As a preclinical medic, the idea of clinical medicine may seem daunting. How does one cope with the transition from lectures, dissections, tutorials, small group teaching and PBLs to spending your days on the wards and interacting with patients? As a preclinical medic myself, I often worry about how do I know what I need to know whilst on the wards? How much do I need to know? How will I make notes and find the time to commit what I have learnt to memory? Fortunately,I had the pleasure of interviewing Mitchell Osei-Junior iBSc (Hons), a medical student at King’s College London with dreams of becoming a Child and Adolescent Psychiatrist/Psychotherapist. Having recently acquired a diplomas in Applied (STEM) Mathematics & level 3 Child Psychology, he is also currently studying for level 4 diplomas in Adolescent and Child Psychology as Mitchell’s main interests lie in psychosocial and developmental psychology. 1. What is the difference between preclinical and clinical years at medical school The main difference between preclinical years and clinical years is the focus of the year.In preclinicals, the emphasis is on you getting the 'basics' of medicine in terms of Anatomy, Physiology and other various human sciences that will form as foundations for clinical years.However, in your clinical years, the emphasis is on 3 main components: I) Knowledge (applying your foundations for understanding clinical conditions) II) Communication (being able to convert medical jargon to lay language whilst also building rapport) III) Practical skills (Because OSCEs become an important thing) 2. How is teaching/learning different during clinical years compared to preclinical In pre-clinicals, you spend a lot of time attending lectures, dissections (to supplement anatomy teaching) and small group teaching (to consolidate what you have learnt in your lectures). In essence, there is a lot of spoon feeding as a preclinical medic! In clinical years, you only have lectures 1 day a week & the rest of your week is spent on the wards. Bedside teaching becomes a regular feature where a doctor/physician's associate takes you around to practice your physical examination techniques on actual patients. In terms of learning, in your pre-clinical years, your lecture notes are usually sufficient enough to get by your exams. No other textbook required.However, in clinical years your Oxford Clinical Handbook will be your best friend. Lectures alone are not enough to supplement your clinical knowledge. There is a lot of self-guided responsibility of learning in clinical years which can feel like a bit of a jump. 3. What would you advise to prepare for the change? What practical advice would you give to medical students starting clinical rotations? In terms of preparing for the change, I would suggest that practicing taking a professional history and attending the clinical examinations sessions during your 1stand 2ndyear is important!Examinations and history taking are your main metaphorical 'sword & shield' for the clinical years. Once you have these skills all you need is building the bricks of clinical knowledge from each patient you meet. In terms of practical advice, I will advise spending induction week for each block building a sign-off timetable. Apart from all the things you need to learn during clinical years, getting sign-offs for your portfolios are key. Space your sign-offs fairly so you still have time to visit wards, speak to and examine patients. This gives you enough time each week to do some much needed independent revision/study. Time management is a really key skill during clinical years. 4. How to make the most out of your clinical years? In terms of making the most out of your clinical years, in the first few weeks of your first clinical block you are most probably going to be really scared of talking to patients and examining them too. Not to worry, every student, foundation doctor, core/specialist trainee, and consultant has felt the same way and remember their first clinical year fondly. Some even have embarrassing stories of mess-ups they had during the period (oh let's not discuss my first time taking a history and accidentally causing a mess with a patient's glass of water during it!) Patients know fully well you are students and you need to learn. So they generally don't mind you forgetting questions that you need to ask, or not understanding certain medical procedures they went through, or accidentally saying medical jargon, or pressing too softly whilst palpating during an examination etc. I would advise during clinical years, clerk as many patients as you can and ask them to clarify treatments they have been through. Patients actually make the best educators and they want you to be an amazing doctor when you graduate. So in summary, if you are not spending at least 30 minutes taking a history from a patient on a ward you really haven't learnt much about them! Also make spare time for yourself to carry out your hobbies! Your mental health is important too. :) Interviewed by Sarah O’Connell

Medical school can be very demanding and challenging at times by having insufficient time to complete everything. However, here are a list of top tips that have helped me to manage my time effectively through medical school so far. 1. Organise yourself: Write down your key dates e.g. deadlines, exam dates in chronological order starting with the earliest deadline and ending it with the furthest. Choose a place where you study often or spend the most time in your house and place your deadlines there to be used as a constant reminder. For me, this is on the wall above my study desk in my bedroom. 2. Set yourself goals/smart targets regularly in relation to the deadlines: SMART meaning specific, measurable, achievable, realistic and time bound. Breaking down a goal in this way ensures that you have defined the steps needed to achieve your goal by giving you a sense of direction in an organised manner. If for any reason, you do not achieve your goal you can look back and identify which parts of your SMART plan need to be improved. An example of a SMART target plan that I used for one of my exams was: S- To achieve an average of 80% in all my anatomy colloquiums in order to obtain partial exemption in the final exam in June M- By ensuring I answer as many practice anatomy questions as possible before each colloquium to determine any weak areas that may need more attention A- Planning anatomy group sessions with friends during our free time and dividing the topics amongst ourselves and taking it in turns to teach & test each other by practising on the cadavers R- To keep a track of all colloquium results T- This should be completed within every 4-6 weeks in time for each colloquium. 3. Write down your university timetable: This provides an overview of the number of hours you will be in university and the number of hours you will have free per day and so helps you organise your week accordingly. I use my time efficiently by doing study sessions in the library when I have long gaps in my timetable, whereas during the shorter breaks I squeeze in a gym session or grab something quick to eat. In addition, I do the ‘bulk’ of my studying and revision on the weekends. 4. Take regular breaks: Scheduling breaks throughout your day can increase the productivity of your work, allows you to refocus your attention and concentration and reduces stress. This could include naps, exercise e.g. going for a walk, hobbies, spending time with God (if you are religious). 5. Create a daily or weekly ‘to do’ list: Listing things that need to be done and writing it down and ticking them off once completed allows to you to continuously monitor your progress and be accountable for your time. 6. Prioritise your list: Figure out which ones are the most important things for that day or week and put them at the top of your list. 7. Learn your preferred studying method: Determining your preferred studying method allows you to be efficient whilst you are studying. For example, if you are a visual learner it is recommended for you to watch YouTube videos or create mind maps, which enables you to have a better understanding of the topics instead of memorising textbooks. 8. Always have something to read or listen to at hand: Keeping flashcards/ revision notes in your bag during the day allows you study on the go for example whilst traveling to and from university. These pockets of time This provides you with more time at the end of each day, which you can use for other interests. 9. Meal prep: Honestly, meal prepping is the way forward! Every Friday I go food shopping and batch cook for the weekend and upcoming week. This saves so much time during the week, especially when I return home in the evenings from late study sessions. I normally choose Fridays as this my least busiest day of the week, but you can choose any day which is most suitable to you. 10. Take some time out for yourself: Whether this is meeting up with your friends, washing your hair (even though this takes ½ a day lol), going to the gym, extra curriculum activities, catching up with on a Netflix series etc. For me this includes: jogging, netball, baking, listening to podcasts or music and catching up with friends. These activities help you to de-stress, hence creating a work-life balance. Written by Shona Manning

It’s official, I’m halfway through medical school!! Last week we had our Halfway Ball at the beautiful Grand Connaught Rooms (London), and it was a lovely evening. It started off with reception drinks and photos, followed by a 3-course meal and finally ended with lots of music and dance. In this blogpost, I reflect on the last 3 years of medical school, which has gone by very fast. This will include some of the things I have learnt and achieved over the years. 1. The jump between A-Levels and Medical School was SERIOUS! a. The majority of us have been the high achievers throughout school and over the years we had perfected our revision strategy, which mostly consisted of following the relevant specifications and doing a bunch of past papers. Then you come to medical school and realise that this same strategy may not work. You’re suddenly surrounded by people who were also the high achievers and you may have not done as well as you hoped in your first medical school exams. It’s important to not be disheartened. Do not compare yourself to others. Use the first couple of months or even the first year to adopt a suitable study strategy that will work best for you. 2. Spaced repetition is the key to SUCCESS! a. After my first exams I adopted the revision strategy of using flash cards and doing spaced repetition. More details of this method of study can be found in the blogpost titled ‘How I study in Medical School: Spaced Repetition’. Using this method of study although difficult in the initial stages, has proven to be very beneficial for me and I still continue to use it now during my intercalated degree. 3. Take your SSC projects SERIOUSLY! a. We often question our universities as to why they keep giving us the extra essays or projects to take and we often believe it is a waste of time. However, they are put in place to help us build our medical portfolios. Be open and speak to many doctors, find out what they have going on, especially if you have found your area of interest. Immersing yourself in these projects can give you many opportunities as I have been blessed to have such as giving and winning oral and poster presentations at conferences. 4. I decided to INTERCALATE! a. At St George’s, intercalating is optional. If you decide to intercalate, you must have achieved above a certain decile in your exams. During my 3rdyear of medicine I weighed up the pros and cons and finally came to the decision of intercalating and it has been the best decision yet. Rather than typically studying one area in depth, I do a bunch of different modules alongside my research project. This year has not been intense as medicine, I’m only in 2-3 times a week which leaves me with plenty of time to do some independent study, research and conduct many school outreach sessions. 5. Find the right BALANCE! a. One thing I always tell people is that it is very important to be organised and to find the right balance. Studying and working hard is vital, however it is also key to set aside some time to unwind and have fun with some friends and family. After all, time goes by so quickly, so why not make the most out of your time during medical school. Overall, I’m very excited for what the remaining 2.5 years of medical school has in stall for me! Khadija Owusu

Black blood donors make up only about 1% of the NHS’s existing donor base, despite the number of donors increasing over the last few years. Amongst the BAME community we make up less than 50% of currently registered donors as well as new donors registering. Unfortunately, the need for black donors doesn’t come down to just wanting more of us on the register. Unknown to most people, donations of blood from black donors are especially important for Sickle cell anaemia. Sickle cell anaemia is a genetic condition that predominantly affects Afro-Caribbean people. With more than 15,000 people in the UK affected by the condition the number of black donors in comparison is disproportionate. The condition affects the blood cells, causing them to be sickle shaped and be stuck in blood vessels causing the symptoms of the condition. People with sickle cell anaemia tend to suffer from painful episodes known as sickle cell crises which are difficult to manage with conventional analgesia. Other symptoms also include increased risk of infection and anaemia. There is also a reduced life expectancy for people living with sickle cell disease especially severe forms. So, why the need for more black donors? We know that people with sickle cell anaemia need frequent blood transfusions to manage their condition and to minimise the painful sickle crises that they endure. It is also known that a rare subtype of blood known as the Ro subtype is needed in these transfusions and this blood type is more likely to be found in black donors. As the blood transfusions needed by sickle cell patients needs to be best matched to them, it is more beneficial for the blood to come from a donor of the same ethnic background. In 2017 GiveBloodNHS launched a twitter thread on black blood donation that went viral for good and bad reasons. The intention of this campaign was to increase awareness of blood donation specifically to help increase registration amongst black donors. The campaign succeeded in this and was especially designed to target and educate the Afro-Caribbean community. Unfortunately, the campaign was met with some resistance and was accused of being racist and selective. Fortunately, this backlash was cleared by the NHS as they reiterated the message of the campaign with facts about blood donation and sickle cell anaemia. Sadly, both within the Afro-Caribbean community blood donation and sickle cell anaemia are not discussed widely enough. The idea of blood donation within our community is often met with negativity partly due to lack of education on process and importance of donation as well as fear or mistrust of healthcare provisions. Here is where we pose the question: Who is responsible for educating the Afro-Caribbean community about blood donation and sickle cell anaemia?Does the responsibility fall on the NHS, healthcare professionals or charities? The responsibility really falls on us, black medics who are uniquely positioned between having access to our community as well as the education and knowledge from our medical background. We should be particularly active in promoting blood donation within our community by being an example ourselves, registering ourselves as donors and as well as starting the conversations outside our medical circles. Awareness seems to fall normally to charities that advocate for sickle cell anaemia such as the Sickle Cell Societyand they’re work for sickle cell survivors cannot go unnoticed as they work to support them though their condition. As black medical professionals we should seek to work with these organisations to learn how we can both raise awareness but also how within our work we can better manage patients when they present with symptoms of their condition. I personally registered to donate blood and donated blood for the first time 2 years ago. In my own mind before donating, the process was daunting, and I’d imagined it to be something far more draining than what it was. Even as a medical student at that time, I was not well informed about the blood donation process and this had led me to delay my own registration. I find it funny that we practice venepuncture and cannulation so easily as medics but when it comes to us being on the receiving end, we have reservations. The whole donation process was easier and far less dramatic than I’d imagined. After about 30 minutes the whole process was done, and I was able to go about my day as normal. After donating I felt to bring up the discussion of donation with family members and as expected it the idea of donation was met with responses on the myths usually linked to the process as well as misinformation. From this, I realised that without us as black medics educating our own community there is no way we can spread the message any stronger. Health issues that predominantly affect Afro-Caribbean people need not fall by the way side as we can raise awareness within our own community. Being our own healthcare advocates within our communities can be such a powerful medium. Coupling this age of social media as well as our unique position as black medical professionals we can truly make a difference in educating more of our community. Learn more about blood donation here: https://www.blood.co.uk/why-give-blood/the-need-for-blood/why-we-need-more-black-donors/ Learn more about Sickle cell anaemia here: https://www.sicklecellsociety.org/

In the summer of 2018, I spent 8 weeks in Saint Vincent and the Grenadines on my medical elective. After waiting for 4 years, I finally got to experience the best part of medical school and I was not disappointed. After 14 hours of travelling, we finally arrived on the island and were greeted by our friendly and eccentric landlord. Her enthusiasm was comforting, the island doesn’t receive many tourists so she was bursting to show off her island; although I was miles away from home, she instantly made me feel at ease. The next day, she was kind enough to take us shopping and show us around the island. Although small, it was absolutely amazing. The beaches looked like a screensaver, the weather was hot and the locals were extremely friendly. We were treated to a “Vincy Sunday lunch” and then of course, we went to the beach, which was only a 10-minute walk away. The next day was our first official day of the elective. We were instructed to take a Vincy bus to the hospital, as it was a 20-minute drive away. After waiting on the side of the road for 15 minutes, we realised that the Vincy buses weren’t buses at all; they were the brightly coloured vans that drove past at 100 miles an hour blasting Soca music. The journey to the hospital was eventful to say the least; a few prayers were said during that journey! After we paid our placement fees ($50 per week!), we were told that we could have the next two days off to get ourselves together and get used to the island, so once again we went to the beach – it was then that I realised this would be a common theme on this elective. For the first four weeks of my elective, I was in the obstetric and gynaecology department. This was a fast paced and busy area of the hospital and consisted of a labour ward, postnatal ward and female surgical ward. As this was the main hospital, it offered the highest level of care on the island. Medical care is highly subsidized by the government, but there is a lack of some specialised equipment, drugs and personnel meaning that there are often times when patients go without. For example there was only one CTG machine in the entire hospital so, whilst in the UK women may be hooked up to the machine for continuous monitoring, here it was only used if necessary and women often had to queue up in order to use it. Despite this, doctors had an unrelenting ambition to do their best for their patients and often arranged medication to be shipped to Saint Vincent so they could prescribe it to their patients. My days usually consisted of ward round, teaching followed by some work on the ward however by 12 pm I was done and free to explore the island. When I first arrived on the wards, I was hit by the stifling humidity. Doctors and medical students have to wear white coats at all times, and most wards do not have air conditioning so whilst everyone else was used to these conditions, I usually spent most of the ward round dripping in sweat. The staff and patients were extremely friendly, and the “local” medical students (of which 99% were in fact from Nigeria) were quick to take me under my wing. The teaching was invaluable, and I was often kept on my toes; the consultant was often quizzing us throughout the morning and many times we were asked to presentations to the rest of the team without much warning. At first I found it intimidating but I soon grew confident and I learnt so much during my time there. I was fortunate enough to be on the island for carnival season, which is known as Vincy Mas. This is a month long celebration in which there are events and parties nearly every night, and this was easily the best part of my elective. Almost everyone on the island took part, and it was not uncommon to see a consultant dancing in one of the bands alongside one of the nurses! Taking part in the festivities made me feel like a true Vincentian as I was able to fully immerse myself in their culture and spend some time with the locals. As you can tell, there was plenty of time to explore the island, which we took full advantage of! After we had seen most of Saint Vincent, we travelled to a few of the Grenadine islands including a boat trip to Tobago Cays to swim with turtles! Following my 4 week Obstetrics and Gynaecology placement, I spent 4 weeks in the A&E department. I chose this because I haven’t had much experience in emergency medicine as I had always found it to be quite daunting, so I decided to challenge myself and experience it for the first time in a different country. As there were quite a few students in the department, most days ended after one hour of teaching at 8:30 am, excluding one day a week where I stayed behind until the afternoon. During my time there, I learnt a lot about trauma management and advanced life support, mostly through teaching but occasionally by observing one of the doctors manage a patient with a life threatening injury. As with most emergency departments, the pace ebbed and flowed. At times there was not much to do then suddenly a gun shot victim would be rushed in, or a child having a severe asthma attack. Overall my elective was an amazing experience, one that I often wish I could relive. The similarities were often comforting but I found some of the disparities in opportunities and resources hard to believe at first. It threw into sharp perspective my own experience of medical school and hospitals in the UK and made me feel incredibly lucky. Written By Ife Williams If you'd like to share your elective experience on our blog post; email us: melaninmedics@gmail.com

One can't deny the fact dealing with your emotions in Medicine is challenging. You come across different things everyday, it's very rare for your encounters not to tug on your heart strings. A few months ago, I started placement. My medical school arranges it in 8 week blocks, where you will spend your time at one hospital moving around different departments based on the theme of your placement. This was a whole new experience for me, going on ward rounds, performing skills on real patients e.g. venipuncture, injections etc. and being part of clinics. Now I don't really know how much I can say I was prepared for placement; the intensity of it all. All of a sudden you no longer find yourself discussing theoretical situations but these patients have life in the them, they're real people with real stories and real illnesses. My first placement block was eye opening to say the least but I wanted to talk about the difficulty I had processing my emotions. My first 4 weeks were spent on the Respiratory Ward. In summary, it was full of a lot of Pneumonia, Lung Cancer, COPD and Interstitial Lung Disease patients. Each morning at 9am the ward round would begin, I would tag along with the team of doctors (normally a Registrar, F1 & F2 sometimes there would be a consultant) as they visit each patient and decide on their next steps and what further tests need to be ordered. On my first day I met a patient with lung cancer and possible metastases to the spine. I knew things were not looking good. Sometimes I feel like knowing so much in comparison to the patient makes me less hopeful and makes me anticipate the worst possible outcome. I'm generally a forward-thinker, so I fast forward my mind to what I think might happen just to prepare myself for when things take a turn for the worst. I guess one could say this is my way of managing my emotions but at times I just think I'm incredibly pessimistic. Each day I would watch as more and more of his family members visited him in hospital, he was one of the loveliest patients that I met during my time on that ward. One day I noticed that he wasn't in his bed, I assumed that they moved him or maybe he went home but the truth is I'll probably never know. While I was on the respiratory ward, there was a patient that I came across who had Pneumonia. For the first few days he seemed relatively stable until one day he rapidly deteriorated. His breathing was increasingly laboured and his blood pressure was dropping; when the doctor ordered supportive care only I kind of new that meant he wouldn't make it. It was a Friday, he was surrounded by his family, their faces morose and down but then I had to leave. The whole weekend I just assumed the worst, I was even a bit scared to come back on the ward on Monday to find out that he'd gone but to my surprise there he was, he had regained the strength that was lost and seemed to be improving! This moment made be process the concept of death, now when you're so far away from it it's easy to view it so simplistically. But when you're face to face with a patient who is literally on the brink of death all of a sudden it seems so difficult to comprehend, how a person could have life in them one minute and then a split second later they're gone. I spent about a week on the Dialysis unit. I had very little prior knowledge on Dialysis and really underestimated the impact it has on a persons life. Patients on haemodialysis come in 3 times a week for 4 hours to be dialysed, this is the process of filtering their blood due to the poor function of their kidneys. Now what shocked me the most was that some of the patients were quite young, I'm talking late 20s and early 30s, of course the majority of the patients were elderly but I just couldn't get my head around the fact that these people will most likely be on dialysis for the rest of their lives if they are unable to get a kidney transplant. I felt so sad, especially knowing that some of them were relying on family members to donate their kidney however due to one reason or another they wouldn't be able to. As a medical student you would speak to the patient and realise how hopeful they were that they would get a transplant but then when talking to the consultant after they would say just how slim their chances were. Was it wrong for the patient to be hopeful even though their chances were so slim? But then again, hope is all that they could hold onto; no one wants to be confronted with the harsh reality that they might spend the rest of their lives dependent on a machine. The truth is my emotions were all over the place, at times I felt heartless, I felt fake because I couldn't relate to what patients were going through or had been through but then other times I felt sad and helpless. Before placement I had such a naive perspective of the clinical world of Medicine, that everything was so black and white but it isn't. Somedays I felt strong where as other days I struggled and that's okay. It is all a process, and with time I know that I will learn to manage my emotions better. As for now, my emotions remind me that I am human.

By Dr Matilda Esan “I would like to speak to a Doctor not a GP!” - this is one of my favourite quotes, from a recent conversation I had with a prospective medical student. My Background My name is Matilda and I am a GP Registrar working in London. I trained at Kings’ College Medical School and graduated in 2015. During my time at Medical School, nothing got my heart racing like a good shift in the Emergency department. In fact, I loved it so much I used to wake up early to get some extra hours in before the other students came and packed it out. Why I choose a Career in General Practice? My passion for Emergency medicine continued throughout my foundation training .However the turning point came in F2, after I had completed a post in General Practice and was going to back to the Emergency department for a second time. On returning, I found the learning experience was still amazing and it felt as good as it did before. However the issue for me was that things moved so quickly that I couldn’t follow up my patients and it was difficult to find out their outcomes. The other thing that got to me was the hours. They do get better as a senior, however in medicine you have to balance up what you think matters and go with your interest and your heart. As a result of this, by the end of Foundation training I started to think of Emergency Medicine training vs GP training and after some careful thought, I chose GP training. Life so far I am a GPST2, currently still going through my hospital rotations. I have to say, I do not regret my decision to enter GP training. It has offered me great opportunities to learn and it has begun to teach me to think outside the box. Other aspects which I have enjoyed include : the great sense of community and comradery amongst trainees. Meanwhile, additional advantages of GP training have been the regular protected teaching time, which allows you to cover a wide range of gaps in your knowledge and the GP Curriculum. The other thing you also find is doctors in hospital specialities actually want to teach you, because they want their patients to be looked after by good quality General Practitioners. For me, hospital medicine rotations are not slavish or just part of the routine. I see them as an opportunity to fine tune my knowledge of evidence based medicine and this contributes to equipping me with the skills I need as an independent practitioner. Finally, the perceptions people have of General Practitioners are really interesting. As outlined in the quote at the beginning of the article, it is unclear to some if we are even doctors!. I recently did one of my GP membership exams and it dawned on me like a slap in the face just how much General Practitioners know. They are a fountain of knowledge in lots of things, hence the term generalist. This exam made me realise that as a future generalist, it is indeed a massive privilege. If I had to summarise GP training so far, I would say it has been eye opening.

I decided to write this specific blog post after I received a message on social media. The message was not meant to be vindictive but it was about my interest in Neurosurgery and how I should consider if this is really the career for me as it is a lot of work and being a female, it wouldn’t fit with a family life as well. Now, this is not the first time I’ve heard something along these lines, whenever I tell people I am considering Neurosurgery as a career and am quite certain that I want to be a Surgeon in general, I always get the “are you sure” “do you know how hard it is” “don’t you want a family” questions. I thought it would be important to speak about, especially as being a black female from Dagenham which already made getting into Med School a bigger deal than normal. Whilst it is true that careers in certain fields have longer hours and take a longer time to train for compared to a career as a GP let’s say, you should not let this limit your mind-set and become the only reason why you go for a certain career. Medical school is long and hard, hence you should find something you’re passionate about and pursue. You should also not allow your sex or ethnicity to stop you from going for those certain careers. Having a mum in healthcare allowed me to see the reality of working long hours and the effect that it would have on family life as being a Band 8A nurse, there are days where she does get home as late as 11pm. However, my dad made this work which shows that it is all about the support system you have around you. Nonetheless, it is important to keep an open mind set, especially as I am only a 3rdyear medical student. This can be done by going to a variety of different talks/conferences for example I am attending a Neurology and Neurosurgery conference at the RSM but also a talk on Colorectal Cancer two weeks after at university. You can also get some shadowing and experience in the different fields you are interested in and throughout your clinical years, you will be exposed to a variety of areas of medicine on placement. It is good to have something in mind but at the same time your mind may change throughout medical school and your time as a junior doctor so look around! In conclusion, I just wanted to remind people that you can do anything! Getting into medical school is such a big achievement within itself, hence you should not let anybody tell you that you can’t do it. Yes, the work load may be intense and you may have to make some sacrifices but in all honesty what is new there? From the 1styear of medical school you began working harder, studying harder and making more sacrifices than the rest of the student population hence this should not be seen as a big deterrent but a reminder of how privileged you are to be studying such an amazing degree. Written By Lizkerry Odeh

What do you think of when someone asks you to ‘reflect’? Sometimes it can appear as a vague and abstract concept. Some people think it is a waste of time to relive a situation, especially the negative ones, that they have already experienced, and others absolutely love it. But in reality, what is it? Reflection is simply defined as ‘serious thought or consideration’ (Oxford Dictionary1). We reflect on situations to give us some insight as to why certain things have happened in the way that they did. It is from there we can adapt our reactions. Whilst we may not be able to completely rationalise occurrences based on our memories (which are prone to change), by reflecting soon after an event, we can see what we did well and where we can improve. A common misconception is that the products of our reflections will be purely negative, but not every experience is a bad one. If something goes well, considering whythis happened is also an important skill. By drawing out these points, we can continue with our successful behaviours and cultivate new approaches to our areas of weakness. Being able to reflect is important at all stages of the medical journey. Whether you are a prospective medical student, currently in medical school or practising in the medical field, reflection is a essential part of your personal and professional development. Without reflection, it is unlikely that we can make meaningful improvements to the way we react to certain things. Maybe you had an interview that you didn’t think went particularly well, or you had a really inspiring and insightful encounter with a patient on your placement. Maybe you didn’t do so well on a mock exam, or maybe you achieved your highest grade ever. Regardless of what happened, there is always some way to identify the good and bad aspects to guide you on how you respond. The GMC encourages us to be ‘reflective practitioners’. Reflective practice has been defined as “the process whereby an individual thinks analytically about anything relating to their professional practice with the intention of gaining insight and using the lessons learned to maintain good practice or make improvements where possible” (The Academy of Medical Royal Colleges and COPMeD2). By completing a reflective exercise, we can have considerable impact on not only our own practice and skills, but also greatly improve the care that our patients receive. So how can we reflect? It doesn’t always have to be a big thing. Reflection can come in different forms – sometimes you can just take a quick second before you go to bed or while making dinner and ask yourself ‘why did this happen?’. Or you may choose to formally write it down and spend a little longer unpicking the situation. It’s up to you. Try and answer these questions: 1. What happened? 2. What did I do well? 3. What could I have done better? 4. What will I change in the future? The most important thing is that you whatever you identify you then use to build an action plan for the future. This is especially important in negative situations. Remember, the definition of insanity is doing the same thing over and over and expecting a different result. You will never improve if you never think of a way to change. You don’t have to do this on your own, but it’s up to you to implement these plans. Then reflect again in the future to assess if they have had any effect (positive or negative). Written by Ewaola Apooyin References 1. https://en.oxforddictionaries.com/definition/reflection 2. https://www.gmc-uk.org/education/standards-guidance-and-curricula/guidance/the-reflective-practitioner---guidance-for-doctors-and-medical-students

The Bawa-Garba Case: In February 2011, Jack Adcock, a six year old who had Down’s Syndrome and a known heart condition was admitted to hospital following referral by his GP. He was seen by Dr. Hadiza Bawa-Garba, a trainee paediatrician in her sixth year of speciality training. Later that day, Jack’s condition deteriorated and he passed away. Bawa-Garba, a doctor with an impeccable record prior to this event, was deemed guilty of gross negligence manslaughterof a child who was under her care. The Medical Practitioners’ Tribunal services suggested a 12 month suspension from the GMC medical register. However, the GMC fought to appeal this decision which resulted in Bawa-Garba being erased from the medical register for UK doctors - thereby preventing her from working as a doctor. Mistakes were made during Jack’s time under her care. However, to what extent were they entirely Bawa-Garba’s fault? Dr. Bawa-Garba, a convenient scapegoat for a failing NHS? Bawa-Garba had just returned from a 13 month maternity break and resumed work at an unfamiliar hospital with no formal induction. Her department was understaffed and with her consultant and registrar on leave, she was expected to take on their roles whilst supervising two junior doctors. To add, computer systems were down that day so Bawa-Garba had no access to Jack’s blood results or x-ray results until later in the afternoon. Although mistakes were made, some say that perhaps if the hospital had been staffed correctly and the right administrative and technical systems were in place, things could have turned out differently. So could it be that Dr. Bawa-Garba has been used as a scapegoat for systemic failings within the NHS? Can we blame racial disparities? There have been several occasions where white doctors have had charges against them dropped despite being involved in cases similar to that of Dr Bawa-Garba. We see misconduct being overlooked and even under-reporting’s of patients exposed to poor practice to the GMC. GMC research found that doctors who obtained their primary medical qualification outside the UK and/or from a BME background are more likely to receive fitness-to-practice complaints than their white counterparts. An example of this is the case of Mr Ian Paterson, a breast surgeon who conducted improper surgery for several years (1997-2011). Mr Ian Paterson has only recently been found guilty of 17 counts of wounding with intent. Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin (BAPIO) told GPonline that “… if Dr Bawa-Garba was white she wouldn’t have landed in such deep trouble” My thoughts as a Medical Student Cases such as Bawa-Garba’s make me worried about my future as a doctor working in the NHS. The thought of making a single error of judgement and then seeing the consequence that it has on my patient and then myself is terrifying. I also worry that I may be more susceptible to harsher scrutiny as a woman of African descent. Nonetheless, I do hope to see more workstreams that address racial inequalities in the medical profession and a greater presence of support and safe spaces for doctors Is Bawa-Garba’s case an illustration of the discrimination against BME doctors within the NHS? What do you think? Let us know your thoughts about this case! Written by Sarah O'Connell References Gponline.com. (2018). 'Inconsistent' handling of medical errors unfair on doctors, BMA tells review | GPonline. [Available at: https://www.gponline.com/inconsistent-handling-medical-errors-unfair-doctors-bma-tells-review/article/1490507 [Accessed 11 Nov. 2018]. Campbell, D. Where does the blame lie when something goes wrong at hospital?. the Guardian. Available at: https://www.theguardian.com/uk-news/2018/aug/13/where-does-the-blame-lie-when-something-goes-wrong-at-hospital [Accessed 11 Nov. 2018]. Media Diversified. Racism, blame & the NHS | Dr Hadiza Bawa-Garba. Available at: https://mediadiversified.org/2018/02/08/racism-blame-and-the-nhs/[Accessed 11 Nov. 2018]. BBC News. The doctor struck off for honest mistakes - BBC News. Available at: https://www.bbc.co.uk/news/resources/idt-sh/the_struck_off_doctor [Accessed 11 Nov. 2018]. Topping, A. Breast surgeon Ian Paterson jailed for 15 years for carrying out needless operations. the Guardian. Available at: https://www.theguardian.com/uk-news/2017/may/31/breast-surgeon-ian-paterson-sentenced-for-carrying-out-needless-operations [Accessed 11 Nov. 2018]. Gponline.com.Doctors' groups throw weight behind Bawa-Garba legal appeal | GPonline. Available at: https://www.gponline.com/doctors-groups-throw-weight-behind-bawa-garba-legal-appeal/article/1488150 [Accessed 11 Nov. 2018].

As a 3rdyear medical student studying at Plovdiv Medical university in Bulgaria I am currently in my clinical years of medical school so here is an insight of my week: Monday: Mondays consist mostly of lectures beginning with an 8am Diaster Medicine/General surgery lecture depending on which week it is, then an Internal medicine lecture followed by Internal medicine practical in the hospital. My highlight today was my internal medicine practical. The topic for October was respiratory diseases. In today’s session my group and I had the opportunity to inspect, palpate, percuss and auscultate a few patients from the respiratory ward where we compared sounds from each patient lungs to determine if the sounds were dull, resonance and hyper-resonance. We also had the opportunity to learn about the differences in x-rays of a normal lung appearance to someone with pleural effusion. After this I went to the library to study for a couple of hours, followed by a gym session with a friend later on that evening. Tuesday: This day consisted of 5 sessions: 3 practicals (internal medicine, hygiene and diaster medicine) and 2 lectures (hygiene and pathophysiology). The most interesting session was diaster medicine as the topic was first aid and this enabled me to draw from my previous experiences. This topic was relatively easy to understand and the order of steps to take to perform first aid were re-emphasised. Wednesday: Honestly, this is the worst day for me because it is the longest day of the week. My day started at 7:45am with a Microbiology lecture. Throughout the day I had a few other practical classes which included: roentgenology and radiology and pathoanatomy. The roentgenology and radiology practical consisted of radionuclide of the diagnosis of the kidneys and the skeletal system. This main topic was bone scintigraphy- the different types, the phases, the features, evaluation and the main indications. The day ended with a Microbiology practical session where I had a class test and it finished at 6pm. Thursday: This is the only day of the week that I don’t have lectures which means I start slightly later (only by 1 hour though). I usually start the day with a pathophysiology practical, followed by general surgery and lastly pathonatomy. However, this particular day was a public holiday in Bulgaria so this meant no university. Therefore, I spent this time wisely preparing for my upcoming pathophysiology test. Friday: By the time it’s Friday I am usually exhausted from all the early starts throughout the week. However, I have to force myself to wake up extra early as I begin the day with a 7:30am (compulsory) general surgery lecture in the teaching hospital yes 7:30 crazy, right? Immediately after the lecture I had a general surgery practical. This week’s topic was breast examination. During this session the professor briefly summarised the theoretical information, then went to the breast clinic. We saw a few machines that are used for breast examinations. This included 3D mammogram tomosynthesis, film and digital mammogram, ultrasound and MRI. We were informed of how each machine works, the procedures taken for each patient, the reason why each one is conducted and how they differ from each other. I then had a quick break to grab a drink/snack then make my way from the teaching hospital to the main campus. Normally I have a pathoanamtomy lecture on Friday afternoon. However, today my group had ‘catch up’ lesson for pathophysiology since we missed yesterday’s session so we traded this instead of the lecture. We had a class test during our pathophysiology session. I then had 2 hours to spare so decided to go grocery shopping. After this, I returned back to university for an OSCE practical session run by the OSCE society. The topic for this session was respiratory examination. During this session I discovered that I have conjunctional pallor which is a sign of anaemia. My evening consisted of catching up with a few of my friends with dinner at my house. Written by Shona Manning

For some medical schools an intercalated degree is not compulsory, it may be optional. During my 3rd year of study, I decided that I wanted to do an intercalated degree. This was for many reasons. Despite it being an extra year of study, I believed that it was the right decision in order for me to maximize my potential during my time at medical school. As I am still unsure of what I would like to specialize in later on, I am doing my intercalated degree internally at St. George’s. Here, I am able to study further in depth a variety of specialties whilst conducting a research project. It has been 1 and a half months since I started, and I have decided to share 4 key tips that I have learnt so far. Get things done early. In medicine, you are not always used to writing many essays as coursework and having many deadlines. However, with an intercalated degree, this is the case. As part of my modules I am required to write essays, whilst also doing my research project. I believe the best way to tackle this is to make a note of the deadline, make a plan for the essay and start writing immediately. This will save plenty of time later on for your research project and for other assignments. Use this year as an opportunity to conduct research and perhaps get published. Many of you may know that getting published can give you a maximum of 2 points for your Foundation Programme Application. Aside from this, taking part in research gives you essential skills that you will need later on post medical school. Doing research and trying to get published is a long, difficult journey, but it is one worth taking. Don’t forget medicine. It is important to note that you are taking a whole year out of studying medicine. In order to have a smooth transition back into medicine after intercalation, it is important to keep reviewing your past material. Try to stay on top of the medicine. Perhaps this could be taking a couple of hours a week out of your normal schedule to revise some of the content you had learnt in your previous academic years. This is your year to do as much as you can. One of the great benefits of doing an intercalated degree is the sudden realization that you have a lot more free time. If you’re like me, you are probably in university 2-3 times a week. As a result, you are able to do a lot more in that free time. Apart from doing your work, you can perhaps take up a sport, join more societies etc. I see it as your year to engage in as much as you can because the next few years of medical school will be very intense. Deciding to do an intercalated degree has been one of the best decisions I have made. Not only am I developing skills that will benefit me in future, many opportunities are coming my way this year such as being able to present my research at conferences. Don’t forget that you also get to graduate at the end of this year with a couple of extra letters after your name. Written by Khadija Owusu