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Article Responses: September2002
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REVIEWS
Who's Best?
Sonali Dutta (September 2002)
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Pavi Kundhal (September 02, 2002)
3rd Year Medical Student pavi.kundhal@utoronto.ca
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Sonalis Dutta asks the important question which school or teaching strategy is the "best". The
short answer is it does not really matter. Good students will do well, regardless of how you teach
them. Couple this fact, with the incentives students have to succeed and the irrelevancy of this
question becomes clear.
Does anyone really believe that patient outcomes from a group of students trained at one school differs from that of another? Attracting students is in a sense a "market", and schools will try to sell their program to attract "buyers".
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PAPERS
Commentary
Mona Okasha (September 2002)
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Simon Harrison
(September 02 2002)
1st Year Medical Student sh1927@bris.ac.uk
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Okasha's commentary on the paper by Wright and Tanner judges it to be 'irrelevant, even if ... amusing'. The paper is not irrelevant: as the authors themselves say 'it is beneficial to identify students ...before they fail.' Okasha offers two related arguments. The second is based on her 'feeling' that 'surely the way to predict success must be
slightly more discriminating than that.' First, why should we be persuaded by Okasha's feelings? Secondly, she seems to have grasped the wrong end of the stick. The paper is about identifying students in need of 'targeted help'. What if the medical school had tried to approach and offer 'targeted help' to the 27 students who didn't provide the photo, and of whom 13 did not pass their exams.
Her first argument has to do with 'confonding factors.' 'Perhaps there are', she writes, 'reasons why students did not provide a photo ... that are also related to whether they pass their exam.' Why, we ask, is this a problem for the paper?
The failure to provide a photograph is an significant marker, precisely because it is related to those deeper problems. (The problem for the paper has to do with rather with whether you agree with the authorss characterisation of the problems as 'inappropriate ... attitude'.
In short, it is rather disappointing that the paper is read as providing amusing 'tips to improve your [the student's] pass rate' (Okasha, sic), rather than as suggesting one way teachers might identifying students at risk of failing, before they do so. Read in this way, the paper is highly relevant - if you belong to a faculty interested in improving 'your pass
rate', by helping students get through their exams. Which is otherwise known as teaching.
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LIFE
A Spotter's Guide
James Thomas. September 2002
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Aneel Bhangu
(September 05 2002)
4th Year Medical Student aneelbhangu@yahoo.co.uk
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With regards to the article "Medical Students: a spotter’s guide" in the September StudentBMJ issue, may I add that the following observations can also be made with regards to how and why such medical students come into being:
1. Truly Caring Individuals
These people help everyone, go to nursing homes in their spare time, and dress up as sheep and bumblebees raising money to help people in some country to which they couldn’t point to on a map. But they really do care. They’re not here for the social status, the pay, the research or the job security, but quite-rightly to bring a ray of sunshine into people’s lives. They make truly superb GP’s, whom the old folk talk about with true fondness in the supermarket.
2. Pursuit of perfect academia
We are the cleverest people in the nation, apparently, so we might as well put that to some good and stretch ourselves for, well, the pursuit of humanity. The potential for research is massive, whatever that means, and we can spend the rest of our lives learning and taking increasingly difficult exams. They become top of their chosen field (professors or surgeons)(or both).
3. Parental encouragement
You’ll either be a doctor or a lawyer. This is drummed into us as babies as soon as they pop out of the womb by proud parents. Lawyers are blood-sucking leeches, whereas doctors are pillars of the community, so let’s make our parents happy. As long as they become doctors, they don’t care which type and see where the wind blows them.
4. Nothing Better to do
Well, these are clever people and they got straight A’s at GCSE and A-Level, but then didn’t know what to do; so on the off chance they applied to Medical School and got in. They do the course and do it competently, but spend their time wondering if it’s really for them. Since they’re here they might as well work hard, so they go on to become consultants.
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REVIEWS
Medical Students Should Not be Forced to Study all Subjects.
Kallur Suresh. September 2002
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David Selvan
(September 06 2002)
Final year medical student daveselvan@lmss.org
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I am writing in response to Dr. Suresh' article titled 'Medical students should not be forced to study all subjects'. It has to be agreed that medicine is becoming more and more specialised and also that there is a lot of material in the undergraduate curriculum, which once a student becomes a doctor, becomes obsolete. But that said, there has to be a basis on which students have to build their future careers. The undergraduate curriculum needs to be generalised since a majority of my colleagues in the final year still do not know what career path they are going to take. Also if we do proceed to change the curriculum in the UK, if our graduates go abroad to gain experience, would specialisation such as proposed, hinder practising medicine in the 3rd world countries? Surely one cannot refuse to see a pregnant lady at the point of labour in the outback because you only specialised in psychiatry or shoulder surgery!!
So although I for one believe that we as students in our undergraduate careers do a lot more than we probably will ever need to know to practice safe medicine in a chosen career speciality, one never knows when that obsolete material which you thought you will never use again, will come in handy such as when you hear over the public address system in an airplane. There is a medical emergency, is there a doctor onboard?
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REVIEWS
Living in Blisters and Pain.
Samena Chaudhry. July 2002
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Anna Kemble Welch
(September 09 2002)
Secretary, DEBRA NZ trustees@debra.org.nz
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Samena's story of Assya's experience, living with EB, describes very well the pain this brave young woman must face daily, and the challenges of this debilitating condition. There is one thing that could help alleviate some of the pain at bathing time - using water that has salt added to the consistency of normal saline. Calibration would be required to work out exact quantities, depending on the size of the bath, but about 1 kg(approx. 2 lbs) dissolved in a bath of warm water eases the stinging of the water. This is a simple thing to change and can make a big difference to the pain of being bathed.
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EDUCATION
Body piercing
Henry Ferguson, January 2000
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Spence
(September 09 2002)
itec anatomy &physiology,and anatomy,physiology and massage therapy qualified gypsie13@btinternet.com
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Having qualified in holistic therapies,i wish to broaden my horizons in a correct and proffessional manor,namely in "body piercing",but have been astounded by the lack of information in courses to become "professionally qualified" in what seems to be a "closed shop" industry.This i feel is a real shame,and can surely only encourage cowboys! Can any one help me in finding suitable tuition in the west country?
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NEWS
Degrees from Soviet Union are Under Question
Sanjay Kumar. September 2002
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Dr.P.Bobby Chandan
(September 16 2002)
registered medical doctor iatros@operamail.com
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degrees from soviet union are under question ; sanjay kumar;september 2002 letter: It is really unfair on the part of the indian medical council to discriminate
against the medical graduates returning from erstwhile soviet union...and its not
surprising that there is no basis for the so called regulatory action they propose in the
form of a screening test and the claims that standards have gone down have no logical
basis as they do not define the meaning ofthe so called down fall in the medical education
standards in any of the cis countries concerned....all the actions of the indian medical council are irresponsible and corrupt backed by a powerful lobby of private medical
colleges in india which have no other aim except to dispense medical degrees for a huge
price to the rich strata of the indian society.It is trifle unfair on the part of the
indian medical council to goto the press with their myopic and unilateral views about the
standards of medicine in the former super power and hence undermine the future of so many
young doctors who have got !
their degrees by hard work and fair means from such countries. I hope that the
international community will recognise the fact that the indian medical council is in fact
a very corrupt organisation with no legal basis for argument and has lost all the legal
battles till date in the supreme court of india and view the degrees from the erstwhile
soviet union with a broader mind and give them the due value they deserve.
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NEWS
Britain is worst in Europe for teenage pregnancy rates
Kay Brennan . July 2002
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Tom Hanna
(September 16 2002)
4th year medical student u03tah@abdn.ac.uk
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The headline Britain is worst in Europe for teenage pregnancy rates, in the July edition news section, gave mecause for concern, but perhaps for another reason than intended. I feel that initiatives to reduce teenage pregnancy rates can cause more harm than good especially when they do not differentiate between wanted and unwanted pregnancies. Imagine how a proud teenage mother might feel, when a headline reveals to all she is contributing to the statistic, which
embarrasses Britain on a global level.
The United Nations presumably produced such a report because of the evidence linking teenage pregnancy to deprivation and a low socio-economic class. Although this is a proven link, extreme caution should be taken in interpreting it and basing public health policies on it. Consider that it is the government's policies on the matter, which is responsible for creating such a link, the chicken and the egg analogy.
It is true that education penetrates the higher socio-economic classes more effectively than the lower for a number of reasons. One of the main initiatives to reduce teenage pregnancy is through education at schools. Therefore the message that teenage pregnancy should be discouraged reaches the students from the higher socio-economic class more effectively. As
a result most of the teenage pregnancies occur in the lower socio-economic class, which is defined by a degree of poverty. The link therefore is only created by the government’s policies on the matter. The more the government apply the
initiatives the stronger the association will seem and so a vicious circle is entered.
The circle can only be broken by accepting that lower socio-economic class, not teenage pregnancy per se is associated with poverty, and that teenage pregnancy is not actually a problem at all. This will reduce the social stigma surrounding teenage pregnancy, distributing rates evenly throughout the population. Unwanted pregnancies will suddenly become wanted,
destroying the link which current public health policies and initiatives are currently based on. The enthusiasm to decrease teenage pregnancies could be redirected towards initiatives to decrease unwanted pregnancies in all ages. Including advice about contraception. I believe that a wanted child of a teenage mother will be better off than an unwanted child of an older mother. The teenage pregnancy rate may well rise as a consequence but this should not a cause for alarm or shame, as it will indicate a rise in wanted pregnancies.
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LETTERS
Playing Doctors and Nurses
David Dean. October 2002
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Mark Young
(September 20 2002)
student nurse/auxiliary Glasgow Royal Infirmary (Lister Unit) mark@gonads.co.uk
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A health care assistant has every right to call themselves a nurse. This is no way belittles a nursing qualification. Auxiliary nurses with experience gained from trained nurses in a working environment understand much more than other health care professionals give them credit for. In my ward, the only thing that the auxiliaries don't do, is
give out the drugs. The trained nurses in the hospital wards that I have worked on couldn't function without unqualified nurses. They pass on a great deal of important information about the patients to the nurses because they generally have more opportunity to spend time with the patients.
I have been working as an auxiliary nurse for three years in Glasgow beginning when I was 16 (I'm now 19) an am beginning
my nurse training in two weeks, only because I feel that I am not getting any recognition for the work that I am already carrying out. Attitudes that put unqualified nurses down don't help the profession in any way. It certainally is a profession.
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REVIEWS
Why Anatomy should still be taught
S Eccles. September 2002
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Richard McCrory
(September 20 2002)
Second Year Medical Student Queens University Belfast rfrmccrory@shantonagh.freeserve.co.uk
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I am in full agreement with Simon Eccles personal view on the role of anatomy teaching in a Medical course. I am intending to do an Intercalated Degree in Anatomy next year. Recent articles in the StudentBMJ have probably already consolidated my decision.
There was a time when a medical student had nothing but anatomy and physiology to study for the first two or three years. Their contact with patients was minimal. Clinical skills were only seen as an afterthought on the part of the medical faculties. Presently updated courses in medicine can provide immediate contact with patients but the students may not know the anatomical significance of the skills they are learning. Claire McKenna's article in the August edition of StudentBMJ regarding the medical knowledge of PRHO's is only the tip of the iceberg. Patients are at risk (and justifiably
so) from junior doctors who lack the necessary spectrum of knowledge that is expected from them. High standards of training must incorporate the fundamentals of medical practice, together with problem based clinical work. If it means that I spend another year studying the machinery under the skin, then so be it. I'll need the knowledge during attachments to general surgery and medicine!
The last thing I want to do is enter a theatre with a copy of Gray's Anatomy under my arm.
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LIFE
The life of a medical representative - a little food for thought
Katherine Anderson September 1999
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Dennis Kent
(September 25 2002)
medical representative denniskentm@yahoo.com
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I was surfing the net and saw the article you shared. And you did catch my attention for the reason that we have a lot of experiences in common. I am also a medical representtive here in the asian region, particularly the philippine islands. Started my career as medical representative right after i finished my college. Actually, the course i finished in college is in no way related to my present job. I am a philosophy major, due to limited job opening in my country i landed in sales and marketing particularly, pharmaceutical ethical promotions.
It was kind of hard at first when i started my training, classroom set up and on the job training. All of us trainess have to pass with flying colors so we can finish the training and get the job. like the things you shared, similar to my experiences here for my company is also european based. We start at 8:30 in the morning. Study the basic topics related to
the job and do well in the product knowledge. We have to do well in our presentations.
When we do well in the training, we get the job. However, when we are in the field already it's a different world. In some ways, some doctors are rude, insensitive and egoistic taking advantage over our humble presence in the area.
I would agree with you, when you wrote in your article that "be nice" to representatives. (excuse the doctors who are humble and fair) It does not mean that because they are doctors they know everything there is to know. We are assigned in the field as a help partner to our doctors in preserving life. We are partners to our doctors, therefore, we should be treated as such. Human as we are, all are expected to treat each other fairly. Our presence in the area entails
partnership. Therefore, we are one with the doctors in preserving and prolonging life.
Anyway, good luck on your studies katherine.
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