Archive for the 'Medical Careers' Category
November 9th, 2011
The average medical student debt on graduation has risen from £23,909 to £24,092, the British Medical Association (BMA) reports.
Photo by upsuportsmouthPoorer medical students’ debts have also soared. Those from low-income backgrounds graduate over £13,000 more in debt than better off students – graduating with a projected debt of £37,588 (up from £26,324 in the past 12 months).
The survey from the BMA also reports that the number of medical students from the lowest income brackets is in decline over the past 12 months.
Co-chairwoman of the BMA Medical Student Committee Elly Pilavachi said:
“Medical students are now facing extremely high levels of graduation debt. Many are clearly heavily dependent on financial support from their families and friends to get through the intensive, five to six-year medical course. However, the picture for those from low-income backgrounds is particularly alarming with their debt levels a staggering £13,000 higher than those from higher income brackets.”
Clearly there is a lot to think about if you are planning on becoming a medical student, or already are one. What do you think about the current financial plight of med students?
October 26th, 2011
Good doctors are good communicators – it’s that simple.
The more traditional “communication skills” teaching has focused on the doctor–patient relationship, yet communication between colleagues in hospital and primary care settings is equally important.
Photo by Skype NomadMPS’s experience over many years is that some of the biggest mistakes in hospitals are the result of poor communication. Although there are often many factors leading to adverse outcomes, it is undoubtedly the case that poor communication and handover can result in inappropriate prescriptions, incorrect diagnoses and patients lost to follow-up. These have clear potential for patient harm, and an associated impact on the team arising from complaints, claims and disciplinary investigations.
Developing both your teamwork and communication skills at medical school will stand you in good stead as a doctor. The GMC emphasises this in its guidance, Medical Students: Professional Values and Fitness to Practise, stating that: “Medical students need to be able to work effectively with colleagues inside and outside of healthcare in order to deliver a high standard of care and to ensure patient safety.”
Communicating well in a team demands more than merely listening and passing on messages. Doctors must work within their competence, seeking advice and assistance from senior clinical colleagues where appropriate.
On occasion, doctors may need to act to protect patients from potential harm caused by inadequate systems or procedures, or as a result of a colleague’s behaviour, performance or health. MPS recognises that this is never an easy decision. If you need advice on the appropriate action to take, you should usually raise this with your educational supervisor and you can always access expert medicolegal advice via MPS’s helpline.
Survival tips for good communication
- You may feel as if you are at the bottom of a long chain – but in fact you are part of a wide communication network within primary and secondary care, including the voluntary and social sectors. Try to think about your individual role – what information should you convey to assist in protecting the patient’s health?
- As a student, the GMC expects you to demonstrate that you are developing teamwork and leadership skills. Be willing to work as a team and take on appropriate responsibility.
- However, never work outside your competence. If in doubt, always ask.
- If you are concerned about a fellow student, colleague or other health worker, raise your concerns with the appropriate person – this is usually your educational supervisor, consultant or GP trainer.
September 18th, 2011
What’s that coming over the hill – it’s a night shift!!
The first night shift stalks you, you see it coming from a distance, creeping closer along the rota and suddenly it’s the weekend before your first shift. Monday to Thursday night, 4 days, and then a day off. How hard can it be?
Honestly, it can be anything from a breeze to a true beat down. That will largely depend on where in the hospital you are covering – Medical ward cover, Surgical Admissions and Ward Cover or A&E. All have their benefits – ok, maybe Medical ward cover doesn’t!
Photo by icatusAs an F1, I found A&E the best place to do the night shift. Please note I didn’t say it was the easiest, nor did I enjoy it, but it is certainly the BEST place to do a night shift. Yes I was SHATTERED by the time morning came around, but I had been SUPPORTED through the night.
In A&E, whenever there is a problem, you can lean over; have a quick chat to a senior, get some advice or reassurance and carry on. The work is constant, but it’s varied and you stand a good chance of learning, and learning a lot if you’re lucky.
Note again, I’ve not actually said it’s hard. Yes you are doing a 12 hour shift, and that is always tiring, however the work is pure back to basics medicine, even down to the opening line “Hello what’s brought you to A&E tonight?” Ok to be fair, that line is not quite what I’d call chirpy at 3am, but still.
In terms of surviving the night shift, I’d advise yet again, make sure you have plenty of food, but there is something that I’m not going to advise, but might give a health warning to, Caffine.
In my experience it doesn’t work. Well not how I’d hoped anyway.
My first night shift, I’d not been able to sleep during the day, which made for a very difficult second half of a shift. 4am had rolled round and I was monumentally tired. Even my eyelids feel tired. But I’d come prepared, or so I thought. Two cans of RedBull, to see me through the night. The work load lessened, and I look towards my caffeinated saviour.
I downed a can, 30mins later, I’m still feeling dead on my feet, no effect, second can, no effect, and then it started. I began to feel very unsettled and agitated. Not a pleasant feeling, but the worst part – I was still half asleep, but now the half of me that was wake felt terrible! So remember, caffine isn’t always the answer.
Plus A&E also has a fantastic sense of camaraderie that’s hard to fault, as everyone fights/works through the night together. To put it simply, even from someone who doesn’t want to have a career in A&E, it is a very unique place in the hospital, and if you approach your night shift with the right approach, you’ll do final – especially if you’ve worked out how to use blackout curtains and sleeping pills to help you sleep through the bright summer days!
Our guest blogger James Gill is an F1 doctor writing about his personal experiences of starting out on the wards as an F1.
September 1st, 2011
Our guest blogger James Gill is an F1 doctor. In this series, he writes about his personal experiences of that very special time starting out on the wards as an F1.
F1 is luck of the draw – F2 is up to you!
By now, three weeks into the job it seems that most of our F1’s, whilst they may not have found their feet completely per se, have managed to work out the various tricks in order to survive, and most importantly serve the particular whims of their consultant.
Photo by barelyanythingAlthough in my experience, and my brief presentation to the new surgical F1’s yesterday, when I say working out the tricks to survive… what I mean is how best to divide their time between making sure that Mr Philips, their one and only patient, has had enough paracetamol to cover his headache whilst he waits for his op, and more importantly how to switch on the TV in the mess.
The surgical F1 jobs in the hospital can be really mixed bags, and it entirely depends on your consultant. One surgeon will micro manage his patients down to individual drug doses, whilst another will be content to NEVER STEP ON THE WARD, only interacting with patients when they are under anaesthetic. The point of this being that as a surgical F1 you need to address how best to use your time.
The Firm system is still in place for surgical teams and that gives the week to week ward work a different pace to medicine. In surgery you can be snowed under with patients and jobs one week, but until your surgeon is “On Take” next, every patient who is discharged is off your list and won’t be replaced. Thus its quite feasible you may end shortly before the next “On Take” of having only one remaining patient to look after – USE THIS TIME!
Surgeons love an audience, if it is your thing use the time you have when the wards are quieter to get into theatre, ask can you assist, of if an exceptionally complex op, just ask to observe, its unlikely they’ll say no. Talk to your consultant as a human being (they might not be, but give it a try) there will always be opportunities, whether it’s getting in on a paper, or helping with a simple audit, but you’ll have to go hunting for them.
Your surgery rotation is a great time to plump up your ePortfolio
Now I’ve banged on about this hellish piece of electronic dictat before but it does have its uses. You might find yourself loath with an unearthly contempt your present job, be that colorectal surgery, respiratory or dermatology. If so your ePortfolio is your golden ticket out.
If you get enough bells and whistles hanging off this electronic annoyance you will be able to have your picks of the jobs for F2, and I cannot emphasise this enough. As a medical student, when you selected your jobs, you chose things you thought might be interesting, or that you might possibly want to have a career in.
Now you know the reality of those jobs good or bad. A well filled ePortfolio is your ticket out of your personal Hell onto the ward you wish you were working on – Remember a bad job on F1 is the luck of the draw, getting the best job for you and your career is entirely down to that electronic hoop jump, so learn how to make it work for you, and grasp whatever extra time you have.
Finally take heart, its payday next week – but more on that later!
August 23rd, 2011
Photo by Special Collections
Writing reports shouldn’t be a daunting task, says MPS Claims Manager Hilary Steele. Here is everything you need to know.
At some stage in your career, you are likely to be required to write a report following an adverse incident. An incident can be investigated in many different ways. For example, as a complaint, a clinical negligence claim, a criminal case, a disciplinary matter by an employer with referral to the GMC, a coroner’s inquest (England and Wales) or fatal accident inquiry (Scotland).
Your written report may be the starting point of an investigation into the circumstances leading to or surrounding an incident. This article sets out how to provide a detailed, clear and objective report.
Circumstances when a report may be required
You may be required to provide a report:
- for your employer as part of an internal investigation
- for a solicitor
- for the police
- for the procurator fiscal (Scotland) investigating either a criminal matter or death, which might result in a fatal accident inquiry
- for the Crown Prosecution Service (England and Wales)
- for the coroner (England and Wales)
- for the patient’s employer or insurer.
Disclosure of information – are you authorised to disclose this data?
While it is tempting to discuss an incident with your colleagues, even those of the strongest character will be influenced by the views of others.
The first point to consider is whether you are authorised to disclose the data being requested. Disclosure of personal data is subject to the Data Protection Act 1998. The legislation applies regardless of age, format or origin of the information. It covers files, letters, databases, reports, photographs, etc. A report will, more often than not, involve the disclosure of confidential information about a patient.
Before disclosing information you must be satisfied that you have the necessary authority to do so; for example:
- you have obtained the patient’s consent – check they are clear about the extent of the disclosure
- you believe it is in the wider public interest (for example, assisting the police in preventing or resolving a crime)
- the disclosure is required by law (statutory obligation or to comply with a court order).
Fact vs opinion
It is likely that you will be asked to provide a statement of fact, ie, giving your account of events leading up to and including the incident. This is not an opportune time to criticise your colleagues. You should only report the facts as you know them. If, however, you are asked to give an opinion, you must only comment within your area of expertise.
Basis of your report
Your report should be based on:
- your own recollection of events
- the medical records
- your usual practice.
Honesty is the best policy
You must write your report honestly and take all possible steps to ensure that you are not influenced by anyone else. It is therefore important to write your report as soon as possible after the event, while the incident is still fresh in your mind, and ensure that you only include details of events in which you were personally involved. If the report is required because of a complaint or claim, make sure that you have seen:
- A copy of any correspondence detailing the allegations surrounding the complaint or claim
- Details of any court proceedings before writing your report.
What should your report include?
- Your personal details. Include your full name, date of birth, address and contact details, graduating university, qualifications and relevant clinical experience.
- Relevant local factors. If, for example, your hospital is on two sites and this has affected time taken to get to the incident, or if the incident has occurred in an environment where it has been difficult to assess and treat the patient, for example a police cell.
- Details of other healthcare professionals involved. Where possible, include your colleagues’ full names and discipline, eg, staff nurse X, the nurse in charge, and Dr Y, lead consultant.
- The patient’s details. Name, date of birth and age
- When recording the patient’s presentation, include the following:
- Dates and, where possible, times using a 24-hour clock.
- Findings on examination and other relevant factors – if the patient was very difficult to examine because he was agitated and aggressive, provide details of how that behaviour was exhibited, eg, “The patient was lying on the trolley and attempting to punch and kick staff nurse X and me. He shouted: ‘I’m going to come back at the end of your shift and kill you’.”
- Diagnosis and whether a differential diagnosis was considered.
- Investigations and subsequent management, including dates.
- Follow-up arrangements and information given to the patient and relatives.
- Other relevant facts. Your opinion is only relevant if the person requesting the report specifically asks for you to provide an opinion. You must not comment on behalf of others. You can, however, include statements made by your colleagues such as “Dr Y said….”
Providing a good impression
- When drafting your report, it is important to consider who will be reading it and tailor it accordingly. However, a good rule of thumb is to address the report to an intelligent lay person.
- Write your report in the first person singular: “I did this….”
- It is advisable to avoid the use of abbreviations and jargon. If you do use them, use only approved abbreviations.
- Bear in mind that the patient or their relatives are likely to see the report and, therefore, you should avoid personal remarks. A flippant remark might be the deciding factor in persuading a judge that you did not take a professional clinical approach to the care of the patient.
- Ensure that your use of medical terminology is correct. Inaccurate terminology, such as describing a surgical wound as a laceration, might have serious consequences for the outcome of a criminal trial.
- Check spelling, punctuation and grammar before submitting your report. A sloppy report may reflect badly on your clinical practice.
- Your report should be typed, signed and dated.
- Keep a copy of the report in your notes and a note of how, when and to whom you submitted it.
Changing your report
It may be necessary for you to provide a supplementary report to deal with issues that come to light after you have written your original report. Before commenting on these issues, review your original report, the medical records and any new documentation.
A second opinion
Finally, you should strongly consider showing your report to MPS before submitting it.
Hilary is a solicitor based at the MPS Edinburgh office. If you need urgent medicolegal advice, or help with writing a report, MPS has a 24-hour medicolegal helpline that is available to all its members. Become a student member for free