Article Responses: November 2002

Articles	Responses
LIFE Medical students and their faith - being a Muslim medic Samena Chaudhary (October 2002) [full text...]	Siti Zufina Abd Samah (October 19 , 2002) Read this response

NEWS Woman of 46 wins place to study medicine Helen Barratt (October 2002) [full text...]	Yoav Tzabar (October 21 , 2002) Read this response Malcolm Rutledge (October 21 , 2002) Read this response

LETTERS Do university league tables grade fairly? Nirav Patel (October 2002) [full text...]	Jamie Nash (October 22 , 2002) Read this response

LETTERS Healthcare assistants should call themselves nurses Mark Young (November 2002) [full text...]	Trudy Hurd (October 22 , 2002) Read this response

LIFE Medical students and their faith-all articles. by Zoe Apple, Suminta Kini, Samena Chaudhry and Helen Barratt (October 2002) [full text...]	Nieves Martin Espildora (October 22 , 2002) Read this response

REVIEWS Doing research in Boston, USA by Aneil Malhotra (October 2002) [full text...]	Layla McCay (October 26 , 2002) Read this response

NEWS Television company wants terminally ill patient to plastinate Anja Weidmann (November 2002) [full text...]	Andrew Dekker (October 29 , 2002) Read this response

EDUCATION How to write a good essay...and win prizes Sabina Dosani (November 2002) [full text...]	wasiq (November 02 , 2002) Read this response

NEWS Graduate students are more challenging, demanding, and questioning Peter McCrorie (November 2002) [full text...]	Mark Salmon (November 04 , 2002) Read this response Steve Hornby (November 17 , 2002) Read this response

EDITORIALS A case of mistaken muscles Hashim Uddin Ahmed & Sarah Ali (July 2002) [full text...]	Rakesh Biswas (November 04 , 2002) Read this response

LETTERS Healthcare assistants should call themselves nurses Mark Young (November 2002) [full text...]	Stephen J. Goldie (November 04 , 2002) Read this response

NEWS How do you make a good doctor? Peter McCrorie, Dr Allan Cumming, Mike Shooter, John Tooke (November 2002) [full text...]	Abi Coleman (November 13 , 2002) Read this response

LETTERS Increased student numbers need enlarged facilities Aneel Bhangu (August 2002) [full text...]	Aneel Bhangu (November 13 , 2002) Read this response

LIFE India: sights, sounds and smells Amlan Basu (August 2002) [full text...]	Maulik (November 16 , 2002) Read this response

LIFE
Medical students and their faith - being a Muslim medic
Samena Chaudhary (October 2002) [full text...]

Siti Zufina Abd Samah (October 17, 2002)
Shadow houseman / semester 10, final year medical student, International Medical University zufina@hotmail.com

I completely agree with the view of the author and the author of the rapid response that being a Muslim does affect the way you practice medicine. Being a Muslim means that you should be accountable to all of your actions because at the end, you are going to answer to God The Almighty at the judgement day about what you did.

Despite the ethics that the medical world preached to us, that medical professionals should be non-judgemental about various issues, namely out of wedlock pregnancy, intravenous drug users and euthanasia, the Muslim doctors should always remember that they are not there just to heal the patients physically. Muslim doctors should also attempt to heal the soul or the "inside" of the patients, more so if they are dealing with patients of the same religion. Undoubtedly, patients often feel close to their doctors and I believe that if the patient seemed receptive, a little advice to heal the soul would not be ethically wrong.

Hence, I believe that Muslim doctors should also have strong foundations in their religion, not only regarding Islamic views on controversial medical issues, also regarding Islam and what it is as a whole. The downfall of Islam today is because the believers do not embrace Islam the way they did in the past. It is not just the duty of the "ustaz" or the religious teachers to help the community to understand Islam, it is everybody's duty.

	NEWS Woman of 46 wins place to study medicine Samena Chaudhary (October 2002) [full text...]
	Yoav Tzabar (October 21, 2002) Consultant Anaesthetist, Carlisle yoav@tzabar.org
	Good luck to her, but frankly, by the time she qualifies, does house jobs etc, she'll be exhausted - I'm 42 and have been a consultant for 5 years and I'm knackered, on-call just kills me. If she has any sense, once she survives house jobs, she should go into a non-clinical speciality.

	NEWS Woman of 46 wins place to study medicine Helen Barratt (October 2002) [full text...]
	Malcolm Rutledge (October 21, 2002) PG2, Logan Hospital drdrmal@bigpond.net.au
	The development of 'graduate' medical schools in Australia has seen an increase in mature age students applying successfully for medical school places. Often, what these students lack in longevity (both absolute and in medicine) they often make up for in maturity and dedication. Most, if not all mature age students have sacrificed an often lucretive career in order to enter the profession. Those I have managed to stay in contact with seem to have remained enthusiastic about their change in career direction and to have gained the respect of their seniors. When the Graduate Medical Course commenced at the University of Queensland in 1997, the average age at entry of the initial cohort was 27 (at graduation 31). While I am unsure of the exact distribution of ages, I believe that there were many in their 40's and a few in their 50's, myself included. (I was a few months short of 61 at graduation.) We seem to have managed to match performance with our younger colleagues while enduring the rigors of the hospital internship/resident system with them. The antipithy of some educators and senior members of the profession towards older graduates has largely faded away along with the ageist jokes. On a personal level, my six years in medicine have given me a huge amount of enjoyment and a sense of fulfillment that was completely lacking in retirement.

	LETTERS Do university league tables grade fairly? Nirav Patel (October 2002) [full text...]
	Jamie Nash (October 22, 2002) 4th year Medical Student, UWCM - Cardiff nashj@cf.ac.uk
	I was somewhat amused to read this article especially when the likes of the Times or other broadsheets (see Guardian below) self proclaim their authority on which university is better than others. It has been proved time and time again that such audits are primarily subjective and different criteria are applied to different reviews of teaching. Add to this the fact that so many of the courses in different medical schools, although following the standard medical curriculum, differ wildly in their implementation of such curriculum; for example my colleagues at liverpool university enjoy very early hands on clinical experience with much teaching focussed on PBL. At my medical school however, PBL rears its head a few times on a 3 monthly basis for the first 2 years, with more emphasis on whole body dissection, SSM and didactic teaching. In fact one of my colleagues at one of the London medical schools relishes the fact that she is on a "doss" course (in as much as medicine could! ever be a doss course) with little assessment until her final year and lax rules of attendance. At the following link (http://education.guardian.co.uk/higher/unitable/0,11985,-4420567,00.php?start=10) you can see that Manchester is the top listed university for medicine, Whereas Oxford comes a paltry 8th. Who are we meant to believe? The mention that students who go to Leicester and Cambridge Uni have little hope of obtaining a job compared to for example Dundee I find somewhat suspect, especially given the shortage of doctors in this country. As a last mote - has anyone else had the same pearls of wisdom from SHO's? "six months after you complete your first house job you all know the same stuff anyway"

	LETTERS Healthcare assistants should call themselves nurses Mark Young (November 2002) [full text...]
	Trudy Hurd (October 24, 2002) nursing instructor, Vermont Technical College hurdnet@together.net
	I confront this attitude often in my beginning nursing students. They feel since they have been working on the floor doing all the nurse's 'dirty work' that they are truly the 'real' nurse. Well, they are not-- and will not be until they graduate and pass their boards. We nursing professionals are presently attempting to upgrade our professional reputation. We have be belittled in the medical field for too long and deserve more respect for our professional knowledge and multiple skills. We have our own scope of practice to which we are trained and educated. I am proud to be called a nurse, but feel I have earned that honor through both my hard work on the floor and hard work in the classroom. So, Mark, you are on the right road to becoming one of us-- a professional nurse. (but you are not there yet) Good Luck.

LIFE
Medical students and their faith-all articles. (October 2002)
by Zoe Apple, Suminta Kini, Samena Chaudhry
and Helen Barratt (October 2002) [full text...]

Nieves Martin Espildora (October 24, 2002)
Paediatrician, Primary Care nmarespil@terra.es

I have read with great interest not only the articles about medicine and religion (particularly H. Barrat), but also the responses. I am pleased to meet future colleagues who are able to discuss this subject. I think these topics are in general little debated, nevertheless its importance. We have similar problems in Spain, with a different appearance. Most of us are catholic but many people think is better not being "too much" catholic and, therefore, each person should keep his/her beliefs for oneself. This is not so clearly explained, but it is quite manifested in every day's life. I'd say many things but I can't handle your language up to this point, so I'll tell some of them:

First of all: I can't leave my faith out of my everyday life, as I can't help act as a woman (and probably you'd judge unfair if anyone attempted to prevent me to do it). I think this fact could be damaging only if I'd attempt to enforce my opinions to anybody (but I don't).

I don't think it is necessary having any particular faith to consider abortion as the induced death of a human being (and less if you have studied Embriology...).

I agree with your proposal for enclosing any atheistic/humanistic opinion, because these are really another kind of attitudes. In theory there are important differences between a doctor with a transcendent approach to the life and the illness, and another with a purely material one, but in practice the moral quality of each professional has many other elements through which we reach to respect every person.

Last and more important: I am sure we'd agree in many things about the relation with the patients and the need to be a competent professional, no matter our beliefs of the lack of them.

REVIEWS
Doing research in Boston, USA
by Aneil Malhotra (October 2002) [full text...]

Layla McCay (October 26, 2002)
4th year medical student, Glasgow University laylamccay@hotmail.com

Like Aneil Malhotra, I spent a great summer in a research laboratory at Harvard Medical School in Boston, USA. The author details the vast amount of organisation and paperwork involved in undertaking this type of venture. This is indeed the case if you require payment for your work. I write to ensure that other students interested in spending the summer doing research in the USA are not put off by this experience.

I chose to go as a "volunteer" and as such, required no advance paperwork at all, apart from a couple of e-mails to the lab, an immunisation record and my plane ticket. As a UK citizen, I travelled on an ordinary tourist visa waiver (up to 90 days) for which I did not have to apply in advance. Instead of payment, I funded my summer with research bursaries and my part-time job in Glasgow. There must certainly be advantages to going down the visa route (eg. being paid for your work!) but if you are just looking for some lab experience and an exciting summer, go for it and don't be put off by the paperwork.

	NEWS Television company wants terminally ill patient to plastinate Anja Weidmann (November 2002) [full text...]
	Andrew Dekker (October 29, 2002) Student: Year 13 Studying A2 Levels, Solihull School, Solihull, West Midlands peter@dekker.freeserve.co.uk
	I found this article very interesting and shocking at the same time. The concept of the evolution of mankind, and the possible improvements upon our current frame is credible however this is indeed a matter of taste. Computer simulations and details of the way in which we evolve, how we have evolved, and why we have evolved would be beneficial to a learning audience however this is not the case. By taking a real person and surgically altering him in order to show possible evolutionary changes would not in any way "pave the way for a future life with a more healthy, capable and long lasting body". Bad taste is one euphemism for the necrophilic voyeurism that would be attracted by this program. I would hope that in this day and age no surgeon could agree to such a farce.

EDUCATION
How to write a good essay...and win prizes
Sabina Dosani (November 2002) [full text...]

wasiq (November 02, 2002)
House Officer, Royal Albert Edward Infirmary, Wigan wasiq79@hotmail.com

Most of us have been reading for the better part of the past 15 years or more. For many of us, most of this reading has been of an academic nature, barring the odd forays into Tolkien and his tribe. We have, on a fairly regular basis, been subject to an evaluation process, and in all probability, will continue to experience examinations in the near foreseeable future. Consequently everyone is familiar with the reading - evaluation - reading cycle, and but naturally, most of us try our best to enhance performance at the evaluation process by consolidating the reading process. But are we trying right?

Need for speed

Everybody, overtime subconsciously develops their own reading pattern and style and confidently presuming this to be an efficient pattern, saunter along comfortably. But ask yourself two questions :

Do I want to do better?
Can I do better?

If the answer to the first question is yes, then read on. And I can assure you that with practise and time, the answer to the second question will also be an emphatic yes. I speak from experience. To begin with, I suggest that, for those of us who haven't undergone training and speed reading, now is probably a good time to get access to "How to read better and faster" by Norman Lewis.

What do i need to read?

The first objective is to identify and write a list of the learning material and resources necessary. This again depends on where one is, in his or her medical or dental career. One could be a first year medical student or a clinical fellow in prosthodontics. What is really important is an acknowledgement, in writing, of the reading material. So, I suggest you to make your own list right away.

My reading strategy

The strategy I have followed boils down to simple maths. Assemble all the reading material required. For eg. Books A, B, C, etc.

My method to avoid reading boredom, which can set in more sooner than one expects, is by combining 2 subjects or chapters not considered very interesting, to form a pair and another pair by combining 2 subjects / books / chapters of personal interest.
After this, I add up the number of pages in the reading list pairs. Assume Book A of this pair has 600 pages and Book B has 400, to add upto 1000 pages.
Set up a target, say 1 month to complete both books, so 1000 pages in 30 days implies nearly 33 pages / day.
Relentlessly keep galloping along after drawing up a schedule and charting your daily progress. Most important at this stage is a keen sense of time consciousness and a will to move fast.
Add more pairs and or change the deadline, it's your call. You are then in a position to objectively determinereading progress.
Also try to keep a specific time every week for rapid revision, since it has been estimated that nearly 50 - 80 % of the details are lost within 24 hrs of the first reading.

NEWS
Graduate students are more challenging, demanding, and questioning
Peter McCrorie (November 2002) [full text...]

Mark Salmon (November 04, 2002)
5th year MBBS student, St George's Hospital Medical School marksalmon@goctors.org.uk

Being a medical student is usually very rewarding, it does however come with a fair amount of criticism. We are often depicted as insensitive, bumbling little boys and girls who drift through medical school on a diet of beer and curry. Fortunately, most of us are tough enough to ignore this criticism and do our best to disprove the stereotype; something which becomes more and more difficult when the criticism is being broadcast over multiple media by respected academics from our own medical school.

Peter McCrorie's comments in the BMJ and studentBMJ are really quite distressing. Of course the graduate entry programme is very different to the existing undergraduate course, but I do not believe that any of us could make it through either course if we were not highly motivated and committed, and as for self directed, challenging, demanding and questioning; just ask my final year colleagues who have just spent the last six months getting themselves through written finals.

I am sure most undergraduate medical students would join me in wishing Peter McCrorie's Graduate Entry Programme the best of luck and hope that it does indeed produce the great doctors he promises, but until then I wish his speculation was not directed at belittling the established course and thus fuelling the social divide between the student groups.

NEWS
Graduate students are more challenging, demanding, and questioning
Peter McCrorie (November 2002) [full text...]

Steve Hornby (November 17, 2002)
Final Year Student, Nottingham stehornby@doctors.net.uk

I write regarding the article about Dr Peter McCrorie, in the last issue of the student BMJ. I personally found his comments regarding the differences between graduate and non-graduate students both unfair and disparaging.

Whilst I would agree that my friends and colleagues who are mature students do exhibit the fine qualities that Dr McCrorie described, I disagree that these qualities set them apart from non-graduates.

I also acknowledge that Dr McCrorie has far more experience than me in the field of medical education, but I was surprised to read his comments in a journal which, I would imagine, is primarily read by non-graduate medical students.

What should we non-graduates and school leavers do with Dr McCrorie comments? Should be down stethoscopes and have a serious career rethink, with the knowledge that we will never live up to our mature/graduate colleagues? I think not.

I feel that the level of dedication and maturity required to start a career in medicine straight from school is no less than the dedication required to shift career paths and join medicine at a later age.

As for his comments about 18 year olds not being ready to take on the responsibilities of being doctor because they do not understand what it is about, I can assure Dr McCrorie, that as I approach my finals at the age of 23, I still do not fully understand what being a doctor is about. This has absolutely nothing to do with the fact that I was eighteen when I started medical school and everything to do with the fact that I am simply not a doctor!

	EDITORIALS A case of mistaken muscles Hashim Uddin Ahmed & Sarah Ali (July 2002) [full text...]
	Rakesh Biswas (November 04, 2002) MD,Asstt Prof,Dept of Internal Medicine,Manipal Teaching Hospital, Pokhara,Nepal. rakesh7biswas@hotmail.com
	Thanks Sarah for your interesting piece in the studentBMJ(july2002,vol10,246) regarding fallacies of ocular muscle testing and rekindling my confusion and curiosity I too had experienced during my 3rd year days when I stepped into medicine from anatomy. I had suppressed my confusion at that time and found your piece extremely helpful in resolving it this time.I read up Gray's as you had advised also topped it with Parson's Eye(both of which confirmed your assertion regarding the function of the muscles and then I went to Hutchison and found that he too was correct.Hutchison never said that SO and IO adduct the eye, it says,(pg291--20th edition), SO and IO act as elevators and depressors when the eye is in adduction. Which is quite true and so to test them we have to keep the eye in adduction.I suppose by this time you yourself would have realised it or somebody else might have pointed it out. Anyway I for one was helped by your original and diligent observation.

LETTERS
Healthcare assistants should call themselves nurses
Mark Young (November 2002) [full text...]

Stephen J. Goldie (November 04, 2002)
4th Year Medical Student, University of Glasgow Stephen_Goldie@hotmail.com

My response to Mark Young's letter is that the Student BMJ is not the correct forum in which to have this debate. The argument should never have been started in this journal in the first place. I find letters on this subject uninteresting and irrelevant to me as a medical student. In the ten years the Student BMJ has been in existence it has built up a reputation as a respected medical publication, reporting issues pertinent to medical students worldwide. I hope this continues.

Please do not take my objections as a mark of disrespect for nurses (my partner is a midwife) however they have more than enough journals and magazines in which to air their views. Letters on this subject waste space in which we could be discussing so many other relevant important medical and medico-political issues. I would have no objections for example to nurses writing to the Student BMJ asking medical students for their support and solidarity in a campaign to improve working conditions for nurses.

I am also glad that Nursing Instructor Trudy Hurd wrote a rapid response to point out to Young that he in fact has no right to call himself a nurse until he is qualified. In the same way that medical students [and dentists] have no right to call themselves doctors until they graduate.

NEWS
How do you make a good doctor?
Peter McCrorie, Dr Allan Cumming, Mike Shooter, John Tooke (November 2002) [full text...]

Abi Coleman (November 13, 2002)
third year MBChB, University of Birmingham AbiGCol@aol.com

I was drawn to thought by the article published in last month's Student BMJ concerning what makes a good doctor1. It was interesting, if not surprising, to see the different views taken by the various educationists interviewed and I feel that they all made relevant statements. In my opinion, however, what is needed is a blend of all four. A medical student does indeed need to develop their interpersonal skills, have a certain level of maturity and empathise with both patients and other staff. However, these are no substitute for sound, clinical knowledge. Rote learning and exams, as any medical student knows, are the only way to acquire this knowledge. Most of the biochemical and physiological knowledge needed is, in my experience, acquired in the first two years. It is easy therefore to feel on starting medical school that lectures and exams outweigh other aspects of medicine, such as interpersonal skills, in importance. It is not until clinical attachments are begun that a more balanced view begins to emerge. It is vital therefore in medical education that the divide between pre-clinical and clinical years is reduced as much as possible. It is useful to have sessions on communication skills and sociology, but there is no substitute for patient contact from the outset. Birmingham university has a scheme running throughout the first two years, where a day a fortnight is spent in a General Practice and each student is attached to a family whom they visit regularly throughout their first two years. I found this invaluable in helping me with interpersonal skills, as a relief from lectures and book work and reminding me of why I went into medicine in the first place. Other universities where there is little or no patient contact in pre-clinical years may well find students benefit from the implementation of such a scheme and generate more well rounded, "good"doctors.

How do you make a good doctor? Student BMJ 2002;10:404-405. (November)

LETTERS
Increased student numbers need enlarged facilities
Aneel Bhangu (August 2002) [full text...]

Aneel Bhangu (November 13, 2002)
Medical Student, Medicine IV, Birmingham Medical School aneelbhangu@yahoo.co.uk

Continuing earlier debate about increasing numbers of medical students, I would like to point out a further and potentially more serious problem than cramped facilities (Refs:1,2).

We are all aware that with large numbers of students passing though clinical medicine firms, wards and theatres are packed and this may potentially limit students' experience. However, and more worrying, the problem of changing student assessment has not yet been addressed.

It is now often expected for a single consultant to assess nearly twenty students on a single firm, when blocks are being shortened at extreme from 2 months to three weeks to accommodate more students, with some consultants only giving on teaching session a week. The consultant cannot be expected to come to know each student well enough to assess them on intricate factors such as learning responsibility, teamwork, manner with patients, competence and now, when seeing individuals so rarely, on attendance. I have been assessed by a consultant who did not even know my name.

However the real problem is with the inconsistency in assessment. Some people assess by giving all students straight As, others by giving their firm all Cs. Some give one student straight As, the rest of the students B's and chooses one student to be the C grade student, all on the basis of a five minute assessment. I have seen one student who attended from 6am to 6pm every day and did all her on-calls only to receive a C for attendance, whilst another student in the same firm got an A despite taking a two week holiday. I have seen an assessor fail a student because he didn't like the state of the current medical education system and wished to make a point (at the student's expense). If one tries to appeal, the authorities state that this can only be taken up directly with the assessor (so quite rightly not to undermine his authority), but the assessor will never change his grade. There is no appeals system for students who feel unjustly graded.

Although forms are produced to help assessors, and these forms themselves are constantly assessed 'to help future years,' the system is totally subjective and open to interpretation, and damage is being felt now and will continue to do so. Furthermore, tick forms for attendance are becoming hated by students and teachers alike, as they devalue a student's attendance at a clinic or theatre as they are forced at the end to ask for a signature, and they tend to focus the student's attention purely onto what's on the sheet.

I would be interested to hear about the picture elsewhere, and more urgently any solutions, since one trial 'guinea-pig' year after the next is not the answer.

Bhangu AA. Increasing number of medical students. Student BMJ 2002; 10:295
Prowse S. Critical Shortage of quality clinical teaching must be addressed. Student BMJ 2002; 10:295

LIFE
India: sights, sounds and smells
Amlan Basuu (November 2002) [full text...]

Maulik (November 16, 2002)
final MBBS, Medical College, Baroda maulik_baxi@rediffmail.com

In his article in November issue, Amalan Basu is seen succeeding in providing information about state of health care and medical education in India. His observations regarding the state of government run hospitals are largely true. The difference between healthcare system in developed nations and in third world nations is very clear.

In India, doctors have to deal with such a large number of patients, that many times he himself becomes a patient. for exmaple, Shree Sayaji General Hospital associated with our medical college has 3 orthopedic wards and each ward has capacity of 56 beds. That means one houseman has to care 56 indoor patients per day, 7 days a week, 12 months a year, as most of the wards are never empty. Tuberculosis is a very common hospital aquired infection in our hospital among doctors.

What the author could not see during his visit in India is the backbone of Indian health system - a primary health centre. it is the patients' first contact with the health system, each catering to needs of 30000 patients on an average.(1) Also known as a PHC, a primary health centre was proposed to be the main tool of improving the health standerds in the country by a committee headed by Sir Joseph Bhore in 1946.(Bhore Committee for Health Planning and Development in India)(2)

When we describe influence of money on health care, we forget PHCs and thousands of such government run institutions. Health care is absolutely free in such institutions, and apart from treatment facilities, they carry services for preventive and health promotive services, which is an integral part of them. Success of family planning programme is largely dependent upon efforts made in PHCs by doctors and various cadres of health assistance appointed by the governments and working voluntarily. Without them, it would not be possible to take care of health of population of a billion in india.

Park K, Textbook of Preventive and Social Medicine,(16th ed) Banarsidas Bhanot Publishers, Jabalpur, India, pg. 619
ibid, pg. 637