn’t difficult to achieve, but many students struggle with it. These are the tools that will improve the structure of your papers:
Essay Map by ReadWriteThink will help you organize your paper through an interactive guide.
From outline… to essay by iCivics is a lesson with side-by-side examples of appropriate organization.
Essay Organizer is an app for smartphones, which you can use to go through the detailed steps of essay writing and take notes at any time.
Great essays don’t come without proper grammar and syntax!
These tools will help you make sure your paper is error-free:
PaperRater will not only provide you with suggestions on how you can improve your paper in terms of style and vocabulary, but will also check it for plagiarism.
Purdue OWL offers any information about essays you could possibly need. It will teach you about proper grammar and syntax, as well as the general requirements for different types of essays.
UNLV Writing Center provides practical tips on essay writing that will teach you how to avoid the most common mistakes.
Check the uniqueness of your paper!
Professors don’t forgive plagiarism issues, so you better use these tools to make sure your paper is unique before you submit it:
PlagTracker is a simple, but very effective tool that provides links to articles and webpages of duplicate content.
Viper is another effective plagiarism checker, but this one requires a download.
Education is an aspect of life that has been particularly transformed due to the remarkable digital changes. Now that you have practical tools within reach, essay writing doesn’t have to be a struggle. Online tools will make this activity less stressful and less time-consuming!
Medical blogging is blogging in the field of medicine. It is a relatively recent addition to the medical field. While its closest predecessor medical journalism; is about 300 years old, medical blogging is currently about a decade old. This blogpost aims at exploring the field of medical blogging and comparing it to related disciplines when relevant. It examines some opinions of bloggers, and reviews some medical blogs aiming to infer reasons for blogging, derive technique or outline of blog and hopefully arriving at a conclusion to the future prospects of medical blogging.
Medicine is the practice of the art and science of healing 'ars medicina'. It is a branch of applied science, which started probably in the pre-historic era. The practice continued to flourish, specialise, sub-specialise and sub-sub-specialise.
The word blog is most probably derived from the contraction of the words 'web log' which is a form of website that is more interactive, allowing comments, tagging,and is displayed in counter-chronological order from the most recent at the top of the page. The term 'blog' is currently used as a noun as well as a verb. The aggregation of blogs is named 'blogosphere', and the blog writer is named 'blogger'. There are single author blogs and multi-author blogs, they are as diverse in there content as the diversity of the bloggers, with regards to form they can be written text, images, videos, sounds or combination of more than one medium. The term 'blogroll' is referred to blogs followed by a person. Blogging is just more than a decade old now. However, the number of blogs have been increasing exponentially at times. The concept of blogging is considered as one of the components of the concept of web 2.0.
Medical blogs refer to blogs that are primarily concerned with medical/health subjects. The name 'medical blog' is derived from content based taxonomic classification.
Medical blogs can be classified by author, there are blogs by physicians, nurses, patients, medical institutions, medical journals, and anonymous blogs. They can be classified by target audience as either to other doctors, patients and carers, general public or a combination of more than one target. There are also medical blogs by patients or patient blogs that expresses their viewpoints. A study examined medical student blogs and concluded that they might be beneficial for students to reflect on their experience (Pinilla et al, 2013). The Nephrology Dialysis and Transplantation (NDT)
made it own blog (El Nahas, 2012). The American Journal of Kidney Disorder (AJKD) made its own official blog (Desai et al, 2013). During the same year, the American Heart Association and American Stroke Association launched their official blog (Sanossian & Merino, 2013). Pereira discussed the blogs by neurosurgeons (Pereira et al, 2012).
In the BMJ doc2doc blogs, they do not have to meet certain number of word count but will have to be reviewed prior to publication. KevinMD requires blog posts to be of maximum five hundred words, Medical-Reference require a minimum of one thousand words. Meducation requires a blog post to vary between 1500-3000 word. Independent blogs may show more variation in the number of words per blog post. Some blogs are predominantly in text format, other may combine multimedia or get linked to other medical blogs.
The BMJ doc2doc tentatively recommends blog posting to be in the frequency of one to two blogs/month. Chrislyn Pepper, a medical blog writer, (2013) states that medical blogging can aim to be 'three blogs of 300+ words each week and three to four short blogs of less than a hundred words five days per week.'
Medical bloggers seem to have various reasons to blog, some communicate clinical data to fellow doctors, in this case some blogs seem to resemble research or review articles in content and language which can contain medical jargon. There are diagnosis blogs that were studied by Miller and Pole (2010). The comparison between the electronic predecessors of blogging including Electronic Bulletin Board, USENET, and emailing in addition to the why of blogging in general has been discussed by Mongkolwat
(Mongkolwat et al, 2005). Some put their hypotheses forward, others share clinical experience or discuss a clinical matter. Some bloggers direct their attention to the general public providing information about medical topics. Some discuss issues which can be difficult to be put in research topics. Dr Rob discussed that importance of medical blogging as an equivalent to the concept of democracy in an online world. Doctor Blogger website offers 10 reasons for medical blogging including public education, correction of misconceptions and establishing a name. For the medical blogger's direct benefit Medical Rant blog offers an overview of personal benefits from medical blogging including stimulation of thought and stimulation of academic writing. Dr Wible seems to use her medical blog to promote a standard of care that seems to be a mix between the medical model and the befriending model of care. Another study examined the young adults blogging and concluded that powerlessness, loneliness, alienation, and lack of connection with others, where the primary outcomes of young adults as a result of mental health concerns (Eysenbach et al, 2012). Wolinsky (2011) enquires whether scientists should stick to popularizing science or more.
Medical blogs are essentially online activity which renders them immediately accessible to any area with internet connection, they are paperless by definition which makes them more environment friendly. The medical blogs are open access by default which adds to the accessibility, and they are decentralised which decreases control over the control and seems to accentuate diversity.
As compared to peer reviewed journals, medical blogs seem to be less referenced, are hardly ever taken as academic writing, the process of peer reviewed medical blogs is minimal if any, and they do not get reflected on resume or be considered as publication, though the term 'blogfolio' started to become a watch word. It seems hard to base clinical decisions on medical blogs. However, medical blogs can offer more diversity into research and non-research medical topics. They are published online with no delay or review time, they can comment on the most recent advances in the medical field or most contemporary issues instantaneously. Very recently, citing blogs seems to become a bit accepted. BMJ Journals have their dedicated blogs
Some online resources give a comprehensive outline on blogging in general and medical blogging in particular including video interview with a medical blogger
Michelle Guilemard in her blog makes a valid point of how medical blogging can enhance career. Medical Squid also highlighted medical blogging as a career
Kovic et al (2008) conducted a research on the medical blogosphere an concluded that 'Medical bloggers are highly educated and devoted blog writers, faithful to their sources and readers'. Miller & Pole (2010) concluded that 'Blogs are an integral part of this next stage in the development '. Stanwell-Smith (2013) discussed the aspect as an important tool to communicate with patients. The blur between academia and blogging was discussed in research blogs. (Sheema et al, 2012). During the same another study discussed the impact of blogging on research (Fausto et al, 2012).
While Baerlocher & Detsky (2008) warn in an article against the hazards of medical blogging due to potential breach of confidentiality. After an exhaustive study of the content of weblog written by health professional, Lagu reached the concern of breaching of confidentiality (Lagu et al, 2007). Rebecca Golden (2007) cites the perils of medical blogging she concludes her article saying 'Science has a peer-review process for a reason'. Brendan Koerner (2007) in wired magazines posted an article about the problems of giving medical advice via blogging. Dr Val Jones makes a point by concluding that social media provide the 'allure of influence'. Thomas Robey (2008) offers arguments for and against medical blogging, including confidentiality, and ruining personal reputation on the negative side, while enhancing democratization of conversation and having a creative outlet on the positive side. Brendel offers an intriguing discussion to whether it would be ethical or not to monitor patients' blog to determine their health status. (Brendel, 2012).
O'Reilly voiced in 2007 the need for blogging code of conduct. The GMC published guidance on the use of social media by doctors and it included blogging as a form of social media. The Royal College of General Practitioners also published the social media high way code to offer guidance on social media including medical blogging. There is also the medblog oath online.
Flaherty (2013) argues that blogging is under attack by micro-blogging, and that it is in its deathbed. Mike Myatt in his article Is Blogging Dead, discusses various views about blogging in an era of micro-blogging The Royal College of Psychiatrists recently introduced a number of blogs including the president's blog, overseas blogs and other blogs. The medical blogging seems to occupy a middle space between the quick micro-blogging and the thoughtful research article. Its diversity and freedom are its strongest tools and can have the potential to be its worst enemies. One wonders whether the emergence of guidelines for medical blogging – given the seriousness of the content – would save medical blogging and elevate it to the next level or change the essence of it. After all, the question is how much the medical field which is a top-down hierarchy accept grass-root movement. Freedom of expression is probably at the heart of blogging. It would be logistically impossible to impose rules on it. However, guidelines and code of honour may help delineating the quality of medical blogs from each other.
This post is previously posted on doc2doc blogs.
Bibliography & Blogiography
Brendel, D. Monitoring Blogs: A New Dilemma for Psychiatrists Journal of Ethics, American Medical Association, 2012, Vol. 14(6), pp. 441-444
Desai, T., S.M.A.N.V.S.K.T.J.K.C.K.B.E.J.K.D. The State of the Blog: The First Year of eAJKD Am J Kidney Dis., 2013, Vol. 61(1), pp. 1-2
El Nahas, M. An NDT blog Nephrol Dial Transplant (2012) 27: 3377–3378, 2012, Vol. 27, pp. 3377-3378
Eysenbach, G., B.K.M.M. What Are Young Adults Saying About Mental Health? An Analysis of
Internet Blogs Journal of Medical Internet Research, 2012, Vol. 14(1)
Fausto, S. Machado, F.B.L.I.A.N.T.M.D. Research Blogging: Indexing and Registering the Change in Science 2.0 PLoS one, 2012, Vol. 7(12), pp. 1-10
Lagu, T, K.E.J.D.A.A.A.K. Content of Weblogs Written by Health Professionals J Gen Intern Med, 2008, Vol. 23(10), pp. 1642–6
Miller, EA., P.A. Diagnosis Blog: Checking Up on Health Blogs in the Blogosphere American Journal of Public Health, 2010, Vol. 8, pp. 1514-1518
Mongkolwat, P. Kogan, A.K.J.C.D. Blogging Your PACS Journal of Digital Imaging, 2005, Vol. 18(4), pp. 326-332
Pereira, JLB., K.P. d.A.L. d.C.G. d.S.A. Blogs for neurosurgeons Surgical Neurology International, 2012, Vol. 3:62
Pinilla, S. Weckbach, L.A.S.B.H.N.D.S.K.T.S. Blogging Medical Students: A Qualitative Analysis
Hi guys, my name is Angela! I am currently an F2 doing a year in Australia! My key interest is neurosurgery and as a neurosurgery SHO now in Adelaide, I thought I'd start a blog on a few neurosurgery/neurology issues I encounter regularly on the wards. This is aimed to help all medical students studying neurology/F1/SHO in neurosurgery. Few topics could include:
Basic management of neurosurgery/neurology patients - the neurology exam
Ophthalmology exam and lesion representation
Raised intracranial pressure
Acute head injury
Decreased conscious level
Electrolytes imbalance in the neurosurgical patient
Fluid management in the neurosurgical patient
Last Wednesday (27/11/13) was Birmingham Medical Leadership Society’s second lecture in its autumn series on why healthcare professionals should become involved in management and leadership.
Firstly, a really big thank you to Mr Smart for travelling all the way to Birmingham for free (!) to speak to us. It was a brilliant event and certainly sparked some debate. A second big thank you to Michelle and Angie – the University of Birmingham Alumni and marketing team who helped organise this event and recorded it – a video will hopefully be available online soon.
Mr Tim Smart is the CEO of King’s NHS Foundation Trust and has been for the last few years – a period in which King’s has had some of the most successive hospital statistics in the UK. Is there a secret to managing such a successful hospital?
“It’s a people business. Patients are what we are here for and we must never forget that”
Mr Smart doesn’t enjoy giving lectures, so instead he had an “intimate chat” covering his personal philosophy of why we as medical students and junior doctors should consider a career in management at some point.
Good managers should be people persons. Doctors are selected for being good at talking to and listening to people – these are directly translatable skills.
Good managers should be team leaders. Medicine is becoming more and more a team occupation, we are all trained to work, think and act as a team and especially doctors are expected to know how to lead this team. Again, a directly transferable skill.
Good managers need to know how to make decisions based on incomplete knowledge and basic statistics. Doctors make life-altering clinical decisions every day based statistics and incomplete knowledge. A very important directly transferable skill.
Good managers get out of their offices, meet the staff and walk around their empires. Doctors, whether surgeons, GP’s or radiologists have to walk around the hospitals on their routine business and have to deal with a huge variety of staff from every level. To be a great doctor you need to know how to get the best out of the staff around you, to get the tasks done that your patients’ need. Directly transferable skills.
Good managers are quick on the up-take and are always looking for new ways to improve their departments. Doctors have to stay on top of the literature and are committed to a life-time of learning new and complex topics. Directly transferable.
Good managers are honest and put in place systems that try to prevent bad situations occurring again. Good doctors are honest and own up when they make a mistake, they then try to ensure that that mistake isn’t made again. Directly Transferable.
Even good managers sometimes have difficulties getting doctors to do what they want – because the managers are not doctors. Doctors that become managers still have the professional reputation of a doctor. A very transferable asset that can be used to encourage their colleagues to do what should be done.
A good manager values their staff – especially the nurses. A good doctor knows just how important the nurses, ODP, physio’s and other healthcare professionals and hospital staff are. This is one of the best reasons why doctors should get involved with management. We understand the front line. We know the troops. We know the problems. We are more than capable of thinking of some of the solutions!
“Project management isn’t magic”
“Everything done within a hospital should be to benefit patients – therefore everything in the hospital should be answerable to patients, including the hospital shop!”
“Reward excellence, otherwise you get mediocrity”
At the present The University of Birmingham Students Medical Leadership Society is in contact with the FMLM and other similar groups at the Universities of Bristol, Barts and Oxford. We are looking to get in contact with every other society in the country. If you are a new or old MLS then please do get in touch, we would love to hear from you and are happy to help your societies in any way we can – we would also love to attend your events so please do send us an invite.
Email us at firstname.lastname@example.org
Follow us on Twitter @UoBMedLeaders
Find us on Facebook @ https://www.facebook.com/groups/676838225676202/
Come along to our up coming events…
Thursday 5th December LT3 Medical School, 6pm
‘Why should doctors get involved in management’
By Dr Mark Newbold, CEO of BHH NHS Trust
Wednesday 22nd January 2014 LT3 Medical School, 6pm
‘Has the NHS lost the ability to care?’ – responding to the Mid Staffs inquiry’
By Prof Jon Glasby, Director of the Health Services Management Centre , UoB
Thursday 20th February LT3 Medical School, 6pm
‘Creating a Major Trauma Unit at the UHB Trust’
By Sir Prof Keith Porter, Professor of Traumatology, UHB
Saturday 8th March LT3 Medical School, 1pm
‘Applying the Theory of Constraints to Healthcare
By Mr A Dinham and J Nieboer ,QFI Consulting
If I had a penny, okay a pound, for every time a patient responded to the request to practice examining them said, 'Well, we all gotta learn', I would be a very rich medical student. (I'd like to add that this is said in a strong West-country accent, just so that you feel like you're really there.) I'm sure that the majority of my colleagues would agree.
Today has been no different except for the fact that one of the patients I met described themselves as a 'whistleblower'. It was like my subconscious slapping me around the face and telling me to stop procrastinating. Why, you ask? Well I'm starting to get a little nervous actually, in exactly two weeks I'll be presenting my thoughts on whistleblowing (you might remember me going on about this during dissertation season) to a load of academics and healthcare professionals. My sphincters loosen up at the thought of it*
Within five minutes of meeting this patient, they had imparted their wise words on me 'Chantal, just remember when you become a doctor - if you're absolutely sure that you're right about something then never be afraid to speak up about it.' Like music to my ears. Well, until he told me that he was convinced that 'cannabis cures all ills.'
Each to their own.
*I sincerely apologise, poor medic joke. Yuck.
Written by Chantal Cox-George,
3rd Year Med Student at University of Bristol
Thousands of doctors are currently preparing portfolios and stressing about situational judgements as they go into core and specialty training interviews. As a medical student I wasn’t even aware when these interviews were and had only the briefest imaginings of what they might entail. Even at finals, specialty applications felt a million miles away; but it’s as if you’ve only just got through the misery of MTAS and you’re suddenly an F2 realising that the last 15 months have, to your surprise, disappeared.
Yes, the interview is certainly a stressful situation, and for many medics it’s only the second ‘proper’ interview they’ve ever had. Time pressures, the scope of stations and performing under the watchful eye of the great and good of the medical profession only add to the stress. But, there are ways to make this process bearable, and, dare I say it, enjoyable (kind of).
The most important step is preparation. Not just the preparation that starts in the days to weeks before the interview; this should be for refining your skills, getting your answers super-slick and getting to know yourself inside-out. Preparation starts at university (and no, which school you’re in doesn’t make a single difference). What the interviewers are looking for can be found in the person specification unique to each specialty (found at http://bit.ly/1eWF6aN). I.e. if you know you were born to perform heart surgery, start looking at what the interviewers for cardiothoracics are looking for. Even if you’re completely confused about your career path, it’s time to start thinking.
Many specialties still have a short-listing stage dependent on the application form. Whether assessed on the form or at interview each specialty will (generally) award points for other/higher degrees, publications, presentations, prizes, teaching experience, audit and ‘commitment to specialty’. At the CT1/ST1 stage it doesn’t matter what subject area you published/presented/taught in etc. to score in that section; but having something relevant will help you discuss your commitment to that specialty. ‘Relevant’ in itself is misleading however; every experience is likely to be relevant when you identify the transferable skills involved and what you learned from the experience. Some specialties are stricter and you’ll need demonstrable evidence that you haven’t just applied on a whim. These tend to be the more competitive specialties which demand evidence you’ve had a really good look at what the job involves and have taken steps to broaden your knowledge.
There is typically also at least one skills station which may be general (e.g. breaking bad news to a patient) or specialty-specific (e.g. interpreting images for radiology) but are still based on applicants demonstrating they fit the person specification. Many of the mark schemes are also freely available on the relevant Royal College website, and I encourage you to have a look and see where you could get a few more points (or give yourself a pat on the back that you couldn’t). It’s unlikely that the mark scheme/person spec. will be exactly the same every year, but the general overview is enduring.
NB. The GP application is a bit different, but that’s for another post.
The take home message is get involved early on, and be involved consistently. It may eat up some of your free time but you’ll appreciate it as soon as you look at the application form. If you’re struggling for practical ideas, take a look at the Royal College and specialty trainee websites for inspiration (some, for example the Royal College of Radiologists, have great audit ideas). The RSM and each medical school have a list of available prize essays and exams. A wise person once said to me “there’s no such thing as a wasted conversation”: Speaking to trainees and consultants about how they got to where they are not only gives you great insight into what they do but being friendly and enthusiastic can open up doors for you to help in audits and publications. And the final tip? Write everything down. Not only will this stand you in good stead as a safe doctor, but you’ll be surprised how much you can forget in a very short time. Then, unlike me, you won’t have to spend ages trying to think of reasonable examples of ‘when I dealt with stress’.
Written by Lydia Spurr, FY3 Doctor
Lydia is a Resident Meducation Blogger
The book of the week this week has been Chris Patten’s “Not quite the diplomat” – part autobiography, half recent history and a third political philosophy text. It is a fascinating insight into the international community of the last 3 decades. The book has really challenged some of my political beliefs – which I thought were pretty unshakeable – and one above all others, the EU. I read this book to help me decide who I should vote for in the upcoming MEP elections.
I have to make a confession, my political views are on the right of the centre and I have always been quite a strong “Eurosceptic”. Although recently, I have found myself drifting further and further into the camp of “we must pull out of Europe at all costs” but Mr Patten’s arguments and insights have definitely made me question this stance.
With the European Parliamentary elections coming up, I thought it might be an interesting time to put some ideas out there for discussion.
From a young age, I have always been of the opinion that Great Britain is a world leading country, a still great power, one of the best countries in the world - democratic, tolerant, fair, sensible - and that we don’t need anyone else’s “help” or interference in how our country is run. I believe that British voters should have a democratic input on the rules that govern them.
To borrow an American phrase “No taxation without representation!”
I believe that democracy is not perfect but that it is the best system of government that humans have been able to develop. For all of its faults, voters normally swing back to the centre ground eventually and any silly policies can be undone. This system has inherently more checks and balances than any meritocracy, oligarchy or bureaucracy (taking it literally to mean being ruled by unelected officials).
This is one of my major objections to how the European Union currently works. For all intents and purposes, it is not democratic. Institutions of the EU include the European Commission, the Council of the European Union, the European Council, the Court of Justice of the European Union, the European Central Bank, the Court of Auditors, and the European Parliament. Only one of these institutions is elected by the European demos (the parliament) and that institution doesn’t really make any changes to any policies – “the rubber stamp brigade”. The European Council is made up of the President of the European Council (Unelected), President of the European commission (Unelected) and the heads of the member states (elected) and is where quite a lot of the "major" policies come from but not all of the read tape (the European Commission and Parliament).
I am happy to be proved wrong but it just seems that the EU, as a whole, is made up of unelected officials who increasing try to make rules that apply to all 28 member states without any consent from the voters in those states – it looks like the rule of “b-euro-crats” (bureaucrats – this version has far too many vowels for a dyslexic person to use).
A beurocratic rule which many of us do not agree with but seemingly have to succumb to, a good example for medics is the European Working Time Directive (EWTD) which means that junior doctors only get paid for working 48h a week when they may spend many, many more hours in work. The EWTD has also made training a lot more difficult for many junior doctors and has many implications for how the health service is now run. Is it right that this law was imposed on us without our consent? If we imposed a treatment on a patient without their consent then we would be in very big trouble indeed!
I cannot deny that the EU has done some good in the world and I cannot deny that Britain has benefited from being a member. I just wish that we could pay to have access to the markets, while retaining control over the laws in our lands. I want us to be in Europe, as a partner but not as a vassal. In short, I would like us to stay within the EU but with major reforms.
I know that any reforms I suggest will not be read by anyone in power and I know they are probably unrealistic but I thought I would put it out there just to see what people think.
I would like to see a NICE’er European Union.
The National Institute for Clinical Excellence is a Non Departmental Public Body (NDPB), part of the UK Department of Health but a separate organisation (http://www.nice.org.uk/aboutnice/whoweare/who_we_are.jsp). NICE’s role is to advise the UK health service and social services. It does this by assessing the available evidence for treatments/ therapies/ policies etc and then by producing guidelines outlining the evidence and the suggested best course of action.
None of these guidelines are enforced by law, for example, as a doctor you do not have to follow the NICE recommendations but if you ignore them and your patient suffers as a consequence then you are likely to be in big trouble with the General Medical Council.
So, here would be my recommendations for EU reform:
First, we all pay pretty much the same as we do now for access to the European market. We continue with free movement and we keep the European Council but elect the President. This way all the member states can meet up and decide if they want to share any major policies. We all benefit from free movement and we all benefit from a larger free trade area.
Second, we get rid of most of the rest of the EU institutions and replace them with an institute a bit like NICE. The European Institute for Policy Excellence (EIPE) would be (hopefully) quite a small department that looks at the best available evidence and then produces guidance on the policy.
A shorter executive summary would hopefully also be available for everyday people to read and understand what the policy is about - just like how patients can read NICE executive summaries to understand their condition better.
Then any member state could choose to adopt the policy if their parliaments think it worthwhile. This voluntary opt-in system would mean that states retain control of their laws, would probably adopt the policies voluntarily (eventually) and that the European citizens might actually grow to like the EU laws if they can be shown to be evidence based, in the public’s best interests, in the control of the public and not just a law/red tape imposed from above.
The European Union should be a place where our elected officials go to debate and agree policies in the best interests of their electorates. There should therefore be an opt-out of any policy for any member state that does not think it will benefit from a policy.
This looser union that I would like to see will probably not happen and I do worry that one day we will wake up in the undemocratic united federal states of Europe but this worry should not force us to make an irrational choice now. We should not be voting to "leave the EU at all costs" but we should be voting for reform and a better more co-operative international community.
I would not dare suggest who any of you should vote for but I hope you use your vote for change and reform and not more of the same.
“To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.”
The words of Sir William Osler, the acclaimed father of modern medicine, are still no less profound. They hark from an age when medicine still retained a sense of ceremony: an amphitheatre filled to the rafters, the clinicians poised in their white coats and ties, all eyes convergent on their quarry or rather the patient seated before them. Any memory of such scenes live out a vestigial existence in black&white photos or histrionic depictions recalling the rise of modern medicine. To think this is how the tradition of grand rounds proceeded in the not so distant past. Today grand rounds have a more tuitional flavour to them. The Socratic dialogue which reportedly took place has been superseded by the much less appetising PowerPoint presentation. It’s a weekly event marked in the calendar. For the ever-busy junior doctor it at least offers the prospect of a free lunch. I gest, they serve a social as well as an educational function.
On the other hand medical student grand rounds are purely a learning exercise. They are most importantly not a race to find and present the most ‘interesting’ case in the trust because this is usually interpretted as a vanishingly rare condition, which even your ejudicating consultant has never encountered in a lifetime of experience. It falls short of the primary aim: to learn about the patients who you will be seeing as a junior doctor and as the addage goes - common things are common. What will make your grand round interesting, is not the patient you choose but how you choose to present that patient.
Unfortunately, as fair a point Sir Osler makes, the old practice of patient participation in grand rounds has long since faded. You will have to call upon your thespian talents to retell the story to your fellow students. Of course not everyone’s a natural showman, however fortune favours the prepared and in my experience there are only a handful of things to worry about.
Structure. This is the back bone of your presentation. Obviously a solid introductory line about the patient with all the salient points goes without saying, it’s no different to presenting to the consultant on ward rounds or in the clinic. Always set the scene. If you clerked your patient on a hectic night oncall down in majors, then say so. It makes the case less one dimensional. The history is your chance to show off - to consider the presenting complaint expressed in the patient’s own words and to form a working differential, which you can encourage your colleagues to reel off at the outset. The quality of the history should guide your audience to the right diagnosis. Equip them with all the information they need, so not just the positive findings. Showing that you have ruled out important red flag symptoms or signs will illustrate good detective work on your part. However you wish to order the relevant past medical/family history, medications, social impact etc is up to you. It’s a subjective thing, you just have to play the game and cater to the consultant’s likes. You can only gage these after a few cases so do the honourable thing and let your colleagues present first.
Performance. Never read your slides in front of an audience. Their attention will rapidly wane (especially if they’re postprandial). The slides are an aide-memoire and to treat them as a script is to admit your presence adds nothing more to your presentation. Communicating with the audience requires you to present uncluttered slides, expanding on short headings and obliging your colleagues to listen for the little nuggets of clinical knowledge you have so generously lain in store.
Insight. When the consultant asks you the significance of an investigation, always know on what grounds it was ordered and the limitations of the results. The astute student will be aware of its diagnostic or prognostic potential.The same may be said of imaging. Perusing the radiologists report and using it to guide the audience through (anoynmised) CXRs, CTs, US etc is a feather in your cap. Literature reviews of your choosing constitute a mandatory part of the presentation. They are demonstrative of not only your wider reading but your initiative to find the relevant evidence base e.g. the research underlying the management plan of a condition or perhaps its future treatments.
Timing. Waffling is only detrimental to the performance. Rehearsing the presentation with a firm mate is a sure way to keep to time constraints.
Memorability, for the right reasons, relies on a concise and interactive presentation. A splash of imagination will not go unnoticed. The consultant marking you has seen it all before; surprising titbits of knowledge or amusing quirks in your presentation will hopefully appeal to their curious and humorous side. If anything it might break the tedium grand rounds are renown for. Oratory is a universal skill and is responsible for so much (undue) anxiety. The more timid can take comfort grand rounds aren’t quite the grand occasions they used to be.
Illustrator Edward Wong
This blog post is a reproduction of an article published in the Medical Student Newspaper, December 2013 issue.
The best doctors in the world still have bad consultation. Sometimes you just start off on the wrong foot. The patient leaving in a floor of tears is usually an indication that this has just occurred. On one of my medical placements I witnessed one such consultation.
A young woman in the early stages of her pregnancy had a per vaginal bleed and wanted a scan to see if the pregnancy was still ok. Medically speaking, a scan wasn’t indicated as the pregnancy was too early on to detect any changes. The doctors noted the “agenda” as they later remarked, and was not going to “play the game” and send the young woman for a scan. She was not happy about this.
The doctor felt that he couldn’t have done more. Medically there was nothing he could offer to the woman other than advice to go home and wait a little while before repeating a pregnancy test.
To me, there was lots that could have been done. This woman was scared and worried and a sympathetic ear and a tissue would have gone some way to making her feel better. The doctor I was with couldn’t see this. They were blind sighted by the repeated requests for a scan and slightly frustrated that the unhelpfulness of this was not being understood.
When the young woman began to cry I was waiting for the doctor to hand over a tissue. “Any second now...” I thought, but it never happened. I wanted to give the woman a tissue and put my arm around her but that would have meant physically placing myself between the doctor and the patients and interrupting a consultation I wasn’t really a part of.
But the truth is. I was a part of that consultation. I might not have been the doctor in charge but I was another person in that room who could have made that situation easier for that patient and I didn’t.
Hours later, on my way home, I was still thinking about this. I felt I had let that woman down. I could see what she needed and I sat there and did nothing. After the consultation I immediately told the doctor what I thought. I felt that the patient had been let down. They took on what I said and mostly agreed with it. All egos were put aside in that frank conversation and the doctor genuinely reflected on how they could have done better in that situation. It wasn’t about me or the doctor. It was about the patient.
As a medical student it is easy to feel in the way in the hospital environment or in a busy clinic. When the consultant is running behind, it takes a lot to ask the patients something or butt in and add something you think is relevant that in the end may turn out to be a very trivial thing. But at the end of the day, it is worth it if it means that there is a better out come for the patient because when all is said and done they are the ones we are doing this all for. I regret not handing that patient a tissue and it’s a mistake I hope never to repeat again.
By Genevieve Yates
One reason why I chose to do medicine was that I didn’t always trust doctors – another being access to an endless supply of jelly beans. My mistrust stemmed from my family’s unfortunate collection of medical misadventures: Grandpa’s misdiagnosed and ultimately fatal cryptococcal meningitis, my brother’s missed L4/L5 fracture, Dad’s iatrogenic brachial plexus injury and the stuffing-up of my radius and ulna fractures, to name a few.
I had this naïve idea that my becoming a doctor would allow me to be more in charge of the health of myself and my family. When I discovered that doctors were actively discouraged from treating themselves, their loved ones and their mothers-in-law, and that a medical degree did not come with a lifetime supply of free jelly beans, I felt cheated. I got over the jelly bean disappointment quickly – after all, the allure of artificially coloured and flavoured gelatinous sugar lumps was far less strong at age 25 than it was at age 5 – but the Medical Board’s position regarding self-treatment took a lot longer to swallow.
Over the years I’ve come to understand why guidelines exist regarding treating oneself and one’s family, as well as close colleagues, staff and friends. Lack of objectivity is not the only problem. Often these types of consults occur in informal settings and do not involve adequate history taking, examination or note-making. They can start innocently enough but have the potential to run into serious ethical and legal minefields. I’ve come to realise that, like having an affair with your boss or lending your unreliable friend thousands of dollars to buy a car, treating family, friends and staff is a pitfall best avoided.
Although we’ve all heard that “A physician who heals himself has an idiot for a doctor and a fool for a patient”, large numbers of us still self-treat. I recently conducted a self-care session with about thirty very experienced GP supervisors whose average age was around fifty. When asked for a show of hands as to how many had his/her own doctor, about half the group confidently raised their hands. I then asked these to lower their hands if their nominated doctor was a spouse, parent, practice partner or themselves. At least half the hands went down. When asked if they’d seek medical attention if they were significantly unwell, several of the remainder said, “I don’t get sick,” and one said, “Of course I’d see a doctor – I’d look in the mirror.”
Us girls are a bit more likely to seek medical assistance than the blokes (after all, it is pretty difficult to do your own PAP smear – believe me, I’ve tried), but neither gender group can be held up as a shining example of responsible, compliant patients. It seems very much a case of “Do as I say, not do as I do”. I wonder how much of this is due to the rigorous “breed ’em tough” campaigns we’ve been endured from the earliest days of our medical careers. I recall when one of my fellow interns asked to finish her DEM shift twenty minutes early so that she could go to the doctor. Her supervising senior registrar refused her request and told her, “Routine appointments need to be made outside shift hours. If you are sick enough to be off work, you should be here as a patient.” My friend explained that this was neither routine, nor a life-threatening emergency, but that she thought she had a urinary tract infection. She was instructed to cancel her appointment, dipstick her own urine, take some antibiotics out of the DEM supply cupboard and get back to work. “You’re a doctor now; get your priorities right and start acting like one” was the parting message.
Through my work in medical education, I’ve had the opportunity to talk to several groups of junior doctors about self-care issues and the reasons for imposing boundaries on whom they treat, hopefully encouraging to them to establish good habits while they are young and impressionable. I try to practise what I preach: I see my doctor semi-regularly and have a I’d-like-to-help-you-but-I’m-not-in-a-position-to-do-so mantra down pat. I’ve used this speech many times to my advantage, such as when I’ve been asked to look at great-aunt Betty’s ulcerated toe at the family Christmas get-together, and to write a medical certificate and antibiotic script for a whingey boyfriend with a man-cold.
The message is usually understood but the reasons behind it aren’t always so. My niece once announced knowledgably, “Doctors don’t treat family because it’s too hard to make them pay the proper fee.” This young lady wants to be a doctor when she grows up, but must have different reasons than I did at her age. She doesn’t even like jelly beans!
Genevieve Yates is an Australian GP, medical educator, medico-legal presenter and writer. You can read more of her work at http://genevieveyates.com/
So you're sitting in a bus when you see a baby smile sunnily and gurgle at his mother. Your automatic response? You smile too. You're jogging in the park, when you see a guy trip over his shoelaces and fall while running. Your knee jerk reaction? You wince. Even though you're completely fine and unscathed yourself. Or, to give a more dramatic example; you're watching Titanic for the umpteenth time and as you witness Jack and Rose's final moments together, you automatically reach for a tissue and wipe your tears in whole hearted sympathy ( and maybe blow your nose loudly, if you're an unattractive crier like yours truly).
And here the question arises- why? Why do we experience the above mentioned responses to situations that have nothing to do with us directly? As mere passive observers, what makes us respond at gut level to someone else's happiness or pain, delight or excitement, disgust or fear? In other words, where is this instinctive response to other people's feelings and actions that we call empathy coming from?
Science believes it may have discovered the answer- mirror neurons.
In the early 1990s, a group of scientists (I won't bore you with the details of who, when and where) were performing experiments on a bunch of macaque monkeys, using electrodes attached to their brains. Quite by accident, it was discovered that when the monkey saw a scientist holding up a peanut, it fired off the same motor neurons in its brain that would fire when the monkey held up a peanut itself. And that wasn't all. Interestingly, they also found that these motor neurons were very specific in their actions. A mirror neuron that fired when the monkey grasped a peanut would also fire only when the experimenter grasped a peanut, while a neuron that fired when the monkey put a peanut in its mouth would also fire only when the experimenter put a peanut in his own mouth. These motor neurons came to be dubbed as 'mirror neurons'.
It was a small leap from monkeys to humans. And with the discovery of a similar, if not identical mirror neuron system in humans, the studies, hypotheses and theories continue to build. The strange thing is that mirror neurons seem specially designed to respond to actions with clear goals- whether these actions reach us through sight, sound, smell etc, it doesn't matter. A quick example- the same mirror neurons will fire when we hop on one leg, see someone hopping, hear someone hopping or hear or read the word 'hop'. But they will NOT respond to meaningless gestures, random or pointless sounds etc. Instead they may well be understanding the intentions behind the related action. This has led to a very important hypothesis- the 'action understanding' ability of mirror neurons.
Before the discovery of mirror neurons, scientists believed our ability to understand each other, to interpret and respond to another's feeling or actions was the result of a logical thought process and deduction. However, if this 'action understanding' hypothesis is proved right, then it would mean that we respond to each other by feeling, instead of thinking. For instance, if someone smiles at you, it automatically fires up your mirror neurons for smiling. They 'understand the action' and induce the same sensation within you that is associated with smiling. You don't have to think about what the other person intends by this gesture. Your smile flows thoughtlessly and effortlessly in return.
Which brings us to yet another important curve- if mirror neurons are helping us to decode facial expressions and actions, then it stands to reason that those gifted people who are better at such complex social interpretations must be having a more active mirror neuron system.(Imagine your mom's strained smile coupled with the glint in her eye after you've just thrown a temper tantrum in front of a roomful of people...it promises dire retribution my friends. Trust me.)
Then does this mean that people suffering from disorders such as autism (where social interactions are difficult) have a dysfunctional or less than perfect mirror neuron system in some way?
Some scientists believe it to be so. They call it the 'broken mirror hypothesis', where they claim that malfunctioning mirror neurons may be responsible for an autistic individual's inability to understand the intention behind other people's gestures or expressions. Such people may be able to correctly identify an emotion on someone's face, but they wouldn't understand it's significance. From observing other people, they don't know what it feels like to be sad, angry, surprised or scared.
However, the jury is still out on this one folks. The broken mirror hypothesis has been questioned by others who are still skeptical about the very existence of these wonder neurons, or just how it is that these neurons alone suffered such a developmental hit when the rest of the autistic brain is working just dandy? Other scientists argue that while mirror neurons may help your brain to understand a concept, they may not necessarily ENCODE that concept. For instance, babies understand the meaning behind many actions without having the motor ability to perform them. If this is true, then an autistic person's mirror neurons are perfectly fine...they were just never responsible for his lack of empathy in the first place.
Slightly confused? Curious to find out more about these wunderkinds of the human brain? Join the club. Whether you're an passionate believer in these little fellas with their seemingly magical properties or still skeptical, let me add to your growing interest with one parting shot- since imitation appears to be the primary function of mirror neurons, they might well be partly responsible for our cultural evolution! How, you ask? Well, since culture is passed down from one generation to another through sharing, observation followed by imitation, these neurons are at the forefront of our lifelong learning from those around us. Research has found that mirror neurons kick in at birth, with infants just a few minutes old sticking their tongues out at adults doing the same thing.
So do these mirror neurons embody our humanity? Are they responsible for our ability to put ourselves in another person's shoes, to empathize and communicate our fellow human beings? That has yet to be determined. But after decades of research, one thing is for sure-these strange cells haven't yet ceased to amaze and we definitely haven't seen the last of them. To quote Alice in Wonderland, the tale keeps getting "curiouser and curiouser"!
Walking into a cubicle, introducing myself and acquiring a patient's permission to ask them a few questions about what brought them into hospital and then to examine them. Sounds simple enough, until you're in A&E, the patient is seriously ill and you're the first person to see them.
I learned the hard way this week, spending an hour with a patient only to realise that they were so confused (in the medical - not the academically challenged - sense) that the history that I had taken was essentially null & void. It was to be their partner and carer who would provide me with the history that would allow qualified members of the healthcare profession to attempt to make their loved one better.
Lesson 1. Sometimes the patient isn't the best person to tell you what's wrong with them.
Lesson 2. Sometimes they are.
On the flip side, some patients LOVE a good chinwag! They'll tell you everything about their health, family and day-to-day life without a moments pause. And it takes some guts to interrupt them mid-flow.. Despite the obvious time constraints, these are my favourite interactions. I often wonder how I find myself in such an honourable position. Why do people feel they can share so much of their life story with me? Some laugh, some cry, others just want to vent their frustrations. Either way I'm there, I'm listening, and most importantly I'm learning.
Written by Chantal Cox-George,
3rd Year Med Student at University of Bristol