MONDAY... My first day after a very relaxing weekend was a very busy on call shift. A surgical on call shift runs from 8am to 9pm and we are the surgical “take team”. This means we see all the referrals from A&E and GP, and we also attend trauma calls. The team usually consists of an FY1, SHO and registrar. There is also a consultant on call, and all the patients are admitted under them, but they usually cover the emergency theatre list during the day whilst we see the referrals. We didn’t get many referrals in the morning, so I kindly helped out with the normal ward round. Around midday we got our first trauma call – a road traffic accident. A trauma call is attended by the on call surgical team, orthopaedics and the anaesthetist. I really enjoy attending trauma calls as you usually get to see some pretty interesting stuff, however there isn’t much for the FY1 to do so we’re usually a spare part. This time, however, I was asked to put in a cannula whilst they assessed the patient. It was a very high pressured situation so I got performance anxiety and couldn’t insert the cannula – luckily everyone was too busy to notice and the A&E nurse quickly swooped in to take over! Two months in and my cannula success rate is only about 50% but I’m getting there... I hope! After the trauma call, the referrals started coming in one after the other and I spent most of the day running around the hospital clerking patients. It took me 2 months but I finally know my way around the hospital. My average step count is about 12,000 per day but today it’s been 15,000. Who needs the gym when you’re an FY1 on general surgery?! TUESDAY... When I started this morning I still hadn’t recovered from the day before, so I decided to quickly get a coffee before I went onto the ward. In our hospital NHS staff get free hot drinks, so you can imagine how many times I go there in one day (hint: at least twice). I’m glad I decided to squeeze in that coffee because today was equally as busy, for some reason all of our patients had multiple jobs that needed to be done. I spent a significant amount of time begging the on call radiologist to approve my CT requests then chasing the results of these scans and updating our registrar who was doing the emergency theatre list. One thing I’ve learnt about being an FY1 is that the bulk of the job is administrative work. You’ll spend a lot of time ordering and chasing scans and bloods – particularly on general surgery. The only time you get to clerk a patient is when you’re on call so I’d recommend making the most of this time – it gives you a chance to practice those communication skills they drilled into you at medical school! Before I left I sat down and updated “The List”. On our first day the registrar stressed how important it was that the list was updated everyday to ensure the ward round runs smoothly so I make sure to do this before I leave each day! After work a few of us decided to get some drinks to vent about our days. One great thing about being a surgical FY1 is that there are so many of us which is great for getting know one another, and teams often help each other out when it gets a bit crazy! WEDNESDAY... Today we only had 20 patients on our list, which is pretty average for us! I was the only FY1 in my team today, but luckily I had 2 SHO’s and 1 registrar with me which helped! When you have a good team, it makes a huge difference and can often be the deciding factor on whether you leave on time or not! Today’s ward round was particularly long; we didn’t finish until around 12.30 pm. By the end of the ward round I was dying for a coffee but I had a meeting about exception reporting with the medical education lead at our hospital. Exception reporting is when you report days where you stay late and log your hours. You either get time off in lieu or paid for those extra hours. Things have calmed down now but there were many many days in the beginning where was I staying nearly 2 hours late every day. I didn’t exception report then, but I’ll definitely start now! Our medical education lead stressed how important this is as I was initially worried that it would reflect badly on me. However she explained that it helps the department identify where extra support is needed. After the ward round I got started on the jobs, had lunch and then continued with jobs for the rest of the day. At around 4 pm everyday we go through the list again with the registrar and check the bloods for our patients. Today we were a bit delayed so this didn’t happen until 4:30, where we discovered our patient had a potassium of 2.8. We followed protocol but it took about 3 of us to decipher the ECG (TIP: always ask for help!) where we discovered some ECG changes so quickly initiated treatment. The patient was stable so panic over – I made it home on time. THURSDAY... Our team was slightly smaller today but we had the same registrar as yesterday so our ward round was super speedy! I was feeling very pleased with myself, having completed all my jobs by 3pm when I got a call that one of the patients I was looking after had become unwell. She was spiking a very high temperature and vomiting. I went up to see her and quickly escalated to my registrar who came to see her with the consultant. I was asked to take blood cultures peripherally and from the picc line – the latter of which I had never done before. What started off as a very chill day had suddenly become really busy! Before I became a doctor, I was terrified of the idea that I’d have to look after sick patients, but in reality you’re very well supported. I’m the queen of escalating early as I’d rather my seniors are aware of the problem before the patient starts to deteriorate even further. I left slightly late today but I wanted to make sure my patient was stable before I handed over to the on call FY1 who was covering the wards from 5 – 9pm. I was exhausted when I got home so cancelled my dinner plans (a recurring theme) and instead had a very early night. FRIDAY... The “Friday feeling” doesn’t hit the same when you know you have to work over the weekend! It was a very erratic morning as two separate consultants wanted to see their patients halfway through the ward round. I understand the logic but it usually means the ward round takes much longer than it needs to be! Luckily we were very well staffed so most of were finished by 2pm! On Fridays we usually make sure to write a weekend plan on “the list” so that the weekend team know exactly what to do. When you’re working over the weekend, you usually cover an entire ward so you don’t know a lot of the patients. Therefore, it’s really helpful when there is a very clear weekend plan so you know exactly what the regular team would like you to do. After all the jobs were complete, my team kindly let me leave 30 minutes early so I could rest up before my 13 hour shifts this weekend. Unfortunately, I have house viewings all evening so not quite resting but I’m glad I can leave early for once! Today was a pretty typical week for me, if I’m being honest it’s been quite quiet! Surgery can be a very busy speciality but I’ve learnt a lot and I’m slowly getting to grips with things! I’m very lucky that I have very supportive seniors and a great team, it makes those busy weeks slightly more manageable! Written by FY1 (Anonymous), General Surgery, London Join the Melanin Medics F1 Doctors Mess Online Group: Virtual support network for African and Caribbean F1 Doctors in the UK https://forms.gle/mDhxzVfwxBfLbHRP6 Cover Image Reference: Getty Images. 2020. https://www.gettyimages.co.uk/videos/black-female-doctor?phrase=black%20female%20doctor&sort=best

WHAT IS THE AFP? The AFP is a type of Foundation Programme that provides a dedicated time for foundation doctors to get involved in either academic research, education, management, leadership and other areas such as health informatics and quality improvement projects. It includes either a 4-month block in your FY2 year or it can be integrated into your second year, for example as a day release (1-2 days a week) throughout FY2. There are a minority of AFPs that are integrated into the two years. It is dependent on the ‘Academic Unit of Application.’ These are a group of foundation schools that have joined together for the purpose of AFP application. For example North West Thames, North Central, East London and South Thames are the London AUoA. You will be required to work on a project that either you have formulated yourself, or a predetermined project, or joining a team on an ongoing project. The level of autonomy and flexibility is AUoA and project dependent. The post comes with an academic supervisor who will oversee your work and there is usually a local university affiliated to your Foundation school that will support your learning during your academic post. Some AFP posts come with an element of clinical work such as on calls or a half day in a clinic that allows you to maintain and update your clinical knowledge. Whilst some may have no clinical commitments in the 4-month academic block. WHY AFP? People choose to do an AFP instead of the FP for various reasons, such as:- As a route into academia for people that already know they want to go into academic medicine. However It is important to know that you do not have to do an AFP to be able to get into academic medicine. As an opportunity to explore whether an academic career is desired. As an avenue for networking, teaching, CV building, some AFPs (especially those with educational and leadership involvement) come with the opportunity to complete a PGCert which can either be fully or partly funded by the Trust. For some, it is a way to guarantee being in a location and or getting desired job rotations. HOW DO YOU APPLY FOR AFP? The application process is done via Oriel similar to standard foundation programme application just with the addition of one extra section on the form. You will be required to rank the academic jobs within the AUoA that you are applying to (you are not required to rank all of them). You can apply to a maximum of two out of 15 AUoAs. The application allows you to add more achievements (e.g. publications, presentations) compared to the standard FP. Once you apply, shortlisting is carried out by the AUoA who then invites you to an interview. AFP shortlisting score is determined by adding academic decile score to the AUoA score. The shortlisting process varies across different AUoA and the achievement may be weighted differently according to the AUoA. Point based- used by all AUoA Ways to score points include:- Other degrees- up to two additional degrees (compared to the standard FP which only allows one additional degree). Presentations (National and International)- up to ten. A poster only counts once i.e if you present the same poster at several conferences, it will only get 1 point. Academic publication- up to ten Prizes- up to ten The London AFP selection includes longlisting, based on your decile score (between 38-42). Followed by shortlisting which is based on the points above and then an interview. White space- used by some AUoA Some AFPs require you to answer six open-ended questions on why you want to take part in the AFP. These questions are unique to AUoA, and are released when applications open. They are usually centred around your academic experience, pertaining to the AFP that you are applying for as well as determining soft skills such as teamwork, organisational and leadership skills. It is best to approach these questions in the same way you would write a personal statement using the ‘STAR’ framework. Shortlisting is either based on the points or by a combination of points and white space answer scores. If you are shortlisted, you will be required to attend an interview. INTERVIEW PROCESS Interview styles vary across AUoA and deaneries. I had interviews for London and EBH/East Anglia so I will talk a bit more about them. London splits the interview into two parts - clinical and academic - each lasting 10 minutes. You will be provided with a brief for the clinical case and academic abstract shortly before the interview starts. The clinical part is usually centred around an emergency case for you to talk through the management options while taking into consideration other ethical and safeguarding issues that might come into play. The academic part, however, may be based on an abstract of a peer reviewed paper or your personal research/publication. You might be required to do a quick critical appraisal of said paper or answer specific questions about the paper. Regardless of the interview structure, the key point is that it is a chance for you to show your passion for academia, demonstrate your competence in clinical medicine and show off your breath of experiences. The EBH/East Anglia AUoA introduced a new interview style in 2020. This interview consisted of three stations with 1-2 questions per station. You might be asked to prepare a plan on how you might approach one of the modules of the AFP. This would also form one of the stations. It is advisable to research the interview style of your AUoA ahead of time and ensure you get lots of interview practice. Candidates find out the outcome of their applications from mid-January, at which point you will have 48 hours to either accept or reject the offer. There are usually multiple cascades for offers, so if you did not get an offer in the first cascade, there might still be a chance with the second or third cascades. The Academic Foundation Programme is competitive as spaces are very limited. If your AFP application is unsuccessful, then you will be automatically included in the FP application for that year. So, if you are considering applying for an AFP but you are worried that you will not get in - apply anyway as you have nothing to lose! Nevertheless, it is important to remember that there are also other ways to get involved with academic medicine besides the AFP. Top tips Firstly, make sure the AFP is for you. Would it meet your goals? Will you enjoy it? Does it come with job rotations that you like? Is there a level of flexibility in the projects (if desired)? etc. Do your research. Try to get into contact with anyone who has done or is doing the AFP that you are interested in. They will usually be able to give you more details about what the job entails. You can also contact the assigned supervisor for any questions prior to your application. Prepare for you interviews- VERY IMPORTANT. It is useful for a small group of peers for interview preparations. Ask for help- Reach out to friends/mentors/academic tutors to proofread your white space questions if applicable or help you with interview prep. Myths I need to have published lots of papers to be able to get in. You do not! There are many ways to score points for your application. Seek and take up opportunities to get involved in research as a student but if you have not published a paper by the application time, do not let it stop you from applying if you really want to do an AFP. Remember there are other ways to score points: Presentations (National and International) Academic publication- must have a PUBMED ID Prizes, Posters Other degrees Decile score Interview performance 2. The AFP is my way out of doing the SJT exam Every applicant must take the SJT. Technically, it is not used in the allocation process for AFP but if you have a very low score, you might lose your AFP. Written by Dr Ekelemnna Obiejesie MBBS BSc AICSM, Academic Foundation Doctor at Brighton and Sussex University Trust References https://foundationprogramme.nhs.uk/faqs/academic-foundation-programme-faqs/ Cover Image ref: USA Today. Osose Obah. https://eu.usatoday.com/story/news/health/2020/06/26/u-s-doctor-shortage-worsens-especially-black-and-latino-groups/3262561001/ Image ref: https://careersblog.enterprise.co.uk/tips-on-using-the-star-technique-to-answer-job-interview-questions/

Reflecting on the last 12 months, I would never have guessed that my first year as a junior doctor would be so gratifying, terrifying, surprising, boring, funny, sad, exciting, puzzling, stressful, enriching… This year has HAD. IT. ALL. The 2.5 days of shadowing during induction left me feeling somewhat unprepared on my first day. Thankfully, I had a wonderfully supportive team and friendly colleagues to guide me as I bumbled through my first few weeks on the ward. F1 has inundated me with new experiences and the learning curve has been steep. I reviewed a patient with “abdo pain” only to diagnose them with a pulmonary embolism after convincing the on-call radiologist that a CTPA was absolutely necessary. After all, “I don’t take referrals from F1s for CTPAs”. I advocated for patients. I held their hands. I relieved an elderly gentleman of his painful paraphimosis preventing a urological emergency in a hospital which has no out of hours urology service. I told frightened family members their loved one might not make it through the night. I spent a whole morning liaising with radiology, gastroenterology, dietitians and a worried wife to organise a PEG (percutaneous endoscopic gastrotomy) extension for my patient, only for it not to go ahead. I was shouted at by frustrated patients and anxious relatives. I’ve clapped and cheered as Covid patients were safely discharged home. I watched as others didn’t make it. I cannulated. I catheterised. I laughed. I cried. Some of you may already have some stories to tell as coronavirus forced you out of medical school and onto the wards as doctors earlier than expected. Others may have volunteered for the NHS or worked as HCAs. Or maybe you focused on enjoying your “final months of freedom”. Whatever your circumstances and prior experience, starting F1 can be daunting. It would be impossible for me to try to teach you everything you need to know about being a doctor and *surviving* F1 so I will simply highlight a few points to remember. You are not alone Sometimes you may hear horror stories about F1s left on their own to manage a ward of 30 patients on their first day or dealing with a deteriorating patient with no senior support. Remember these are just horror stories! The overwhelming majority of foundation trainees do not share these experiences. In reality, you are never alone as an F1. There should always be an SHO, registrar or consultant responsible on your ward who you can call on (even if they are busy in clinic, surgery or seeing a referral elsewhere). You are not expected to know everything - especially in the first few weeks - so please ask even if it’s just for reassurance! Role play Recognise what is your job and what isn’t. Sometimes you may have jobs and paperwork pushed your way that isn’t really your responsibility. There are ward clerks who book appointments and arrange transport, discharge co-ordinators who liaise with social workers about social care, nursing staff who change dressings and administer medications. Whilst it is not unreasonable to help your colleagues when you have the capacity, it is generally quicker, safer and better for your patients when the correct person completes the job they have been trained to do! What can I do for you? Learn how to delegate when necessary. If you are on call covering the wards and you are asked to review a sick patient, always ask the nurses to obtain any useful investigations (e.g. ECG, blood sugar, neuro obs) and check if they can take bloods, cannulate or run blood gases. They won’t necessarily volunteer to do these things if you don’t ask. They can help you get a head start in managing the patient before you have even stepped onto the ward. HELP! It’s an emergency! MET (medical emergency team) calls and cardiac arrests Many new doctors’ ask, “When is it appropriate for me to put out a MET call?” Answer: If you’re worried about airway compromise, put out a MET call. If you need more hands, put out a MET call. If you’re thinking about putting out a MET call, then it’s time to put out a MET call. If a patient arrests then it’s a no brainer, put out a MET/cardiac arrest call (it’s normally the same team). You will never be asked, “Why did you put out a call?” but you may be asked, “Why didn’t you put out a call earlier?”. If you ever do need to put out a MET call, remember to pull the emergency buzzer by the bed if you haven’t already and ask someone to put the call out for you. Never leave an unwell patient alone! Your hospital may also have a critical care outreach team (CCOT) comprised of skilled nurses with ITU and resuscitation experience. If your patient is unwell but the team on the ward is able to manage them without involving the medical emergency team, they are a very useful point of contact. They can assist you with your initial assessment and management and are very handy with cannulas and blood gases! Love to learn It may seem obvious that the aim of foundation training is to equip you with the necessary tools and “foundation” to become a good doctor. However, the NHS is a public service and system that relies on its staff to “get the job done”. It is easy to succumb to service provision (doing cannulas, writing discharge summaries etc.) and forget that you are also there to learn. You may no longer be a medical student but you are still training. Keep asking questions even if you don’t need to know the answer to do your job. Don’t be afraid to ask for teaching from your seniors or to learn new skills or procedures. You don’t need to be able to drain ascites or perform a lumbar puncture as an F1 but learning these skills makes the experience much more interesting! It can be difficult to learn or practise certain skills when SHOs and registrars are hunting for procedures they need to get signed off, but that shouldn’t completely obstruct your own learning. Your network is your net worth Take the time to know your nurses, HCAs, ward clerks, consultants, pharmacists, physios etc. Not only is it invaluable to have people you can rely on, but having a good working relationship with your colleagues means that if you need to make a questionable referral, ask for a sign off or request for TTAs to be authorised and dispensed after 5pm then you know who to call on. You will also have a more enjoyable work life if you have friends to laugh and commiserate with! Get involved There are always numerous opportunities to get involved during foundation training including teaching, leadership, management and quality improvement. You could plan weekly bedside teaching with medical students, organise events for the mess, advocate for your fellow junior doctors in the JDF (junior doctor forum) or design an audit/QIP. Don’t underestimate the value of getting involved in the medical community: locally within your hospital or more widely in national meetings, events and conferences. Remember this is probably the first time in a few years where you won’t have to come home to books, study and revision so you can maximise what you achieve during the working day. Getting involved does not only increase your non-clinical skills and your sense of belonging in the workplace, it can also help you in your career as in my next point. When I grow up, I want to be… If you’re like me and you have no idea what career you want to pursue in medicine then you’re probably not thinking about applying for your next post or training programme after foundation training. Unfortunately, if you’re not keen to take time out of training then you have less time than you think to develop your portfolio and apply for that next step. I’ve been enjoying F1 so much, I’ve only just woken up to the fact that applications open in November! Fortunately, F1 is a fantastic year to build up your portfolio simply by “getting involved” as I described in my last tip. Keep a record of any teaching you deliver and ask for written feedback from students. Write up your quality improvement project (QIP) and submit an abstract to a conference or journal. Request a letter of recommendation from the mess or JDF detailing your contribution to the welfare of junior doctors in your Trust. All of these things and more contribute to any application you make for training programmes after F2. There is considerable overlap between what different specialities and programmes are looking for in your portfolio. It doesn’t matter if you don’t know what you want to do yet. Taster days I’m sure many of you will have tried to choose jobs which cater to your interests or future career plans. However, if you don’t have that O&G job you really wanted or the ortho job of your dreams, then don’t worry. Tasters are a great opportunity to try out a specialty of interest or something completely new with which you are unfamiliar. You may be eligible to up to 5 taster days during F1. Completing taster days can show commitment to specialty. Even if you do not end up choosing that specialty as a career, it will serve as a talking point in interviews for why you decided on something else. I was fortunate to undertake several taster days in Paediatrics during F1 which were insightful. However, despite years of flirting with the idea of becoming a paediatrician, after my taster I realised that perhaps Paediatrics isn’t for me. Healthy mind, healthy doctor This job can be immensely rewarding but at times stressful and emotionally draining. Look out for each other at work and check in with your medic friends at other hospitals. Sometimes, you may be involved in particularly distressing MET calls or cardiac arrests or have difficult encounters with patients. It’s important to try and debrief with your colleagues or team afterwards to talk through what happened, how you felt and what could be done better in future. This doesn’t happen all the time and it isn’t always the culture especially amongst more senior doctors or consultants. Don’t be afraid to initiate this as it can be very cathartic and beneficial for your wellbeing and professional development. Sharing some of these challenging experiences with your housemates, friends and family (medical and non-medical) is important and you will need a network of people to turn to throughout your career. Home time Leave on time! You don’t always need to be a hero. There is a system in place that should enable you to hand over outstanding jobs to the next shift. Obviously, don’t abuse this by handing over work that could easily have been completed during the day. Always ask yourself, “If I don’t do this now, will it jeopardise my patient’s safety or unnecessarily delay their discharge?”. If the answer is no, it can wait until tomorrow. Remember, leaving just 15 minutes late every day for a month adds up to 5 hours of lost time! Exception reporting If you do have to leave late or if you find you’re having to come into work early in order to carry out your normal duties then please exception report. Exception reporting is the system whereby you inform your employer that your actual work differs from your agreed work schedule i.e. you have worked beyond your rostered/contracted hours. The report is sent to your educational supervisor, clinical supervisor and guardian of safe working or director of medical education. You should try to exception report within 2 weeks of the incident or 1 week if you want to claim payment. For any additional hours you work (this can be as little as 15-30 minutes!) you are eligible to either time off in lieu or additional pay. The exception reporting system exists not only to ensure that you are properly remunerated for any excess hours you work, but to highlight any issues with your work schedule. For example, if enough doctors submit exception reports enough times regarding the same rota then it suggests that the work schedule is inappropriate and needs adjustment. This can translate to the work schedule being changed in the future to accommodate the 30 minutes at the beginning of every shift that you need to update the ward list or the extra hour needed every other week to complete your Horus portfolio. “App”-solutely brilliant! There are lots of useful apps available to support you during F1. Below are some apps I regularly use: Microguide Search for your trust and download their guide to access the most up to date trust guidelines on antibiotic prescribing. Find the correct antibiotic, dose, route, frequency and duration based on the indication and alternatives in case of allergy. Please note that some trusts have additional guidelines available to view on Microguide for example; • Barking, Havering and Redbridge University Hospitals Trust - “Pharmacy Clinical Guidance” with useful prescribing information on replacing electrolytes amongst other guidelines • University of Southampton NHS Foundation Trust - “DiAppBetes” for diabetic emergencies and more • Oxford University Hospitals NHS Foundation Trust – “Pain Guidelines” for pain management in different patient groups Always remember to refer to your Trust or national guidelines first before looking at others! Induction Again, search for your hospital and save it to your favourites. You can find the extension and bleep numbers for every ward and department in the hospital. The data is crowdsourced from staff members so occasionally the information is out of date. However, it’s very easy to add new numbers, edit existing ones or flag when the data is incorrect. BNF Despite being vital for the PSA exam, the BNF is not necessarily the “know-it-all” resource for prescribing. Some drug monographs are very detailed and allow you to discern the correct dose of apixaban, for example, stratifying by indication, stroke risk factors and dose adjustments if there are bleeding risk factors. However, other monographs are quite vague. For example, if you want to know the exact dose of thiamine and vitamin B compound to give to a patient at risk of refeeding syndrome then expect to find a range of doses to choose from. You will find what you prescribe may come down to personal preference, trust guidelines or the classic method of “choosing the lowest dose” or “the one in the middle”. If you’re ever stuck, ask a senior or your helpful ward pharmacist! MDCalc Now that you’ve finished medical school you don’t necessarily need to calculate the Glasgow score for severe pancreatitis from memory. This app will do it for you! Just sign up for free access. Other commonly used apps and websites Dr Toolbox – available on the app store. Requires a Trust login. PocketDr – available on the app store for £2.99. Requires a Trust login. TOXBASE – requires a Trust login. Medusa – requires a Trust login. Whatever happens please don’t forget to… ENJOY IT!!! FY1 is an incredible year. It is the first time in your career when you can call yourself a doctor and the only time you will have so little responsibility as one. You may just be starting now but before you know it your first year as a junior doctor will be over. Enjoy it whilst it lasts! Join the Melanin Medics F1 Doctors Mess Online Group: Virtual support network for African and Caribbean F1 doctors in the UK https://forms.gle/mDhxzVfwxBfLbHRP6 Written by Dr Stephanie Ezekwe MBBS BSc (Hons) Academic Foundation Year 2 Doctor in North Central and East London

The last week has been hard. Traumatic. Exhausting. Frustrating. Everywhere you turn, you cannot escape from the harsh reality of racial injustice. The social media timeline littered with the video of a black man being murdered in the name of ‘law enforcement’. “I can’t breathe.” – one of the final statements George Floyd uttered before his death. I’m not sure what makes me shudder the most. The fact that I watched a man be brutally killed in broad daylight. Or perhaps it was the lack of empathy of the police officer as he continued to exert disproportionate force on the man’s neck. Or maybe the fact that the man’s outcries of pain were ignored. “I can’t breathe”. In medicine, this is probably one of the most worrying statements to hear. We’re trained to assess medical emergencies in the order of priority: Airway, Breathing, Circulation etc. The statement “I can’t breathe” raises immediate alarm bells, knowing fully well that life may be at stake. Yet in this situation it did not matter. It’s difficult to carry on as normal after seeing a man be killed. A man that could have been your loved one or anyone you know. A man who was a victim of someone’s racist judgment that ultimately lead to his life being tragically lost. It's becoming all too frequent. George Floyd, Ahmaud Arbery, Breonna Taylor and Belly Mujinga all lost their lives at the hands of racial injustice. It is irrational to even question the existence of racism at this point. It is even more ridiculous to question why Black lives matter. Black lives should matter to every medical professional. It is by no coincidence that the BMJ published an issue on ‘Racism in Medicine’ this year. Racism impacts us all. Racism impacts our patients. Racism impacts our colleagues. Racism impacts our interactions. Racism impacts Medicine. At its worst, racism kills. We cannot ignore this. The evidence is striking. Data analysed and collated by Dr Amile Inusa and Olamide Dada Health inequalities: Black women are 5x more likely to die during childbirth than white women in the UK. Black people are 4x more likely to die with COVID-19 than white people in the UK. The ethnicity pay gap means that for every £1 a black female doctor earns, a white female doctor earns £1.19 and a white male doctor makes £1.38. 95% of the frontline doctors that died because of COVID-19 were from an ethnic minority within the first month. Ethnic minority doctors are reported to the GMC more than twice the rate as white doctors. Ethnic minority doctors are more likely to be referred to the General Medical Council, have their cases investigated, and face tougher sanctions than their white colleague Black NHS staff report the highest incidence of bullying & harassment from their colleagues and leaders. Doctors from ethnic minorities are still twice as likely to be affected by discrimination at work and are at increased risk of experiencing bullying and harassment from both colleagues and patients In NHS healthcare leadership, 92% of board members in NHS trusts are white. This is the reality for Black medical professionals in the UK. We can’t run from it. The dark shadow of racism looms over us wherever we go. Whether it be overt or covert, it is there. To ignore the damaging impact of racism is to ignore the pain of a people. It is tiring to explain repeatedly why we matter or how institutional racism affects us, but we do it anyway. We want people to understand why things need to be changed for the better. We desire change not just for ourselves, but for the generations to come. We advocate. Even when the going gets tough. Even while experiencing the effects of our own racial trauma. We advocate because the future depends on it. Our vision is paramount to the work we do: We envision a future where diversity in Medicine thrives and every person is able to fulfil their maximum potential irrespective of their race and socioeconomic background. We are dedicated to supporting individuals of Black heritage in Medicine to the best of our ability and we are committed to doing all that we can to stand against racial injustice. If you are non-black person reading this, know that your colleagues need you. Know that your voice is equally as crucial to the conversation. Know that your actions matter. We all have a part to play to support each other and the prevention of further heinous crimes which are incited by racism. What can you do? SIGN THE PETITIONS Take meaningful action. Every signature represents a voice saying that the situation should not and cannot be ignored. DONATE There are a number of fundraising pages to support the loved ones in raising funeral costs of those who tragically lost their lives. You can also donate to charities and organisations actively fighting against racial injustice. BE INFORMED Speak to people and recognise what you don't understand and be willing to learn. There are a number of resources e.g. books, podcasts, article and media that can be used to educate yourself. BE VOCAL To understand is the beginning, to act is the result. "Anti-racism is the commitment to fight racism wherever you find it, including in yourself. And that's the only way forward." - Ijeoma Oluo CHECK IN ON YOUR BLACK COLLEAGUES For your colleagues performing their daily duties can be difficult; plagued with the fear of not knowing who is for you and who is not simply because of the colour of your skin. This an emotional and traumatic experience. Ask how you can provide support. Donate to Melanin Medics: www.melaninmedics.com/support Relevant Links: www.bit.ly/bellymujinga www.bit.ly/blacklivesmatterMM www.bit.ly/detroitbailsupport www.bit.ly/georgeflloyd www.bit.ly/ahmaudMM www.bit.ly/MMgeorgefloyd www.bit.ly/MMbreonnataylor www.bit.ly/bellymujingapetition Written By Olamide Dada

The coronavirus does not discriminate between individuals. It can affect anyone and no one is immune from its impact. However, recent data suggests that the severity of the COVID-19 infection amongst the Black And Minority Ethnic (BAME) population is disproportionate. What is the problem? Data from the Intensive Care National Audit and Research Centre (ICNARC) suggests that 34% of the critically ill coronavirus patients are from BAME backgrounds. This research was based on 3300 patients from ICUs across England, Wales and Northern Island. The first 10 doctors to die in the UK from COVID-19 were all BAME. 70% of the 54 front line healthcare workers that have died in the UK because of COVID-19, were BAME. These numbers worsen on a daily basis. According to the 2011 census, just 14% of the UK population are from BAME backgrounds. In the US, both the overall number of confirmed cases and deaths is broken down by ethnicity. In Chicago, approximately 70% of the coronavirus victims were black, despite black people representing only a third of the population. Similar numbers have also been seen in New York, Detroit and New Orleans. What could be the reasons? Several reasons could be underpinning this, but we know that Coronavirus has amplified the racial and economic disparities that still sadly exist in our world today. The Science It is widely known that certain diseases are more prevalent in particular ethnic groups. Although the precise mechanisms are unclear, it is likely that genetics play a huge part. For example, people from Afro-Caribbean or Asian descent are more likely to suffer from cardiovascular disease and diabetes than their European counterparts. Two conditions that have been shown to be associated with more severe outcomes from COVID-19. Although the direction of cause and effect is yet to be determined, many healthcare professionals attribute the racial disparity of COVID-19 deaths to this reason. Additionally, the biopsychosocial effects of racism may lead to high levels of stress, which is a known risk factor of hypertension and as a result, cardiovascular disease. This suggests that the increased prevalence amongst the BAME community may be the result of a complex interaction between genetics and environmental factors; wherein a genetic component is further exacerbated by social stressors. There may indeed be genetic differences or factors of genetic susceptibility, however this disproportionality is occurring across different ethnic groups; making a genetic cause less likely. This highlights the pressing need for further research before any solid conclusions can be made. Nonetheless, we must not forget that the overwhelming determinants of health are socially created. Socio-economic factors UK BAME communities rank poorly in socio-economic indicators of poverty and deprivation; an outcome of longstanding structural inequalities in Britain as well as the institutional racism in government policies relating to immigration, housing, criminal justice and social welfare support. A large proportion of the BAME population having public facing occupations. They make up a large share of jobs considered essential in tackling the virus, the very roles that are making our self-isolating process more manageable; from the essential cleaners to the healthcare professionals; customer assistants in our local supermarkets to delivery staff, transport workers and many more. However, this means that the racialised aspect of the crisis is further compounded. So whilst many of us are able to stay at home, they cannot. Therefore, their risk of contracting the virus is substantially greater. Cultural differences Another factor to consider is different cultural beliefs and behaviours. Amongst BAME communities there is a stronger culture of multi-generational living. This is when multiple generations in a family live in the same home. As a result, there is over-crowding in households and under recent circumstances, places the elder population and those with co-morbidities at a greater risk. Researchers at the University of Oxford have suggested that this factor contributed to the accelerated spread and crisis in Italy, as a large proportion of their population are elderly and people are more likely to live with their grandparents. The message needs to be clear. Is enough being done to ensure that everyone is fully receiving and comprehending the guidance that is out there? Is the information being translated for those whom English is not their first language? Due to new policies in preventing the spread of disease, family members are no longer allowed to visit their relatives in hospitals and therefore are not able to assist in translating. As many of our readers are BAME healthcare professionals, it is key that we use our voices to properly educate our families, friends and our respective communities and debunk the many, many myths (many of which are arising from the hundreds of forwarded WhatsApp messages) and spread information not fear. What next? Both the British Medical Association (BMA) and the Labour Party have called on the government to launch an enquiry and urgently further investigate this disparity. On the 16th of April, the government announces that they will be launching a formal review into why people from a black and minority ethnic background appear to be disproportionately affected by COVID-19. This enquiry will be particularly beneficial by providing an intersectional analysis exploring associated the risk factors of COVID-19 and ethnicity-based data in order to better inform healthcare providers and prevent the further loss of lives. This will undoubtedly uncover more evidence on the complex yet striking relationship between health and racial inequality in Britain. BAME healthcare workers make up a significant proportion of the victims of this virus. Although there may be several reasons underpinning this, this unfortunate situation has further revealed the underlying inequalities facing BAME communities as a whole. We need to ensure that all healthcare workers are safe and appropriately protected with Personal Protective Equipment (PPE), our population is safeguarded, and the government takes action. The NHS has always heavily relied on its ethnic minority staff. They make up a significant proportion of the NHS workforce and unfortunately many are losing their lives in the battle against COVID-19. To all the healthcare professionals; the vast majority of whom came from overseas and gave their lives to the NHS to save others, as well as our other essential key workers who have sadly lost their lives, may their souls rest in perfect peace and our condolences to their loved ones. Written By Khadija Owusu, Olamide Dada and Ife Akano-Williams

Recently the government announced that the lockdown period was to be extended for a further three weeks. Whilst we understand that this is necessary for the safety and wellbeing of the general public, we also understand that social distancing may be frustrating for some of you! We have put together a list of (social distancing friendly) suggestions to help you preoccupy yourself during this time. Exercise It is well known that physical activity helps to improve your mood and help with anxiety. Although gyms are closed, there are still many ways to get that endorphin rush that comes from exercise. Right now home workouts are your best friend, and YouTube is filled with so many great videos that you can do from the comfort of your bedroom. From yoga to HIIT there is something for everyone, no matter how big or small your space is. If you want a gentler form of exercise – take advantage of the daily outdoor exercise allowance and go on a walk. If you have any green spaces around you this is even better as being around nature may help to still your mind and help you recharge after a long day. IDEAS: Home workout challenges (Youtube, Instagram Live) Walk or Run Cycling Skipping Nourish your social life We know this phrase might seem a little bit crazy right now because how can you have a social life when you can’t leave your house! Luckily there are several ways to stay connected with friends and family during this time *cue Houseparty, Zoom and Facetime*. Some of you may be social distancing alone but feeling connected to people is important, more so right now. If you’re able, reach out to your friends and family; it may give you a different perspective and give you some extra support. IDEAS: Write down a list of all the people you want to contact that week and plan to call different people on different days, spreading over the course of the week One-to-one calls or Group calls Organise an online Games Night with friends Self-care The current situation is impacting everyone and we are all worried about our own health and that of our loved ones so it is completely normal to feel anxious during this time. Whenever you can, take some time out of your day or week to focus on yourself. Self care looks different for everyone but the overriding principles remains the same. It is any activity that you purposely do to take of your physical, emotional and mental wellbeing. One good way to practice self care is to do something therapeutic. As mentioned earlier, self-care is unique to each person so this may mean doing a face mask or practicing make up skills! Meditation and mindfulness is something a lot of people find calming and there are a lot of free apps that can make your mindfulness and meditation journey a lot easier. Another effective way to practice self care is to take care of something else. There are many on-line plant nurseries that are still open so you could invest in some plants and start an indoor garden; a great way to bring nature indoors. There are many things you can do to take of yourself and if you know that a particular activity makes you more relaxed, set time aside to do it. IDEAS: Set a designated self-care day Schedule rest days Restrict your use of social media e.g. limit your use to only certain hours of the day Gardening Read and set targets Online Courses (Check out the FREE online courses offered by: Ivy League Open University Try something new We’ve all got something we’ve always wanted to do but never got round to it; that really interesting hobby you’ve always wanted to try but kept putting off. Now is the time to dust off those old ideas and bring them into fruition! Home baking is a great way to kill some time and there will always be a guaranteed reward at the end of it, the quality of which will of course depend on your baking skills, however! Social media is showing us that everyone has a top chef hiding inside of them, why not grab some bananas during your weekly food shop and whip up some banana bread! Home improvement For many people, a tidy space means a clear mind. Spring is in full force and so there is no better time to do some spring cleaning! Declutter your space – take a few things out of room that you don’t use regularly and donate it to charity. Start an arts and craft project and create some nifty handmade storage containers so you can store away some items! If you’re lucky enough to own your home, you could fix up that area of home you’ve always wanted to improve! Some examples include installing some shelves for photos or books, or even creating a makeshift home office space. Order your supplies from an online store and get it going. Make it a Habit Do something for the Soul e.g. meditate, mindfulness, read Do something for the body e.g. exercise, yoga, workout Do something for the brain e.g. study/academic work, an online course, puzzles, learn a new skill Do something productive e.g. chores, organising, planning out the things you need to do Do something for the heart e.g. call family/friends, hobbies, paint, bake, read, cook Do something fun e.g. chill (e.g. Netflix, movies), social media, board games Do something to wind down e.g. journal, express gratitude, sleep, pamper yourself Spend time outside (if you can) e.g. read outside, work outside, workout Source: Twitter - @plntbasedcutie We all have free time on our hands, and a lot of us don’t know what to do with it. There are several ways to tackle this problem, and in the process improve our physical, emotional and mental well-being. Written by, Dr Ife Akano-Williams

With our country facing one of the biggest challenges in history, it was no doubt that an army of volunteers would be required to support our beloved NHS as it is stretched beyond measure. We wanted to share first-hand experiences of medical students volunteering in the NHS to help give you an insight into what it is really like, dispelling some of the myths and showing how you can make a difference. Kwarteng Sarfo's Experience In 2014 when I started this medical school journey, I honestly didn’t think this is how it would end. Medical finals reduced to three online tests, a respiratory illness sweeping the nation and a bunch of Instagram challenges. Regardless though, I have seen the good in it. I have seen the hidden side of the NHS. Following my graduation, a week ago, I decided to volunteer, hoping to provide assistance to the various sectors within Imperial NHS Trust that needed. Part of it was the innate altruism that I regurgitated during my medical school interview, but I will be honest, I needed to get out of the house. 24 hours with the family was getting a bit too much. Before I left, I received some serious prayers from my worried mother, in addition to the misleading WhatsApp messages sent from the aunties and uncles, about how to deal with coronavirus. You could say I was “ready” to do what I could to tackle coronavirus. Sunday evening, I moved into the Imperial provided accommodation and completed our online induction modules because you know, social distancing. Later on, I got the email detailing my allocation. “You have been allocated to the Surgery cancer and cardiovascular management department” The who of the who department? I thought I was going to be honing my skills of cannulation, venepuncture and catheterisation because when I thought “shortage” I thought it meant only “clinical shortage.” I was wrong. For the past week I have been working as a validator tasked with two jobs: Job number 1 ⁃ In normal circumstances, when doctors see a patient, in addition to writing structured notes they are supposed to conclude the consultation. In broad terms, a patient is either discharged or in need of a flow up. Unfortunately considering the ongoing pandemic, this task has been left incomplete by many doctors. This is where I come in. My first task in simple terms, is to look through past consultation and assign a conclusion to the case. This involves looking through clinical notes and making a decision of finality or continuity Job number 2 ⁃ With this upsurge in coronavirus, various patients have had their elective surgeries cancelled in order to curtail the spread of covid-19. This is a brilliant approach, unfortunately, NHS have a policy that doesn’t help the situation. In order to understand this policy, you need to understand the term RTT. This stands for referral to treatment time, that is, the time taken from a patient’s referral to be received at a hospital to when the patient is treated. NHS says, 92% of hospital referrals, their RTT should ideally be 18 weeks. Meaning the time taken from your referral to be received to when you get treated should be within 18 weeks. Another part of this policy is that NHS has a zero tolerance on an RTT of 52 weeks. So, you shouldn’t be waiting for a year to get treated for something you were referred to the hospital for. Of course, this is a brilliant policy but...Coronavirus. This pandemic has caused many hospitals to remove many off the elective surgery list. Inadvertently, this delays a patient’s RTT and with every week a patient is over the 52 weeks threshold, a hospital gets fined a hefty amount, we’re talking pounds in the thousand. This is where I, a recent medical school graduate, who struggles remembering his NHS email password, comes in to “help.” It has been a super steep learning curve, but I have learned so much! I’ve had a week’s training in Cerner, Microsoft teams and excel and I honestly couldn’t be better prepared to deal with IT related stuff as a foundation doctor. I have come to appreciate the diligent staff that work in the shadows of NHS to ensure the patient we booked 6 months ago attends their surgery on time and at the right date. I have come to appreciate that a hospital isn’t just the medical staff that make clinical decisions rather it includes the superheroes that look through some doctors indiscernible notes, to identify if a patients elective surgery, that was cancelled due to coronavirus, is of a high or low priority. Yes, my current role is very different to what I expected I’d be doing to help this pandemic. Yes, it would be great to find a juicy vein for venepuncture, but I am learning something new I didn’t appreciate before COVID-19. There’s more to the NHS than the front-end assembly of doctors and healthcare staff. We have some unappreciated superheroes in the backend ensuring you are receiving adequate care in adequate timing. Charlene Khoza's Experience Eye-opening. That’s how best I can describe my experience of volunteering so far. I chose to volunteer in a non-clinical role, working to organise and distribute the PPE that the clinical staff need. I have learnt just how much work goes into ensuring there are adequate supplies of the gloves, masks and other essential clinical equipment that keep the hospital going. It is hard. I have learnt about the secret tunnels, doors and routes in the hospital basements that are used to deliver equipment. I have learnt what happens between ordering something and it arriving on the ward. Even though there may be shortages, there is someone working to make sure that staff get what they need. This role has also taught me that sometimes the best way to help is to offer a listening ear. Doctors, nurses and other healthcare staff are human too and just as afraid of this situation as the next person. They need someone to share those fears with and who can reassure them that they are doing a great job and that there are adequate supplies to keep them safe. Being the voice over the phone telling them those things has been a humbling experience. I started off feeling unsure about what I could contribute and what would be of most benefit to the hospital I am in. But as time has passed, I have realised that I do have something to offer. Even if it may be something as simple as smile – it makes a difference. Written by Dr Kwarteng Sarfo and Dr Charlene Khoza Are you interested in volunteering with the NHS during this time? We recommend searching for volunteering schemes at your local hospital. There are many other ways you can support those around you at this time too. Look out for our next article!

Cancelled exams. Cancelled electives. Cancelled placements. An indefinitely postponed graduation and a call to join the frontline in the fight against COVID-19. This is the reality for final year medical students, facing one of the toughest decisions they are likely to make in their lifetime. Following the recent announcement by Matt Hancock, the secretary of Health, the government announced that over 5000 final year medical students will be graduating early and joining the frontline to join healthcare workers in the fight against COVID-19. This was a decision that caught many by surprise, including the aforementioned final year medical students across the country. Early Provisional Registration and Foundation Interim Year 1 (FiY1) posts Final year medical students who have graduated from a UK medical school will be eligible to volunteer and take up Foundation Interim Year 1 doctor posts (including those on the primary list and reserve list for the 2020-21 UK Foundation Programme). In order to be granted provisional GMC registration, doctors must be part of a Foundation Programme, i.e. be in a recognised Foundation Year 1 (F1) post, which can be a short-term post such as an FiY1 post. Students must choose whether or not they wish to obtain early provisional registration and join the frontline. There is no obligation for students who have recently graduated to serve in the NHS immediately. According to the BMA, these will be paid posts on a fixed term contract for 4-5 months before individuals would normally have joined the foundation programme. Volunteers will have the choice to work in hospitals trust near to their medical school or at the trust they have been allocated to work in as part of the UK Foundation Programme. The local foundation school will be responsible for overseeing the training of interim F1s during this time. Plans for final year medical students are dependent on the individual medical schools and local arrangements. This is dependent on whether medical schools have fully assessed the competencies for new doctors required by the GMC. The aim is for final year medical students to join the workforce as soon as practical. Some medical schools are only letting final year medical students work as HCA’s for the time being Sources: UKFPO, GMC, BMA. It is important to note that these new job posts may be subject to changes, so we encourage you to stay updated by regularly reviewing reliable sources. Are Final Year Medical Students Ready? The lack of clarity is resounding. We have spoken to final year medical students from various medical schools across the country; some who have just officially graduated having sat their exams only a few weeks ago and others who have had their final exams cancelled. Not quite the victorious end which many have dreamed of; nevertheless, life must go on. We asked what their questions and worries were with regards to the government announcement. The main questions were surrounding: What is to be expected of them? Will they have the appropriate supervision that they need? Is there enough PPE to protect them from the disease? Is their knowledge sufficient enough to step up to the task being asked of them? How will they be viewed if they don’t step up? What is in place to ensure a smooth transition from being a medical student to being a doctor? “Hearing that both my written and clinical exams had been cancelled was a huge relief. It’s common knowledge that finals are amongst the hardest exams you’ll have during your time at medical school. However, the novelty soon wore off. The decision to get final year medical students working early was communicated to the public before it was communicated to us. We found out at the same time as everyone else, despite these decisions directly impacting our lives and unfortunately, many of us do not feel ready. Our exams were scheduled for May/June so whilst our knowledge is adequate, it is not as good as it should be. Additionally, the pressing nature of this situation means many issues have not been addressed. The most important being that after June, many of our housing contracts will be up. How are we expected to work without having anywhere to live? Despite my reservations, I’m more than happy to help the NHS during this time of crisis, but I do not believe it should be as FY1’s. The thought of having to take up a role that I have not fully mentally or academically prepared for is very daunting.” – Final Year Medical Student Should medical students even be asked to step up in this capacity? It’s a tough ask but it reveals the extent of the dire times that we are currently in. With shortages of healthcare staff existing nationally prior to this crisis, the guidance to self-isolate for two weeks if you or anyone you live with has any cold like symptoms has resulted in even greater shortages. In as much as we need more support, students must be aware of what they’re stepping in to: a system already bursting at the seams now overwhelmed with a pandemic which shows no current signs of slowing down. The reality of the problem A lot of doctors say that the best learning is done on the job, but the current circumstances are very different. We spoke to a doctor (SHO) about what he feels final year medical students should know. “When I first started as an F1 I was nervous to prescribe paracetamol for patients. Frantically checking co-morbidities and drug interactions etc. Getting stressed taking bloods from patients or trying to place cannulas and do ABGs in real life scenarios knowing I was responsible. Now imagine the same scenario times 100. I have 25 COVID-19 positive patients. When you go in there with an apron, gloves and a mask, and the patients are coughing everywhere. Look frail. Struggling to breath. Basically, dying in front of you. Consider how you will feel. Not only the pressure of trying not to come out telling everyone you failed. But also, to try minimise your own exposure to this deadly virus. But then also consider the emotional stress. This is not something to take lightly. I appreciate all of you willing students and I applaud your bravery. But I want you to truly know what you're volunteering for.” Let’s talk peer pressure Competitiveness amongst medical students is nothing new. It’s what you’d expect when you're bringing together a number of students amongst the top 10% of the country. But now is not the time for peer pressure to be rampant, each individual needs to act according to what best suits them at this time. Although these interim FY1 posts are voluntary, there is the worry that if you don’t volunteer, you will be missing out on a once in a lifetime experience, being left behind or looked down upon by your peers for being too scared to face the pandemic. Rather than peer pressure, let us ensure we are extending support and encouragement to our peers, reminding that no matter what they decide to do in this time, it is okay. Whether you decide to step up now or later, you are still as valuable. Our MM Tips Do what’s best for you. Discuss with friends or family, or make the decision on your own. Weigh up the pros and cons and understand the challenge ahead. It's okay to be afraid. Fear is a completely natural response. You are not alone. The current uncertainty is likely to be unsettling but you are capable. The GMC are responsible for acting in the best interest for medical students, doctors and patients and if they and your medical school believe that you have received sufficient training to practise as a doctor, you have no choice but to take their word for it. Familiarise yourself with the Advice available and stay updated. British Medical Association: If you haven’t yet, join the BMA – membership is free for Final year medical students up until October the 1st. https://beta.bma.org.uk/advice-and-support/covid-19/your-contract/covid-19-early-provisional-registration-for-final-year-students Join the BMA Medical Students Facebook Page: https://www.facebook.com/BMAstudents/photos/a.341683459180314/3454069574608338 General Medical Council: https://www.gmc-uk.org/news/news-archive/early-provisional-registration-for-final-year-medical-students UK Foundation Programme: Make sure you are familiar with the advice from the UKFPO. Ensure you are receiving what the UKFPO guidelines state: Induction, Full supervision, Debriefing, Recognition of your contribution at this time, Remuneration, Indemnity, Access to other resources provided to foundation doctors. These are essential components that should not be foregone to you starting work despite the times we are in. These components are necessary in order to keep you safe and well covered. Make use of the resources available Facebook Group: https://www.facebook.com/groups/medics.academy.final.2020/ Medics Academy FREE F1 Prep: https://www.medics.academy/courses/F-Docs-Programme Foundation Doctor Handbook are offering FREE copy of their app: Foundation Doctor Handbook - Assessment advice, management algorithms, reference docs and clinical calculators. Everything a FY Dr needs! Apple: https://t.co/AzzAAFVxL4?amp=1, Android: https://t.co/eTUyJxFWWt?amp=1 Coronavirus Tech Handbook: https://coronavirustechhandbook.com/medical-students BMA Wellbeing Support: There is always someone you can talk to. The BMA Wellbeing Support services provides confidential 24/7 counselling and peer support services open to all doctors and medical students on 0330 123 1245. BMA - Wellbeing support services https://www.bma.org.uk/advice/work-life-support/your-wellbeing/counselling-and-peer-support Written by Olamide Dada

As part of our plans to expand this year, we have decided to share the stories of many Melanin Medics (both doctors and medical students). We believe that it is very important to show that our journeys to Medicine may differ greatly but ultimately the destination remains the same. Through out the year we will be interviewing various Melanin Medics at different stages in their training/ careers, giving them the opportunity to share their personal stories of the steps they took to excel in their careers and get to where they are today. Recently, we had the opportunity to interview Ayowade Adeleye, an international student from Nigeria studying Medicine in the UK. MM: PLEASE CAN YOU TELL US WHAT MADE YOU WANT TO STUDY MEDICINE? AA: Medicine was always the first thing I wanted to do, but along the line I diverted a bit and considered other career paths, in the end I came back to my “first love”; as they say “your first answer is often the correct one”. I also knew that I wanted to study something that gave me a balance of science and caring for people (cliché, I know but it is true). As someone who gets bored really easily I knew when choosing my career I needed something that would keep me interested and involved for a long time. I found Medicine intriguing enough to keep me interested for my whole life. Medicine gives a variety of options for my future career path and within my future career path it also provides various opportunities e.g. whilst practising I can explore teaching as well which is what I love. MM: WHAT OTHER CAREER OPTIONS DID YOU CONSIDER? AA: I considered engineering but the amount of math and physics in uni scared me away; I also considered Social work but I wanted something a bit more science related. Interestingly, I never considered law or business and I’ve always been quite creative and into graphic design but I preferred it as a hobby rather than full time career. (For those who may not know, she designed the MM logo). So I actually found my way back to medicine by eliminating everything I didn’t want to do. MM: WHAT MADE YOU DECIDE TO STUDY ABROAD? AA: The educational system in Nigeria is heavily based on rote learning e.g. memorisation, learning facts and just basically studying to pass exams. While some people thrive in this system, I knew that I couldn’t maximise my potential in such a system. I wanted a system that was more involved in hands-on learning and acquiring applicable knowledge and that was what the UK system was, particularly Cardiff. MM: WHY DID YOU CHOOSE THE UK, SPECIFICALLY? AA: I considered applying to America and Canada, but in both countries I had to do a primary undergraduate degree before getting into med school. I also considered applying to Eastern Europe, but they offer a traditional course which as I mentioned earlier was not suitable for me. The UK offered the most direct route to medicine as well as the most suitable method of learning for me. MM: COULD YOU TELL US A BIT ABOUT YOUR JOURNEY TO STUDYING MEDICINE IN THE UK. AA: My school in Nigeria was an international school that ran an ‘Early Decision Programme’, to give high achieving students the opportunity to sit the traditional 2 year A-Levels in 1 year. So basically, I started my A-Levels before sitting my O-Levels (GCSE’s) and then continued my A-Levels in August 2014, so I graduated from High School in June 2014 and I sat my AS exams in October/ November 2014 and wrote my A2 exams in May/June 2015. During my A-Levels I applied to UK Medical Schools for the first time, My first application was not successful. I believe this was due to a number of factors; I was 17 at the time (most UK medical schools require you to be 18 before you start the course), I didn’t have enough information about specifically applying to Medical Schools in the UK and I was doing my AS exams at the time so I couldn’t really focus on my application. But I had an offer from the University of Southampton for Audiology and thankfully by the time by A2 results came out, I met the entry requirements. I studied Chemistry, Biology, Physics & Sociology and I achieved 3A’s & 1B and subsequently accepted my offer to the University of Southampton and the plan I had was to do Graduate Entry Medicine after completing by Audiology Degree but just as I was processing my Visa to come to the UK , my parents decided I should make another attempt at applying for to the UK for medicine so I had to take a Gap Year. This was one of the best decisions I ever made. MM: WHAT DID YOU DO DURING YOUR GAP YEAR? AA: During my gap year, the plan was to put all my energy and focus into my application. So I spent the first month of gap year writing my Personal Statement which was corrected, revised and reviewed so many times and thankfully I got a lot of help from my parents, aunties, uncles, doctors and ‘The Medic Portal’. Once I had my final draft, I spent the next part preparing for the UKCAT with the help of ‘Medify’ & ‘The Medic Portal’ and sat the test in Nigeria. By the end of November/ beginning of December I had heard back from all of the Medical Schools I had applied to and received Interviews for all of them. So on the 26th of December 2015 I travelled to the UK by myself  for the first time and luckily all my Interviews were within a month of each other so I didn’t need to make several trips. I received interviews from Hull York Medical School, University of Leicester, Cardiff University & University of East Anglia and was privileged to receive offers from all. At the end of the day it was just God that helped me through it all, as I don’t think I that I did anything extra or special. I also utilised my gap year doing so many things that I’d  always wanted to do such as voluntary work and training in hair styling and make up artistry. My school in Nigeria also made it mandatory for everybody to apply to university in Nigeria. So having applied to University of Ibadan Medical School, I received an offer to study Medicine as a direct entry student which meant I went straight into 2nd year because I already had A-Levels. So while waiting for hear back from the UK Medical Schools I started Medical School in Nigeria. Where I spent about 6 months studying medicine. MM: WHAT WAS MEDICAL SCHOOL LIKE IN NIGERIA? AA: Medical School was interesting, even though I was there for a short time I enjoyed my time there and made a lot of friends who I am still in touch with today. However, in regards to the Medical School curriculum, I struggled a bit because as previously mentioned there was a lot of information to process in a short time and I found it a bit abstract because there were no clinical correlations and the course was very traditional. MM: WHAT IS YOUR CURRENT MEDICAL SCHOOL LIKE? AA: I am a 2nd year Medical student studying in Cardiff and I absolutely love it. The course is amazing. The course is called “Case-Based learning” which was devised by the university itself. We get given a case at the beginning of the 2 week period and all of our learning is based around the case. For example, if we get a patient who presents with a heart attack in the case scenario, we have to learn the relevant scientific and clinical concepts in regards to the heart and the cardiovascular system. We also have weekly placements and clinical skills sessions related to case. One of the major underlying features of our course is the ‘Spiral Curriculum’, which means that over the course of our degree we constantly revisit concepts that we have previously encountered and build upon them, this prevents us from forgetting about it and also provides us with the chance to understand topics that we may be unclear about. I absolutely love it and if I had to describe my course in 2 words, I would choose the words ‘relevant’ and applicable’. MM: HOW DID YOU FIND THE PROCESS OF ADAPTING TO A DIFFERENT COUNTRY? AA: Whenever I tell people that I am from Nigeria, they pull a long face and immediately start feeling sorry for me, because I am so far away from home. I find it funny when people do that because I hardly get homesick. This probably because I went to boarding school in Nigeria so this eased my transition. Cardiff also made it quite easy for me to adjust, as the campus is embedded in the city which meant I regularly had to interact with the community outside of the student population. I’ve also been very blessed with I have made who are like family to me and I speak to my family back home often so I don’t feel homesick. Cardiff is a second home to me now. MM: WHAT DO YOU DO BESIDES BEING A MEDICAL STUDENT? AA: I’m presently the Vice President of a society in the university called ‘Timothy Bible Study’, a Christian society meeting weekly to fellowship with one another and discuss the scriptures. I am also involved in a Christian Performing Arts Organisation called ‘SOEL Connect’ as a member in the Gospel Choir and leader of the Outreach team involved in creating publicity for events we hold such as the biannual Concerts. Additionally, I have a blog called ‘The Still Small Voice Says’, which is a Christian blog that encourages young people to find comfort and encouragement in the word of God. I love to cook and I also do a bit of  Graphic Design & video editing. MM: WHAT TIPS/ ADVICE WOULD YOU GIVE TO OTHER MED STUDENTS? AA: For prospective international medical students I would definitely recommend that you do your research, be open to receiving help and give it your best shot as UK medical schools tend to only accept a limited number of international students e.g. my medical school only accepts 10 international students per year. Be focused; once you decide what you want to do run with it and don’t let anybody discourage you. I was once told it was impossible to get into a UK Medical School without doing a premed degree first but look at me now, I’m here by God’s grace. I would advise that current medical students find a good friendship group as they will serve as a support system in good times, bad times and lonely times. Medical school is truly a roller coaster ride and you need people who can hold your hand through it all. Know yourself so that you know how you study and so you can recognise when your body is telling you to take a break, don’t overwork yourself! MM: WHAT ARE YOUR FUTURE PLANS? AA: I’m not sure what speciality I want to go into yet but right now I am interested in Obstetrics & Gynaecology as well as Endocrinology but I know that Medical School is the place to discover what you like and what you don’t like. I have an interest in teaching & Medical Education, so I hope that sometime in the future I can go back to Nigeria and help remodel the Medical School Curriculum in Nigeria so that students like me can stay in Nigeria and still get the best education possible. Thank you Ayowade for sharing your #JourneyToMedicine with us. Follow Ayowade on her Socials: @ayowade (instagram), Ayowade Adeleye (Facebook) and don’t forget to check out her blog ‘The Still Small Voice Says’. If you enjoyed reading this blog post, please share and follow our blog! Would you like to share your Journey to Medicine on the Melanin Medics blog? We would love to hear from you. Please get in touch – melaninmedics@gmail.com

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 Community Sexual & Reproductive Health (CSRH) Registrar: Dr Annabel Sowemimo! Please tell us a little bit about yourself and your career journey so far I am currently Community Sexual & Reproductive Health (CSRH) Registrar based in Leicester and I also run Decolonising Contraception - a collective of Black & people of colour working in sexual health. After completing my foundation programme, I completed an MSc in Sexual & Reproductive Health research at the London School of Tropical Medicine & Hygiene and also a Diploma in Tropical Medicine & Hygiene with MSF. Why did you choose this Specialty? Throughout medical school I had such varied interest loving science and the humanities - I was on Drama Society and organised an outreach project called DramaJam, I was President of Student’s for Global Health and editor of their magazine at one point. I intercalated with Medical Anthropology and after that i was set on finding a special that built on the social science skill set I really enjoyed. CSRH is such a wonderful mixture of all my interests combining clinical practice, public health & management and leadership. There is a huge scope for research, innovation and community work - I just don’t there is any other specialty like this. What your role in this specialty entails? On a day to day basis, I work between the community sexual health clinic and the hospital gynaecology department. My competencies include gynaecology including menopause & early pregnancy care, genitourinary medicine, psychosexual health, managing sexual assault and lots more. You have Consultant’s with quite a wide scope of clinical practice. During your time in Medical School, did you enjoy this specialty? I don’t think I discovered CSRH existed until my final year of medical school. Nationally, there are only about 36 trainees currently and there were far fewer when I was at medical school. Even now most other specialties are not really sure what we do and who we are. CSRH use to be a sub-specialty of O&G but in 2010, it became it’s own specialty and we have been growing ever since. What is your greatest achievement till date? Definitely founding Decolonising Contraception which discusses the health inequalities amongst Black & people of colour within sexual & reproductive health (SRH) by having the difficult conversations about race and culture that people struggle to have. When I started I was nervous that people wouldn’t get it or my colleagues may not be supportive however, I have since spoken at the Faculty of Sexual & Reproductive Health (FSRH) conference and the British Association of HIV (BHIVA) conference. We had a stand at the British Association of Sexual Health & HIV (BASHH) conference this year and I had such amazing conversations about the barriers between doctors and patients. We also do public engagement events and this year I have spoken to so many Black women about their reproductive health - I just really want to make sure I can advocate for the people that don’t get to sit in the rooms I do. What has been your biggest challenge working in this specialty so far? I think CSRH being small and new is a challenge. Firstly, when I applied there were only four jobs nationally. I had my heart set on doing CSRH so I knew that I would go wherever that job was yet, I understand that other people may not be able to move around as freely. I now have an ST1 which is great but for two years I was the only CSRH trainee in my city and they hadn’t had one before so, there can be a lot of logistical hiccups and you have to be incredibly organised. What do you like to do outside of work? I can’t sit still which I think is partly due to dyslexia - my mind is always working over time. I love writing and I write for a few platforms gal-dem.com and Black Ballad are my favourites. They have really made an incredible space for people like me and it is so great reading the work of other women of colour too. I sit on a few committees including the Faculty of Sexual & Reproductive Health International Affairs Committee and I am a trustee for Medact. When I’m not doing all this I release my strength at the gym (yes I am one of those awful people who likes exercise..sorry) - I took up boxing a few years ago and I had a very solid jab! What advice would you give to someone interested in this specialty? Don’t be put off by the competition ratio! If you think this is the right specialty for you then, you are probably right and it goes beyond your academic potential. Make sure you know what CSRH involves and the issues the specialism faces, try to do a taster week and come to along to FSRH events. It is an incredibly friendly specialty and some of my colleagues have become amazing friends.

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 Consultant Oral & Maxillofacial Surgeon: Dr Natasha Berridge! Please tell us a little bit about yourself and your career journey so far? My name is Dr Natasha Berridge. As an Oral & Maxillofacial Surgeon, I am dually qualified in both Medicine and Dentistry. In total, I spent 10 years at university achieving my intercalated BSc in Pharmacology, Bachelor of Dental Surgery (BDS) and Bachelor of Medicine (BM). Following my foundation training, I commenced my core surgical training in London at Imperial NHS Healthcare Trust, subsequently gaining membership of the Royal College of Dental Surgery (MFDS) and Royal College of Surgery (MRCS). I was fortunate to secure my Higher Surgical training (ST3-ST7) in Oral & Maxillofacial Surgery in North West London and completed my surgical training after becoming a fellow of the Royal College of Surgery; FRCS (OMFS). I then completed the prestigious Training Interface Group (TIG) Fellowship in Reconstructive Aesthetic Surgery. I am on the GMC Specialist Register of Oral & Maxillofacial Surgeons and currently work as an NHS Oral & Maxillofacial Surgery Consultant specialising in the management and reconstructive aesthetic treatment skin cancer. In addition, over the past years, I have developed my non-surgical speciality interest in facial aesthetics and have just been awarded a Masters’ Degree with Merit in Aesthetic Medicine & Skin Ageing (University of Manchester) where I also received the Outstanding Achievement Award for my postgraduate studies. After years of writing papers for peer reviewed scientific journals, co-authoring the internationally popular Primal Head & Neck DVD-Rom for Dentists/Dental Hygienists, I have recently become Resident Medical Specialist to online lifestyle magazine Salon Privé, where clients are able to enjoy reading updates on the latest trends in Health & Beauty. Why did you choose this Specialty? I’ve always been fascinated by the art of surgery and in particular facial anatomy. Given my background in Dentistry, pursuing a career in Oral & Maxillofacial Surgery seemed like the most logical step to take. Without doubt, Oral & Maxillofacial Surgery (OMFS) affords the opportunity to manage a diverse group of conditions that requires a high level of expertise in both soft and hard tissue handling. During your time in Medical School, did you enjoy this specialty? I became aware of the speciality of OMFS in the early years of my Dental degree at King’s College London. I thoroughly enjoyed the time I spent on placement with the Maxillofacial Surgeons and was sufficiently inspired to choose to spend my Elective with the Maxillofacial Unit at University College Hospital (UCLH), time which was well served as I was later awarded the AstraZeneca Elective Prize for an Oral Presentation detailing what I had learnt during my time with the Maxillofacial team at UCLH. What is your greatest achievement till date? That’s difficult to answer as I feel that all of my experiences to date have undoubtedly contributed to my lifetime goal of becoming a facial surgeon. It’s been a very long journey, not always easy and with unexpected personal life events along the way. However, the one trait that I believe has helped me through those years of gruelling surgical training is my resilience/tenacity. Even as a child, if I was told by others that I wouldn’t be able to do something, there negativity had the opposite effect and quite simply ignited a determination to prove the ‘nay-sayers’ wrong. I’ve always demanded the highest performance of myself at all times and have focused on the ‘end goal’ of becoming a surgeon. Twenty-three years later and wiser, I am now one of the small number of women of colour who are Consultant Oral & Maxillofacial Surgeons in the United Kingdom. What has been your biggest challenge working in this specialty so far? Despite it being 2019, a handful of my patients and colleagues (young and old) are visibly surprised when I tell them that I am a Consultant Surgeon. Some feel that I don’t look old enough and commonly I’m assumed to be the nurse. Whatever their perceptions, unintentionally it’s a form of bias but I’ve learnt not to take offence to these comments. It’s great to be able to challenge the unconscious gender bias surrounding the way that people often think of surgeons; that they are “naturally” men. Surgery, in particular, OMFS is still very ‘male-dominated’ but I feel that it’s steadily changing. There are certainly more women, and especially women of colour completing higher surgical training that will eventually allow them to practice as an NHS Consultant. What do you like to do outside of work? I spend a lot of time at work, so I love nothing more than having family time and experiencing those precious life moments with my two younger sons and husband. I’ve also recently become quite the fan of hot yoga, which I find fabulous both for physical toning and emotional relaxation. What advice would you give to someone interested in this specialty? Surgery is tough and not for the faint hearted. Dedication, diligence and perseverance are an absolute must for those considering pursuing a career in surgery. Higher surgical training is intense and there have been many highs and lows. Fortunately, the highs have far outweighed the lows. Having patients trust me with their health and lives is a huge responsibility and privilege that I never take for granted. To perform life-enhancing corrective facial surgery is hugely rewarding. For those interested in pursuing a career in OMFS I would recommend spending time shadowing a Registrar in training by attending ward rounds, observing in theatre and outpatient clinics. If still interested, there are events held throughout the year that are sponsored by professional bodies such as the British Association of Oral & Maxillofacial Surgery (BAOMS) that would give a fantastic insight into the scope of surgical practice in OMFS.

Thriving Amid Adversity Re•sil•ience /rəˈzilyəns/ noun 1. the capacity to recover quickly from difficulties; toughness. I’ve never really considered myself to be resilient until I was asked the question ‘what does resilience mean to me?’ I remember starting off with “Resilience is a set of tools and behaviours that will keep you coming back - smarter, harder and stronger….” Like most people I applied to medical school in year 13 and unfortunately did not make it to the interview stage therefore, I decided to study biochemistry for three years. Throughout my time at uni, I knew I still wanted to study medicine so continued to work towards that whilst getting a degree. If at first you don't succeed dust yourself off and try again My first post uni cycle was 2018 where I received an interview at one medical school but unfortunately did not get in again. This completely broke me, at the time I thought to myself ‘I have the grades, I have the work experience, I prepared fervently for the interview, what did I do wrong?’. I was told by people I know to even complete strangers to “give up on this medicine dream”, “by the time you’re finished you’ll be old, how will you find a husband”, “women should finish their education early”, “Do a masters instead”. I knew deep down that I still wanted to peruse Medicine, even though it felt like the odds were against me, not just because I promised my mum a few weeks before her death at the age of 14, that I would be greater than her and make her proud but because deep down I knew this is what I’m passionate about and want to peruse. I remember saying to my aunt, I’m going to keep trying to peruse my medical dream because I’d rather try and try again than give up and be unhappy doing something else. After applying to medicine again and this time not only receiving multiple interviews but offers too, I was over the moon and knew that my persistence and resilience had paid off. Resilience Over the past two years I’ve learnt first hand what being resilient really means. Being the primary carer for my aunt whom suffered from diabetes and kidney failure, due to a failed double transplant. She had been home bound for the past two years. Despite her situation, she was always so positive and eager to push and rehabilitate herself in order to improve her progress. The passing of my aunt a few months ago, has been really hard, not only did she teach me to keep fighting but how to be resilient. Despite being home bound for two years, she would try her best to make light of every situation, continuously praising God and encouraging me even though my battles weren’t even a tenth of what she was going through. Ultimately, as a Christian, I know I wouldn’t be where I am today without God. Me being resilient is not by my own doing but His. ‘Those who hope in the Lord will renew their strength. They will soar on wings like eagles; they will run and not grow weary, they will walk and not be faint’ Isaiah 40:31 NIV I hope to be able to teach others that hardships are character builders and that changing the direction our lives set for us starts with ourselves. It is important to change our focus from causes and blame to asking ourselves what can we do about it and where do we go from here. Follow your heart and believe in yourself. Whenever I doubt myself I remember my aunt telling me “keep striving forward, you were made for this. Don’t let anyone tell you you deserve anything less.”