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So you have finished uni, you’re fully qualified as a Junior Doctor and you’ve managed to land a job after an intensive application process. What next? Do you sit back on your laurels and enjoy that salary? Or do you take the plunge and jump onto the first rung of the property ladder?
Life is hard for a first-time buyer, now more than ever. There are fewer high loan-to-value mortgages than back in the glory days pre-2007 and after prompting from the Financial Services Agency, banks are reeling in on interest-only mortgages, which were a lifeline to first-time buyers.
It is going to be a while before you save for a deposit, what with paying back your student loan and saying goodbye to student discounts and benefits. However, once you have a few thousand in the bank you then need to find a mortgage you can actually afford.
Many potential borrowers get excited when they calculate how much they could actually borrow. The rate is usually four times your salary, so with an average doctor’s starting salary being around £33,000 or so, you could borrow £132,000. But, and there are some buts, what you can actually afford to pay back and what you can borrow quite often differ.
Say you want to borrow £120,000, if you can muster up a 10% deposit and opt for a three-year fixed rate deal over a 25-year term, you are looking at paying back £772.43 per month. And, seeing as the average UK house price is £205,598, this £120,000 figure is miles below this price.
Getting an affordable mortgage is therefore rather tricky. So what do you do? Well the best advice is to save as big a deposit as possible. Bigger deposits mean less risk for the bank and this results in a better rate for you, and opens you up to better mortgage deals.
You can also look at paying over a longer term as this will work to reduce your rate. But some banks are rather restrictive over this, so you need to fully investigate what each mortgage offers and thoroughly read the small print.
Before going to your bank, make use of online calculators such as the mortgage calculator from Santander. There are also repayments calculators so you can see how much you can borrow and how much you will have to pay back each month. Once you have found the right balance, only then can you approach your bank.
And if you do decide to get a mortgage, right now could be time to lock in a fixed-rate deal. OK – so for the past few months and for probably the next couple of months a tracker mortgage will come out as more cost effective, but the interest rate isn’t likely to get any lower, and with fixed-rate deals at their lowest levels right now, it makes sense to secure these rates for the next two to five years.
One topic that continually crops up in medical student questions is clinical cases exam technique, and issues that can revolve around it. For this reason we have produced a list of the most important things you need to know.
This is based on common errors in exam/ OSCE techniques that crop up in medical examinations from our experience.
Here are the first 5 tips for preparing for your verbal examinations, the next follow soon.
Let’s consider the following features and clinical examination…
A 36 year old male gives the following history:
“I’ve been getting hot for the last 6 weeks, on and off and have been off my dinner, pretty much all the time. I’ve been generally not right, tired and that. I’ve started to get a bit breathless too, not coughing and the like, but still having problems when I’m out. Bad like. Gets worse when I have a fever. Like I’ve had a friend who had the same thing about 3 years ago and he had really bad lung fibrosis, because of infections during his childhood. Not like me and that I’ve always been well. I have still got problems injecting the drugs and that, but like my key worker, she says that me methodone will help me deal with that kind of problem, so form that side I’m pretty happy.
Your Examination Findings are:
Hands Normal.
Pulse 80.
No Signs in the face.
BP 182/92 Pan systolic murmur left sternal edge.
Otherwise NAD.
Tip 1. Look professional
Dress smartly and conservatively, in accordance with the accepted policy for dress and infection control. We think this means, white shirts (ironed!), smart black shoes, trousers or dress.
Tip 2. Organise your presenting posture to minimise nerves
This is it. Hands behind your back. Head up. Speak clearly and decisively. By organising your posture fidgeting with your hands (common in stressful situations) will not be possible. Standing with an open posture (feet apart, slightly out turned) is a common technique used in business, and will help you present in an organised fashion.
Tip 3. Structure your presentation of medical terminology
This needs to be structured in the same was that you elicited the clinical case history. PC, HPC PMHx, for example:
Mr X is a 36 year old male with a background of intravenous substance use, who presents with a 6 week history of malaise, retired office worker presents with a three week history malaise, night sweats, dyspnoea and anorexia…
Note the use of medical terminology to describe symptoms. This is not the same as describing clinical signs in the history, which you should not do!
Tip 4. Interpret as you go
Don’t be afraid to explain your interpretations of the clinical cases as you assess the situation. For example with history: “The history importantly raises concerns: substance misuse (introducing a blood borne infection, other viral infections and T cell Disorders transmitted by IV drug use), symptoms that suggest a systemic illness/ infection (fevers, malaise, anorexia) that would have a wide differential based on this information that would include….”
Tip 5. Learn to summarise in one sentence
Floundering, being vague, or summarising in a small essay just won’t do. Be clear and to the point – for example “36 year old male, current problem of intravenous substance misuse with 6 weeks of symptoms that include anorexia night sweats and general malaise.”
We hope this helps some of you student doctors in preparing for your OSCEs…. view the final 5 tips here!
A medical student is practising for her OSCE exams on the ward…
She examines a 19 year old female patient admitted with asthma on the medical assessment ward for revision purposes.
The patient has a past medical history she has the occasional migraine, and eczema.
The observations are as follows.
BP 128/70
Pulse 98 regular
Fingerprick blood glucose 8.3
Oxygen Sats 97% on Air
She performs a cardiovascular and opthalmological examination.
Cardiovascular examination: Split S2 (second heart sound) on deep inspiration.
Ophthalmology examination: Normal Eye movements. Pupils 6mm and reactive to light. Eye movements normal. Visual fields normal. No scotoma. Fundoscopy examination of one eye is shown below…
Do you get this good a view when performing fundoscopy? Of course not, this is a digital retinal photograph-remember when you are using a hand held opthalmoscope you only get to view a bit of this at a time, which is why its important you should know which eye this is!
Why not have a go at the questions below? We’ll put up the answers in a couple of days…
Interviews are all about preparation -- thinking about what questions you may be asked and making sure you have some positive points as a response.
But what about when you are asked to expose your weaknesses?
When posed the question “Please can you tell me your weaknesses or flaws” think about this in a positive manner.
Explain your weaknesses as strengths to maximise the return on the interview you are having.
You shouldnt mislead or lie to interviewers but if you strategically prepare your responses as explained in this video it will assist in getting the maximum from an interview situation.
A 64 year old man presents with a history of weakness and fatigue. He has lost 3 stone in weight. On systemic enquiry, he has no other clinical symptoms, other than a mild dry cough which he has had for 3 days and some occasional dysuria, present intermittently for 6 months. His examination findings are as follows:
No Jaundice , anaemia, cyanosis, jaundice or lymphadenopathy
noted rash under both eyelids.
BP 134/66
Pulse 78 regular
Sats 98% air
BM 4.5 mmol/l RR 16
Normal Cardiovascular Respiratory Gastrointestinal examination.
Neurology as follows:
Grade 4 power upper and lower limbs symmetrically.
Normal sensory examination.
Normal reflexes.
No clonus
No fatigability
Where is the likely pathology?
Central Brain Lesion
Brainstem Lesion
Cord Lesion
Peripheral Nerve
Neuromuscular Junction
Acetylcholimesterase enzyme problem
Muscle lesion
None of the above
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