In anticipation of all the new doctors starting this Wednesday, we are reposting our advice letter to FY1 doctors! Good luck to everyone starting this week! Dear FY1s/Final Year Medical Students, Firstly congratulations on your graduation from medical school! As a result of the pandemic, it has been a tough year to be a final year medical student. Despite the difficulties, you have survived and achieved what you set out to, all those years ago when you applied. Now that you are finally foundation doctors, here are some rules to help you along the way. Part 1: Clinical Commandments Commandment 1: I Will Be Organised This may sound like a basic one but I cannot stress enough the importance of being organised as a foundation doctor. An organised FY1 really does help make the ward run more smoothly and makes life easier for seniors. For the ward round, update the patient list and have enough copies for everyone. For each patient, look at the drug chart and see if it needs to be rewritten - there is nothing worse for the on call team than being bleeped to rewrite a drug chart! In a similar vein, make sure you prescribe all of your patients’ warfarin doses before you go home. Throughout the ward round, compile a list of jobs that need doing. Having a good, structured jobs list leads us to the second commandment: Commandment 2: I Will Prioritise When looking through your jobs list it is important to prioritise tasks. For example, it is a good idea to get scans requested and discussed as early as possible, as well as any urgent referrals to other specialties. As an FY1, you will frequently be asked about discharge summaries. Ensure that you prioritise the most time sensitive ones such as those for patients going home with dosette boxes - these often need to be in pharmacy before lunchtime for patients going home that day. Normally one of the lowest priority jobs is putting blood forms out for the next day as this is usually the last task done before going home. Prioritisation is equally important during on call shifts. You may get one bleep about a patient with cardiac-sounding chest pain, and another about prescribing a sleeping tablet. It is clear here which job takes priority, but what about when you receive two simultaneous bleeps about chest pain? Enter the third commandment: Commandment 3: I Will Always Ask For Help Remember that in medicine you are part of a team and help is always available. If you are swamped on your on call, ask your fellow FY1 or SHO for help. There are also other incredible sources of support such as nurse practitioners and the critical care outreach team. As an FY1 you are not expected to know it all. Always work within your own competence and escalate to your seniors as necessary. In appropriate cases (i.e. not when someone is about to arrest - put that 2222 call out immediately), make sure that you have done an initial assessment and management plan before escalating to your seniors. When it comes to assessing the acutely unwell patient, it is always a good idea to have a strong structure... Commandment 4: I Will Not Forget My A to E Throughout medical school we are constantly reminded of the A to E method of assessing patients, so we won’t list the details here. Just remember that this structure is useful because it ensures that you cover all bases and don’t miss anything out. Once you’ve completed your A to E, use the SBAR structure to handover or escalate. Commandment 5: I Will Make Technology My Friend Sometimes you will forget some of your A to E. Sometimes you will forget the protocol for the investigation and management of PEs. Sometimes you will forget which drugs need to be stopped in AKI. It happens, and it’s okay. There are many apps that have been created to help us out. From Pocket Dr to MDCalc, make use of tech available. Your trust may even have its own app or have its guideline available on the microguide app. For those of you that prefer books, The Oxford Handbook for the Foundation Programme is a good one to carry around. Part 2: The Self Care Commandments Commandment 6: I Will Eat Lunch This commandment refers to the need to take breaks. When you are FY1 the workload can seem overwhelming and the job list endless. For this reason you may find yourself doing one more task before eating, then another, and another, until before you know it is 4pm and you haven’t eaten anything since breakfast, nor had any water or looked away from your computer screen! This non-stop attitude is not sustainable and can lead to burnout. Additionally, let’s not forget that old adage, tired doctors make mistakes. Commandment 7: I Will Leave Work on Time... ...Or as close to on time as is possible. This commandment follows on from taking breaks. Obviously there will be occasions when leaving promptly will not be possible. This usually occurs when starting a new rotation and getting to grips with the job, or if there is an emergency, or if it is just one of those crazily busy days. However, do not make a habit of leaving work late. Of course it is important to get all your jobs done but make sure you handover what needs to be handed over and go home. Just as not taking a break will cause burnout, so will staying late for two hours everyday. Commandment 8: I Will Not Take Work Home With Me Once you do get home, try not to think about work. Maintaining a good work-life balance is incredibly important for your wellbeing and longevity as a doctor. Medicine can sometimes seem all encompassing but remember that you are a well-rounded individual with multiple interests and hobbies. Do not forget about them. From yoga to choir, all of these activities help make you a resilient and happy doctor. Commandment 9: I Will Keep My Portfolio Up to Date There is a lot of admin to do as an FY1 and letting it all pile up can make it an extremely stressful experience. From mini-CEXs to CBDs, there is a lot that you are required to get signed off. You can take the stress of portfolio demands away by regularly working on it. All it takes is 30 minutes every fortnight to have a stress-free end to the year. This advice also goes for any portfolios needed for subsequent applications. Collect evidence for your achievements as you go along because trying to get proof of something that you did two years ago can be a nightmare! Commandment 10: I Will Check My Pay and Rota The system is not perfect and sometimes mistakes are made regarding pay and your rota. Make sure you look at your payslip each month to check that you are receiving the right amount. The BMA can offer support for this as well as a free contract checking service for members. It is important to make sure that your rota is compliant and finally, to make sure that you are getting all of your annual leave! To conclude, these are the commandments of being an FY1. It is a tough, but enjoyable year and what you have been waiting for since applying to medical school. Don’t forget the advice given to you and that support is always available if you need it. You’ve got this! Written By Dr Katy Chisenga-Phillipps, Clinical Fellow in Geriatrics

Last week Melanin medics held their first annual conference called “The Future in Mind.” The event explored experiences and wellbeing of black medical students and doctors during the pandemic and explored the opportunities and future we can work towards. The conference was kicked off with a wonderful discussion between Dr Khadija Owusu and our first keynote speaker Professor Dame Elizabeth Anionwu. Professor Elizabeth gave insight into what it was like becoming the first Sickle cell/ Thalassaemia nurse in the UK and the responsibilities that also followed it. She described her experiences as a young student of mixed heritage (Irish and Nigerian) studying nursing in the 60s in the UK. She recalled a pivotal moment where speaking up early in her career almost cost her career and was failed for that module. However, having allies within her community who were willing to fight on her behalf overturned that decision. Professor Dame Anionwu left us all feeling encouraged and inspired to take challenges head on. Our next discussion topic was focused on doctor’s wellbeing, and this was a panel discussion moderated by Dr Mobola Odukale from the melanin medics team along with panelists: Aishnine Benjamin, who works as the head of Equality and Inclusion at the BMA. Dr Jermaine Bamfo a trainee Psychiatrist and advocate for increasing mental health awareness and Dr Anu Obaro, a radiologist and PhD researcher, a passionate educator and racial equality advocate. There were a series of topics discussed, such as the impact of the COVID-19 pandemic on the mental health of our black doctors and what support is available. How to effectively whistleblow within the workplace, allyship vs advocacy and why there is a stigma surrounding seeking help with mental health within the black community. This was a great conversation that left the audience well informed and educated. Moving on throughout the day we had another great charged panel discussion, moderated by melanin medic’s Dr Ayomide Ayorinde. With panellists Dr Jeff Allen, a senior lecturer and the year 1 director of MBBCh programme at Cardiff University, Professor Dave Subodh Dave, the Dean-elect for the Royal College of Psychiatrists. Malone Mukwende, award winning medical student and founder of Blacandbrownskin and Professor Nisha Dogra, an Emeritus Professor of Psychiatric Education and lead for integrating diversity at the University of Leicester. This panel focused on diversifying the curriculum and if change was on the horizon. Majority were of the consensus that there was progress made within this area, however the progress was slow and more needed to be done. Personal experiences were shared regarding reactions from medical schools in trying to diversify the curriculum. It was noted that change had to come from the top and leaders should be held accountable for not doing enough to help support black doctors. This was an interesting and thought-provoking discussion. Next, attendees partook in two interesting workshops spear headed by Celutions on self-care and Dr Iyare Nehikhare on mentorship before our final keynote speaker of the day Dr Aggrey Burke. Dr Aggrey Burke shared his experience of becoming the first black consultant Psychiatrist in the UK and what this meant for him. He also gave accounts of a paper he wrote in 1986 with Dr Joe Collier on racial and sexual discrimination and how at the time they were blamed for causing disruption. But eventually this paper would bring about the start of change that they wished to see. He explained that from his experience there was change for the good, but although we are not quite there year there is still hope on the horizon. Some things I learnt from the day: · Become a member of a trade union in your trust. Often these are the people that can help fight for you if need and you can do the same for others. · Be an advocate in your community but don’t put so much pressure on yourself to be able to fix it all. · Look after yourself and your mental health. Unfortunately, we are replaceable in the workplace, so we need to make sure we do all we can to look after ourselves. · If you need help with career progression, do not be afraid to seek out a mentor and approach them to ask if they would consider being your mentor. This was such an encouraging event, and we hope to continue to have more of these discussions. Written by Dr Mobola Odukale Melanin Medics Blog Writer

The Melanin Medics Blog Series showcasing black Medical Professionals in various Medical Specialties. Sharing their journeys, challenges and life lessons. #RepresentationMatters. This week we're featuring a dermatology consultant: Dr Sharon Belmo! Tell us about yourself and your career journey so far I am a London based consultant dermatologist. I was born and bred in Scotland to Ghanaian parents. I graduated from Dundee medical school in 2006, where I did my foundation training. I then did core medical training in Liverpool and completed my MRCP exams, followed by two 6-month dermatology LAT jobs in both Liverpool and Newcastle. After this I went on to do my dermatology specialist training in Nottingham, where I did my specialist certificate exam (SCE) in Dermatology, obtaining CCT in 2015. It was a long journey with lots of exams but worth it! I have been working as a dermatology consultant in London ever since. Early on in my training, I noticed that there was a lack of attention to skin of colour. This became my passion and specialist interest. I set up the Centre of Evidence based skin of colour resource in 2016 and continue to work as an advocate of dermatology for skin of colour. Why did you choose this speciality? Dermatology is such a varied speciality as no two peoples’ skin is the same. Within dermatology, there are also multiple sub-specialities, like paediatrics and dermatology surgery, as well as there being a large scope for research and academia. I always loved surgery but never quite wanted to be a surgeon and was more so a medic at heart. I am also quite academic, therefore found dermatology to be a perfect fit for me! Being so interested in equality and diversity, I cannot think of a better speciality other than dermatology – the study of SKIN! It is also a speciality with good work life balance which is really important. What does your role entail? I treat skin, hair and nail conditions such as eczema, acne, psoriasis and different types of alopecia. A large bulk of dermatology also involves mole checks, skin cancer and skin surgery. I am also involved in teaching, training and academia. During your time at medical school, did you enjoy this speciality Very much so, but the rotation was very short, just 2 weeks! I think that is an issue in most medical schools. What is your greatest achievement to date? My beautiful 2-year old daughter! I’m a working mama ☺ It is possible! Work-wise, it would be pushing dermatology for skin of colour in this country and introducing skin of colour to the dermatology specialist training curriculum. What has been your biggest challenge working in this speciality so far Joining the speciality as one of the few black dermatologists in the UK and challenging the system in terms of lack of diversity and skin of colour training. Being questioned about my age (I am older than I look!) and country of origin. Dealing with the subtle racism we experience in the UK. This was more so outside of London. I find that this can be harder to prove and can sometimes be worse than outright racism (which I have thankfully had very little of as a doctor). What do you like to do outside of work? Other than being a busy mum, I love travel, I am a huge foodie and am absolutely obsessed with anything related to fashion! What advice would you give to someone interested in this specialty? Dermatology is a difficult speciality to get into, but it is a wonderful speciality. If it is something you really want to do, persevere. Even if you don’t get a training number first time, so what? Try again. Everyone’s journey is different. You will get there eventually. There are things that you can do between core medical training and dermatology training if necessary, e.g., a dermatology diploma, speciality doctor jobs and courses and conferences. We need more dermatologists of colour, especially black doctors, so keep going. Find a mentor, attend dermatology meetings. It is now possible to attend virtually worldwide which is great! Gear your CV or portfolio towards dermatology by doing things like projects or audits in your local dermatology department, shadowing a dermatologist, attending conferences like BAD, AAD or EADV or courses such as Biology of the skin or BAD’s DermSchool. Obtaining a derm training number can be competitive so you really need to demonstrate your interest in order to be shortlisted.

I remember first hearing about COVID and trying to understand how it would affect us here in the UK. As I watched the virus spread across the world, edging ever closer to our shores, ravaging countries like Italy, I could feel my anxiety levels rising. And then it came. Infection levels rose, rotas were suspended, annual and study leave cancelled, exams were cancelled, redeployment ensued... As someone who likes to plan and anticipate future problems, a novel virus and the uncertainties surrounding it definitely began to take their toll on me. Early in the pandemic I was reassigned to geriatrics and spent a lot of my time on the ‘red’ geriatrics wards (a ward where everyone had a confirmed COVID diagnosis). There were quite a few discussions about which level of PPE we should be wearing because many of us did not feel safe in the standard apron, gloves, face mask and visor. The reason for this was because many patients on the red geriatrics wards suffered from conditions such as dementia and sometimes did not know or understand that they had COVID. Subsequently, they did not understand the social distancing or isolation implications that came with such a diagnosis. I remember one patient in particular who frequently managed to sneak up behind you and hug you or run their fingers through your hair. This was a friendly gesture on their part, but as you can imagine extremely anxiety-inducing for us. Other challenges in geriatrics included communicating with patients with dementia, delirium or any other cognitive impairment. For someone who is already disorientated, having a healthcare professional loom over you in a face mask and visor can be quite scary! Additionally, I found it extremely difficult emotionally when patients deteriorated and came to the end of their life without having their loved ones there to support them. As a black doctor with a black family, the constant reminder of the impact of COVID on our communities was a continuous source of worry. For example, I spent a lot of time worrying about my mother, a mental health social worker in her 60s. As a keyworker, she was still going to work everyday and thoughts of her catching COVID from the office or a patient often crossed my mind. I did not see my family for a significant period of time because I was concerned that I could pass COVID on to them. As well as worry and anxiety surrounding COVID and communities of colour, I felt a deep sense of frustration, anger and injustice. Why were we being affected so disproportionately? Was anyone going to take this seriously? People of colour make up a large proportion of frontline workers in this country - we have literally been dying for this country. Our concerns and welfare must be taken seriously. The past few years have been a strange and difficult time for us all and I could not have gotten through it without the love and support of my family, friends, and incredible colleagues. Although I am hopeful that we will soon emerge from this crisis, as a country with a high death toll I pray that lessons will be learnt, and victims not forgotten. Written by Anonymous

My name is Lorraine and I’m a 28-year-old, currently about to complete my 2 nd year of Graduate Entry Medicine at the University of Nottingham. When dreaming about going to medical school, I never anticipated that I’d have taken the route that it took to get me here – I didn’t even know that GEM existed! However, in retrospect, I appreciate the pros of taking the scenic route. In school, I was always a ‘gifted and talented’ student with the ability to get A grades. However, I was easily distracted and at the time didn’t appreciate the importance of effort and dedication. I got As and Bs at GCSE and went to college thinking this would be a good foundation to get the As necessary for Medicine. During induction, my Chemistry teacher-to-be saw my GCSEs and told me I couldn’t get into medical school with them – with a lack of support, it’s no surprise that I dropped his class during AS-level! Again, I was too laid back for my own good and ended up leaving with grades BCD. I knew this wasn’t good enough, so decided to apply for Paediatric Nursing as I thought it would be similar to Medicine. After a term, I quickly realised the role differences and decided it wasn’t for me. The next academic year, I began studying Biomedical Science, a degree that I felt would still allow me to have healthcare experience and develop my scientific skills. But, it was during that course that I fell pregnant with my son. At that point, I was at a crossroads – do I pack it all in and go back home, or do I try to continue? Luckily for me, I cared a lot more about my studies than I let on and I’m also more resilient than I sometimes give myself credit for. That summer, 5 months pregnant, I sat my end of first year exams before taking a gap year for maternity leave (he was due in October so the timing couldn’t be more perfect!). I then transferred to a London university for 2 nd and 3 rd year to raise my baby while completing my studies. It wasn’t the easiest thing to do, and although I graduated with a 2:2, I was so very proud of myself (I scored 59.3%, so 0.2% away from being rounded up to a 2:1, I’ve never known frustration like that!). As you may or may not know, the majority of UK universities require a minimum of a 2:1 for Graduate Entry Medicine. I was limited to only 5 universities with my 2:2 and would had have to have a master’s degree in addition to be eligible. I then studied Reproductive and Developmental Biology at Imperial College London – not only to reach this requirement, but also because it’s an area I’m so passionate about. My passion linked with my determination to prove my academic ability led to me graduating with a Distinction! My proudest moment to date (other than becoming a mummy of course!). At the age of 26, I got an offer to study Medicine at the University of Nottingham, and the rest is history. I definitely didn’t decide to take this route. However, I’m grateful because everything happens for a reason. Had I gotten in at 18, I wouldn’t have all the life and work experience I have now. I may not even have my beautiful son! I wouldn’t have had the pleasure to say that I am an alum of Imperial College, and I wouldn’t be able to say that I’m a Master of Reproductive Biology, which will help me for my desired future in Obstetrics. I have learned so much about myself – that I achieve my best when I try, and most importantly that I am a diamond. Pressure really did get me to where I am. I also learned that Medicine is not only for the ‘smart’ but more so for the determined. As long as you want it, there are ways to achieve it – definitely not overnight remedies, but you have to be prepared for that. If I had any advice, it would be this. To the capable (which is any of you reading this) - never give up. You may have had rejections, I had 3. I got into medical school on my 4th application, and I am still here, passing exams and proving my suitability as a future doctor. To the school leavers-to-be – take your studies seriously. Don’t be like me, thinking your brightness will be enough to carry you through! Always take breaks, but also know when to say no. Focus on revision, your future self will thank you for it. To the mature students – it’s never too late! It doesn’t matter how long it takes or how you get there, as long as you do. I’ll be 30 when I graduate, and I know people who were 30+ when they started! If one day you’ll be 45 anyway, why not be 45 and a doctor? And to the parents, it won’t be easy, but in some ways it will be. Why? Because you have the strongest source of motivation than anyone else – your babies. Make the most of family, friends and childcare to support you, use bedtime as study time and know every step of the way is for them. There you have it, probably one of, if not the most unconventional routes to Medicine. And although in hindsight I could say I could have done things differently, truth is, I probably wouldn’t have it any other way! Lorraine x IG: @themummymedic

I have been studying Medicine at Norwich Medical School for the past four years - I have definitely learned a lot and gained a lot of experience over the years! Course Structure: The five-year MBBS Medicine degree follows an integrated structure, with huge emphasis and early exposure to clinical and practical skills as well as theoretical knowledge - right from the beginning of Year One. Essentially, this means that we go and see patients within our first month of medical school! This is unlike more traditional medical schools that split the course into pre-clinical and clinical years. Each year of the course is taught and organised according to different system-based modules, using the integrated structure which consists of: Problem Based Learning (PBL) Lectures Seminars Cadaveric dissections in anatomy GP placement/primary care (usually one day per week in every module) Hospital placement/secondary care (usually runs for four weeks in every module) Opportunities for electives and intercalation *In Year 5, the focus is majorly on clinical attachments with programmes such as student assistantships – in order for the final year students to solidify their clinical knowledge for their upcoming Foundation Year roles. One of the best things about Norwich Medical School is the early patient contact that we get to experience, and the emphasis on practical skills teaching during placement. Going to placement so frequently helps to consolidate and build upon our theoretical knowledge that we would have been introduced to and learnt during the teaching week (via lectures, PBL, seminars, dissections etc.). It quickly prepares you for real-world scenarios and the clinical and professional environment. Also, it builds confidence in the clinical environment and allows you to develop the all-important communication skills required for patient contact. Another important bonus is the free transport and accommodation arranged and provided by the medical school for all placements throughout the entire five years. This is so handy since some of the placements can be quite far away from Norwich. Societies & The Social Side! There is a never-ending list of societies in UEA and in the actual Medical School itself, ranging from sports clubs, to cultural and religious societies, to academic societies. There are always events being held, along with various commitments and opportunities that allow you to get involved in areas that appeal to you, as well as make unforgettable memories and new connections. There is something for every single student and you will never run out of ideas on things to do, whether on-campus or off-campus in the Norwich city (there are so many huge landmarks and beautiful places to explore and enjoy). It is a smart idea to join the medical societies, including MedSoc, as they run important revision events and social events throughout the entire year - pitched to whatever year you may be in, covering the range of medical specialities taught in medical school. The African and Caribbean Medical Society and the general university-wide ACS (African and Caribbean Society) are hugely supportive, welcoming, and provide good networking and mentorship opportunities throughout the year – so definitely check them out! Final Advice & Tips Having travelled from London to come and live in Norwich for medical school, my personal experience is that London is much busier, more convenient and more diverse. There are more options in London and travelling is much easier, so if needed, I always recommend bulk-buying black hair products, ethnic food, seasoning etc., before coming back to Norwich! For those without a typical pre-med background, consider the Medicine with A Foundation year programme – something that a lot of people don’t know about! Find a balance between working hard and actually enjoying your 5/6 years in medical school – don’t miss the opportunity to make great memories to look back on after all those years (this is why UEA is known as ‘The Home of the Wonderful’!) Written By: Sandra Mireku Medical Student at Norwich Medical School

A part of the black health matters series, this week we are looking into topics surrounding mental health within our communities. We are delighted to introduce the wonderful team at Colourful-Minds. We're Colourful-Minds! We are a team of psychiatrists, psychologists, allied mental health professionals, volunteers from other professional backgrounds as well as individuals with lived experience of mental health difficulties. We are made up volunteers from a variety of ethnic and multi-faith backgrounds. As well as inhabiting black and brown bodies we also represent a variety of identities that find themselves marginalised in society. We are passionate about advocating for the mental health needs of people from black and minority ethnic backgrounds. As many of us are clinicians working in mental health, we have observed first-hand the disconnect between black and minority ethnic communities and mainstream mental health services. We have also identified that stigma and shame surrounding mental illness in these communities has contributed significantly to this disconnect. We aim to bridge this gap by presenting relatable faces of mental health services and amplify the voices from these communities so they can be heard in spaces where decisions are made about their care. We are dedicated to being ambassadors for black and minority ethnic people with mental health difficulties, and aim to reduce stigma, prejudice and discrimination as well as promote equality. We do this through, advocacy, education and research. By engaging with mental health, 3rd sector and community organisations, we are able to deliver dynamic workshops in our local community and beyond providing the space for important dialogue and learning on topics around mental illness and well-being. Health promotion and education is an important and effective strategy for preventing mental ill health. As we expand as an organisation we aim to engage with as many schools, churches, mosques and other community organisations as possible. By improving public understanding of mental illness we can promote better engagement with mental health services, particularly within the black and minority ethnic communities. Experiences of mental health problems reflect different cultural and socio-economic contexts. Individuals from these communities are statistically more likely to be diagnosed with a severe mental health problem and are more likely to be admitted to hospital. Studies also show that they are more likely to experience poor outcomes and disengage from mainstream services. We look forward to a future in which schools, churches, mosques, community clubs, youth centres all have access to education about mental health, well-being and mental illness; delivered by mental health professionals or trained volunteers. We also hope that our work will support much needed reform in mental health services so that they can be better adapted to meet the needs of the communities they serve. Find out more about Colourful-Minds on their pages: Website: http://colourful-minds.org.uk Instagram: colourfulminds_org Twitter: @MindsColourful

In 2013 I went to visit a friend studying medicine in Poznan, Poland. We had previously studied Biomedical Science together in the UK and both wanted to pursue medicine in the future. Before going I had some thoughts on how the trip would be. How cold it was going to be, how I would be treated as a black young woman travelling alone, the language barrier, but I was pleasantly surprised. So impressed that I also applied to the same medical school that academic year. When unfortunately, I did not receive any medical school offers in the UK, I made the decision to accept the offer from Poznan. I started medical school at the age of 23. It would often cross my mind that at this age a lot of people would be graduating from medicine by that age. The next four years were definitely a challenge and the course was not easy, but I honestly believe it has been the career best decision I have ever made! When I graduated, I was most nervous about not being able to carry out basic clinic procedures as my course was more theoretically based, and learning how to take bloods and insert cannulas were not included in our curriculum. I also worried about medical documentation, what if I write too much or too little. To be honest after talking to friends who did not study abroad, I realised we all had the same thoughts when we started, but thankfully, there were always people around willing to help and teach. Whether your journey to medicine is tradition or a non-traditional pathway, everyone’s journey is special and unique. Here are some tips for the journey: Obtain guidance and advice from someone who has been on the same journey Continue taking part in volunteering and work experience opportunities to help towards future medical school applications Look at all of your options and weigh them up Do not lose focus and be ready for hard work Do not lose hope Remember the end goal Believe in yourself Written by Dr Mobola Odukale FY3 doctor working in Kent

I still find it hard to believe that I managed to get a place to study Medicine at the University of Oxford – with it being the number one university in the world for that subject! Oxford is a beautiful city and there is always something to do. I don’t think I could ever get bored of this place. I’ve definitely been pushed academically (more so than I could have imagined) but I guess that’s what is needed to make a good doctor. It’s been weird spending what should have been my second year mostly online, but I guess some aspects of remote learning have been fun (i.e. not needing to wake up for 9AM lectures!). Course structure The Medicine course at Oxford follows a very traditional pathway. The degree is six years long, with the first three years being pre-clinical and the last three years being clinical. This means that the first half of the degree is spent going over the science behind the degree, and gaining a deeper understanding and appreciation for the body, before being taught and practising clinical skills. This structure is great for those who don’t necessarily want to get straight into the action, and would rather take the time to understand the theory first. I just find it helps translate better, in terms of knowing how to get to a potential diagnosis if you understand how and why things may have gone wrong. Your first two years are spent with your whole year doing the same lectures and practical work. This is quite nice as you get to meet with people from other colleges. Third year is focused on research projects. You get some choice on how you want to spend that year by choosing specific topics which you would like to learn in more detail. The clinical years are spent doing, I guess, clinical stuff (I’m only in my second year so my guess is as good as yours). During pre-clinical years, you don’t get as much patient contact compared to other universities. However, at Oxford, there is an opportunity to be overseen by a GP tutor who can introduce you to patients, with whom you can have conversations with about their medical condition and their lives. I think it’s a good start to getting patient contact without being intimidated from the get-go. Things to do There are societies for almost anything you can think of – both at college and university level. This means that there is a vast number of events and committees to be a part of, if you’re looking for some fun and some responsibility! As a fresher, I tried to be really involved with The Medical Society (MedSoc). This is because they helped to integrate the medics of our year so that we could get to know people from different colleges, a lot better than just sitting next to them in a lecture. Other societies also help to introduce you to people from other colleges - through sports, music, drama etc. Got a love for rowing? There are rowing clubs you can be a part of. Do you really love cheese and wine? Well, there’s a society for that too. There’s just so much choice when it comes to things to do, so definitely keep an open mind! The African and Caribbean Society (ACS) is my home away from home. The people are amazing and do a great job of helping you settle into university, find support networks and just generally have a good time! Definitely check them out because they are very supportive from start to finish. Tips Your degree is temporary, memories are forever. By this I mean, still focus on your academics and work where necessary, but don’t miss out on opportunities with your friends. There is time to catch up on things during the term or even during the vacation. So, I would say find a way to manage your workload and schedule, so that you aren’t always saying ‘no’ to events with friends. If you want to keep eating food from home (i.e. seasoned food), be prepared to walk or cycle far. You’re not going to get your plantain or Maggi seasoning from Tesco’s and the nearest place you can get those items is a good thirty/forty minute walk from the city centre. The same goes for any hair products. So, I would recommend finding a decent online retailer or just bulk-buying before you leave home. Remember, your tutors are there to support you so don’t be afraid to ask for help! Studying at Oxford will definitely allow you to make many fond memories. Enjoy it, and find that balance between working hard and playing hard to get the most out of it! Tolu Duckworth

This week we talk to Dr Mariam Adegoke about her career so far in general practice! Please tell us a little bit about yourself and your career journey so far? I graduated from the University of Liverpool almost 7 years ago and have worked in various roles in medicine since then. I did my foundation jobs in North West London and upon finishing them I wasn’t really sure which direction I wanted to go in. Trauma was one of my top choices but I couldn’t decide between trauma medicine (aka emergency medicine) or trauma surgery (orthopaedics). My CV and previous experience had been geared towards orthopaedics but I wasn’t 100% sure so I moved to Australia and worked in A&E there. I loved it! The lifestyle was great - you work to have a great life doing the things you want, not the other way round as we tend to do here - living just to work. They also really created a safe place for staff to learn. It was everything you’d want from an employer. Why did you choose this specialty? After a while running traumas it lost its edge and I started to find it quite repetitive as a lot of it is pattern recognition. The A&E doctors in Australia also cover the Early Treatment Zones - similar to the urgent care centres that we have in the UK. I found that I was increasingly drawn to this less acute side and because of how the health system is set up there, a lot of patients who couldn’t afford to see their GP attended A&E and were seen in the ETZ. I liked the pace and the continuity, but also the feeling of no two days being the same. That’s what drew me to wanting to specialise in general practice. General Practice is so varied in terms of the presentations you see. One person might come in with a low mood, another for a fit note, and another with mild chest pain that turns out to be a cardiac emergency. I find the variety enjoyable. During your time in medical school, did you enjoy this specialty? We had very little exposure to general practice at university. We had 7 weeks in fifth year and I did enjoy that as it was the first time that I felt like a ‘proper doctor’. This is because I was seeing the patients whilst the GP sat in. That placement was a very distant memory by the time it came to applying for general practice and one of my worries was that I would finally do a GP placement, hate it and be back to square one in terms of choosing a specialty. What is your greatest achievement to date? I set up my own medical wellness and aesthetics clinic based in Islington. It was not without its challenges but it’s rewarding to have a place of my own and be able to make a dream come true. I am passionate about wellness and think that lifestyle medicine is the future. It’s all about empowering people to make the small changes that will make a huge difference. It is rewarding to be able to be part of that journey with clients. I often get asked why wellness? Growing up in a Nigerian household, I saw first hand how family members struggled to make lifestyle changes to benefit their health. The standard advice they were given by their GPs was no good. Through this I really saw how the ‘one size fits all’ approach does not work, especially for people from ethnic backgrounds. Rather than one set advice list for everyone, small substitutions (such as changing ingredients to fresh, swapping palm oil to olive) go a long way and allow people from ethnic backgrounds to enjoy the foods that are part of their culture but with healthier changes. It is this use of lifestyle medicine as a part of disease prevention but also managing chronic diseases, that made me want to set up a practice in the wellness industry. As for aesthetics, I always had an eye for it and was interested in doing it since becoming a doctor. However, it wasn’t until I went through treating stubborn pigmentation of my own, including being treated in clinics that didn’t know how to treat black skin, that I began understanding more about skincare. I wanted to share my expertise with other black women so that they had safe practitioners they could see, without the risk of the lack of clinician knowledge exacerbating their skin problem. I trained to be able to offer a fully comprehensive service and I take pleasure in being able to find solutions to people’s skin/aesthetic concerns. What has been your biggest challenge working in this specialty so far? I’ve only worked in general practice in a post-covid world. For many, switching to mainly telephone triage has been a big adjustment but for me it’s how I (re-)met general practice. Even still, I’ve missed the face to face patient interaction and it undoubtedly affects rapport with patients. I look forward to getting that aspect back as we slowly ease out of restrictions. What do you like to do outside of work? Hobbies wise - I’m a keen photographer, I love travelling and I’m a gym bunny. If it involves being active and exploring, I’m there. Equally I’m a massive foodie and love brunching (counting down to May 17th!) What advice would you give to someone interested in this specialty? General Practice is so varied and can be anything you make it. Gone are the days of full time sessions - most GPs don’t do more than 7/8 sessions full time (3.5-4 days). You can fill your time doing other things - whether that’s working in medical aesthetics like I do, or doing locum work, being a GP with an extended role (e.g. in minor surgery, ENT or dermatology), working in TV medicine or doing something outside of medicine completely. The world is your oyster!

The Mind Us Wellbeing Fund is a free mental wellbeing support service for doctors and medical students of black African and Caribbean heritage, including individuals of mixed-race heritage. The fund will provide access to culturally competent psychological support delivered by ethnic minority psychology professionals. The COVID-19 pandemic has been shown to have had a disproportionately negative impact on the Black African and Caribbean community. Not only have there been alarmingly high mortality rates within the general public but also amongst healthcare professionals. The pandemic has also highlighted the stark health inequalities and barriers to healthcare that those within the black African and Caribbean community face and has exacerbated existing health inequalities in the UK. These inequalities coupled with the early lack of resources for frontline staff and adverse experiences of the workplace lead to high levels of apprehension and fear amongst ethnic minority staff. It has also had a damaging effect on the wellbeing and career support of many medical students and doctors from ethnic minority groups. Concerned by the lack of appropriate and targeted strategies to support this at-risk group, Melanin Medics established The Mind Us Wellbeing Fund. Through the fund, Melanin Medics will provide access to online supportive one-to-one wellbeing sessions for medical students and doctors from a black African or Caribbean background, including those of mixed-race heritage who have been adversely impacted by COVID-19. This will be a safe space to discuss any workplace related or personal stressors that have arisen due to recent events, and the therapists will suggest practical steps to help manage this as well as direct to further support if need be. The Wellbeing Fund forms a component of a wider array of initiatives supported by BMA Giving focused on supporting the mental wellbeing of black African and Caribbean medical students and doctors, called the Mind Us Project. The Mind Us Project aims to provide accessibility to wellbeing services for Black African and Caribbean medical students and doctors in order to help combat some of the negative ramifications of COVID-19 has had on their mental health whilst simultaneously facilitating career support. Olamide Dada, Founder and Chief Executive of Melanin Medics said: “At this time, it is necessary for us to provide both doctors and medical students who have made an invaluable contribution during the pandemic with the support they deserve. Over the past year, we have continued to navigate extremely challenging times and believe that the Wellbeing Fund will play a part of supporting both mental health and wellbeing as we continue to move forward.” “We are committed to initiating the changes that we wish to see through the establishment of a psychological support service which provides culturally appropriate and targeted support our current and future workforce and mitigate the long-term impacts of COVID-19 on mental wellbeing.” Chaand Nagpaul, Chair of Council, BMA said: “In the last year we have seen the tragic impact that Covid-19 has had on ethnic minority communities, exposing longstanding health inequalities. Doctors and medical students from Black African and Caribbean backgrounds, already facing the pressures of responding to the pandemic, have faced further anxiety and distress knowing they are at increased risk from the virus. In addition, they have suffered further distress in witnessing friends, loved ones and other people from the same background dying and becoming ill in disproportionately high numbers. “The aftershocks of the pandemic will continue to be felt for a long time, not least by those who have so selflessly been working in the health service, providing care to people during the most testing circumstances. But doctors can only look after patients if they too are looked-after and so the BMA is pleased to be supporting this important work from Melanin Medics. We hope this will provide an invaluable lifeline to doctors and medical students from Black African and Caribbean backgrounds.” Individuals will be able to access the Wellbeing Fund from the 5th of April 2021. For information about The Wellbeing Fund, or to find out more about The Mind Us Project, please visit our website at www.melaninmedics.com/wellbeing-fund. About Us Melanin Medics is a registered charity and home to the UK's largest intergenerational network for current and future African and Caribbean doctors. Melanin Medics has been focused to implement positive solutions to overcome racial and socio-economic barriers in Medicine by promoting diversity in Medicine, widening aspirations & aiding career progression. They run a number of programmes, events, engagements, outreach, networking opportunities, workshops and mentorship in order to achieve their mission. The organisation currently serves over 600 members of African and Caribbean descent within our networks of medical students and doctors in the UK. Melanin Medics stands as a leading voice in the national conversation on promoting diversity in medicine and widening participation and continue to advocate for racial equality in medicine.

Wellbeing is the state of feeling happy, healthy and comfortable. Writing this blog post could not have come at a better time because 11 months into being doctor and I can admit that I am not at the level of health or overall happiness that I was once at. Things were a lot worse, especially in the peak of the pandemic, but after taking some time off work and implementing the changes I am going to discuss, I can say that I am not where I want to be but I am not where I used to be. Being a Doctor is a very fulfilling and amazing job (one I will not change and am very grateful to have) but with many things in life, it comes at a cost, especially in your junior years. We all know that medical school can leave you very isolated from your non-medic friends. I remember summer nights and weekends in which I missed house parties, festivals, weddings and even THE Afronation all in the name of OSCE practice and medical school exams! I told myself that things will get better once I become a foundation doctor and I can confirm to you that, I was mistaken. The transition from being the most experienced student in your medical school to the least experienced at work is one that greatly affects your confidence and leads to anxiety. Many medics have a Type A personality; so having to admit that I did not know everything, feeling anxious about my decision making, and having to understand hospital politics, led to several encounters that convinced me that I did not deserve to be a doctor. Professional medical training is varied depending on the hospital you work at but one thing is guaranteed. That is, as a junior doctor, you will feel like a glorified secretary more often that not and you often have to tie up the loose ends with very little extrinsic affirmation. I say this not be pessimistic, but to give you a real insight into the emotions that many of my colleagues and I have experienced during our time so far. But as you progress and your emotional intelligence develops, things get a lot better. I can recall a time in which I was doing a discharge summary, HANGRY (this is a colloquial term to describe the anger you experience when you are very hungry) and I prescribed a patients antibiotics as twice daily as opposed to three times daily. After being bleeped by the very polite screening pharmacist in order to clarify my prescription, I was convinced that I was the worst doctor and my patient would have gotten sepsis and died because of my prescribing skills. I went into a rabbit hole of pessimism and lost confidence in myself which in turn made the problem worse. After a prolonged period of self-development and deep reflection, I soon realised that my wellbeing was in a terrible state, and that was not due to my professional medical training, but due to the importance I had placed on my medical training. Below are some tips I implemented which greatly improved my psychological and social wellbeing. 1. Everything has equal importance This is a concept I learned very recently. Everything has equal importance or nothing has importance at all. We often find that when we place too much importance onto something, we often achieve the very opposite effect to what we desired. One thrives in life when an equal importance is placed onto everything. The desire and drive you have to become an amazing doctor and making sure your DOPS are signed off, is the same you should have towards prioritising your mental health and ensuring that time spent with your family and friends is ticked off your check list. Foundation training can be time consuming but with real intentionality and learning how to organise, you will find that you will have pockets of time to fit in exercise, socialising and self-care. Diagnosing a patient with a condition means nothing if you haven’t diagnosed yourself as needing rest. Recognise that your purpose is bigger than being a doctor, and in order to fulfil your purpose, you need to be a well rounded and holistic individual. Your wellbeing is made up of a perfect unanimous working of all the areas of your life. You will never achieve true happiness, health and comfortability if you are prioritising only one part of your life. 2. Learn how to say no and take breaks If you do not know how to rest then you do not know how to work. When you first start work, your insecurity and desire to be liked or viewed in a positive light causes you to bite more that you can chew. You volunteer to become mess president, get involved in 100 audits, take on extra shifts and write essays of discharge summaries. Remember that people will treat you how you treat yourself. If you want to be a work slave then you will be treated as one. You soon learn what needs to be done urgently and what does not need to be done. As a junior doctor, you work as part of a multidisciplinary team and you are responsible for helping the other members of your team. It is okay to say no sometimes and admit when you feel overwhelmed. It is okay to ask for help, it does not make you less of a doctor. People will respect you more when you say no as opposed to say yes and do a half-hearted job. ‘No I unfortunately cannot cover that on-call because I currently feel burnt out and I worry that I will not be able to provide good patient care. Can I keep this day off to rest? I am still open to helping out in the future’. I remember days in which I would say yes to every request knowing that I have a million other things to do, I would stay at work until 10pm and only surviving on 4-5 hours sleep because I had spent all day saying yes to doing non-urgent bloods, cannula’s and catheters. One thing that I started to do is admit that I was overwhelmed and busy and would start to encourage the nursing staff to try. The conversations would go like ‘Doctor, Mr X’s cannula came out, can you come and do it please? ‘ My response would be ‘Sarah, I am currently really busy reviewing a patient and overwhelmed, could you kindly try to have a go or ask the ward sister to try and if you are not successful, give me a call back. I will come and do it before his next medication is due.’ 3. Let work, work for you and not the other way round My schedule is made up of my regular working hours, week and weekend on-calls coupled with my desire to decorate my Horus portfolio*. There is an unspoken competitiveness sometimes at work, and that coupled with insecurities, makes one put their all into their working day, going above and beyond not only for patient care to but to prove a point to your colleagues. Working all the time left me so tired, drained and burnt out. Even with my new found financial freedom, I still found myself too tired to engage in social activities and even conversations outside of work. I began to withdraw to the point at which the thought of social interaction used to give me anxiety and make me more tired. By the end of my zero days (the mandatory days you get off after on-calls), I found myself not feeling well rested and ready to begin the cycle again. What I soon realised is to maximise your time off by booking your annual leave around zero days and bank holidays. I would also say, if possible, take a day off on a Friday or Monday every 2-3 weeks in order to treat yourself to a long weekend. Swap your on-calls with your colleagues to dates and times that best suit you both. In F1, you all get paid the exact same amount and on-calls average out throughout the year. The truth is, as long as there is a junior doctor on-call for that shift, not too many people even sadly care. Every trust is different, but the majority are accommodating for swaps. * (an online portfolio which all junior doctors must complete which includes reflections, teaching logs, summaries of patient encounters and directly observed procedures) 4. Recognise that you can only pour out what you are filled with Recognise and remember the importance of self-care and days to replenish your stores. Have selfcare days and do what makes you happy. Mute the WhatsApp groups, turn off your notifications. Leave being a doctor at work, respectively, and remember that there is a lot more to you than your profession. A broken doctor cannot fix broken patients , you can only pour out what you are filled up with. Dr Maame Benko BSc MBBS Foundation Doctor