Twitter for Medics, and more.

My browser's been directed to an interesting article on the BMJ website regarding the ongoing ascent of the medical Twittersphere. A good introduction to Twitter for the medical professional, or the medically inclined, it deals with what Twitter can do within this sphere, how to get started, and also points you to a number of people worth following.

I've been on Twitter for quite sometime now. My use has been sporadic, and is usually directly proportional to the amount of time spent on the computer, or in study. I use it for a variety of reasons - entertainment, communication, education, information and sometimes just as a valve to let off steam. Twitter's value, as the article will point out, comes from who you're connected to, and how you interact with them. It is a bit different to Facebook, which throws boundless, often useless information at you from the get-go. Twitter requires a bit of groundwork, and once that's done, it will repay you in dividends. That, and it is always growing and evolving. It's a beautiful thing.

I'd have thought that on getting a smartphone, my Twitter account would bloom into a frenzy of activity, but it seems not to have done so. I must not have needed it. I think, however, that in this day and age of information on demand, it's left me feeling a bit left out, and I'm looking forward to jumping back in.

Goodness knows there's enough happening to make it an interesting experience.

Meanwhile, a couple of people I follow who I would thoroughly recommend:

• mommy_doctor: Anaesthetist in America who regularly updates on interesting cases, interesting medical facts and life in general. A good all-round intro to what Twitter's supposed to look like.
• bengoldacre: UK doctor made famous for his 'Bad Science' book and foreverputdownage of Gillian McKeith, pseudodoctor extraordinaire. Excellent resource for the chronically disgruntled.
• bungeechump, silv24, kimmkendall: Junior doctors with plenty of note to say and share with.
• amcunningham, drcolinmitchell: Medical education aficionados who will be happy to discuss anything, and will always learn and teach.
• doc2doc, DrVes: Articles and interesting discussions are always forthcoming. Up to date.

There are loads more. Get in there and find out.

A Boulder New Year

In Malta, for a brief period of rest and recuperation, it has been an utmost pleasure to spend Christmas and the New Year with friends and families (in the plural, as then there were two). It has provided time to step away from the daily grind, and allow for some thought and planning for the year ahead.

New Year's is an arbitrary day more or less all of us take to think about what we'd like to achieve over the coming year, to build and improve upon what has come to pass in the previous one. We realign our priorities, reforge our resolve and generally give ourselves a boot up the arse to get on with whatever we're doing. There's nothing to stop us from doing all of this on, say, the 13th of April, but the 1st of January is often a quiet day, and it's what everyone else is doing, so we do it too.

2011 holds a lot in store for a variety of people. Friends and cousins are getting married (as are the British royalty), some of us are expectant of new job offers, there are exams to be sat and courses to be attended. The UK hopes to see an economic upturn (despite soaring VAT and fuel prices), and Malta is on the verge of its second religo-secular schism (although no-one but the politically extinct or suicidal will take definitive stances). Each one of the above has a different 'impact' level on my or anyone's life, and we will all prioritise appropriately. Some will tailor their year on the fly, and others would like to micro-manage it. It's worth taking the initiative, and having a plan for the major events - the large boulders that direct the flow of the river the canoe of our life floats upon.

The rest is often a pleasant, sometimes surprising divergence.

Online squabbles are Labour-intensive.

I'm sat in my living room, munching through a plate of imqarrun (baked pasta, to the non-natives), and surfing the internet before my shift starts this evening.

It says a lot that in the run up to the election in the UK, an election in which I have a vote, I devote more reading time to the Maltese blogosphere than the British one. This does not in anyway denigrate the local scene; goodness knows such gems as J K Rowling's defence of labour and Clarkson's bloodthirsty (if not childish) attack of the same make excellent reading. Somehow, though, there's a certain attraction in the more parochial squabbles amongst the Maltese.

Daphne and her Labour-hating rhetoric, TYOM and their Daphne-hating gibberish, and J'accuse, who simply takes a pot shot at anything that's passing. These, and many others, have you transfixed. None are discussing much of substance, but it's addictive nonetheless.

It just goes to show, you can take the medic out of Malta, but you can't take Malta out of the medic.

And so, to the night duty.

Saving the Day in a Split Service

Over the past three months that I've been working in Urology, I've come to grips with the fact that I'm working in a hospital which is separate from the 'main' hospital. It's a small 187-bed hospital which houses ENT, Ophthalmology, Orthopedics, Urology and a number of MFE wards. The district general, on the other hand, has most of the general medical and surgical wards, and with them, ITU, A&E, radiology and pathology services. It is the epitome of a split service.

The distance between the two hospitals is not great: 5 miles for British readers, the distance from Mater Dei to Boffa, for the Maltesers. Despite the vicinity, it is still a split service, and while familiarity arises out of the cosiness of the smaller hospital, issues arise when patients in the one hospital require the services found in the other.

A daily trial faces patients attending A&E with renal colic, for example. They are triaged in the District, and recieve an abdominal film before being referred to the urologists. The 4-hour A&E deadline means that once they've been accepted by the urology registrar, they need to be booted out of the A&E department as soon as possible, and so they make their way, via shuttle, to the urology ward in the other hospital. But of course, gold-standard investigation of suspected colic is not simply a plain abdominal film, but is now a non-contrast CT scan. Surprise surprise, the CT scanner is located in the DISTRICT hospital. Thus, after being clerked by the urology FY1 they're put on a shuttle again, and sent over for their scan. They eventually get back to the ward some 8 to 12 hours after originally presenting. Patient ping-pong is both costly and traumatising to the patient. It is, however, a necessary evil.

All pathology specimens are sent over to the district via shuttle; very urgent samples which cannot wait for the next shuttle are sent over by taxi. As the blood gas machine in our hospital is malfunctioning, ABGs must be put on ice and taxied over as soon as possible. Needless to say, the longer the ABG's left in its bottle, the less reliable the result.

A couple of days ago all these issues came to a head; one of our patients went into peri-arrest. Tachycardia, worsening heart failure and a background of COPD pushed this patient into ACS, and it was downhill from there. Thankfully, two of us were on the ward and spotted the deterioration, and we got cracking. BLS and ILS training really come into their own, and you tend to run on automatic. At a point, though, the registrar said that enough was enough, and we put through an adult resuss call.

The anaesthetist on call was first on scene. The outreach nurses were quick on her heels, and the medical SHO pulled up the vanguard. The next person to make her presence felt was the ITU registrar, who turned up on the ward in the form of a phonecall. That's right - ITU's on the other side, with HDU and CCU. The Med Reg is on the other side. The resuscitation nurses are on the other side. Available, but not, in the same instance.

The patient made it, thankfully. The entire team present was well-oiled, and the medical SHO really stole the show, leading the team extremely well. We blue-lighted the patient over to CCU in the District, and he's since stabilised. Hopefully, our timely intervention had something to do with that. A less-experienced team leader and the unavailability of a medical registrar could have lead to a different turnout, but this time, it went well.

Each time we gripe about the slipt service, we're reminded that it's a temporary situation, and all will be resolved when we migrate to the new, amalgamated hospital in November of this year. That's not going to be fun (anyone remember the Mater Dei Migration?), but at least it should make resuss calls a bit safer for the staff and, at the end of the day, the patient too.

Making the Most of a DGH.

It's that time of year when 5th years back home in Malta face the very difficult decision of whether or not to kick off their career in medicine in Malta or elsewhere, namely the UK. By now, all successful applicants to the UKFPO have received their allocated rotas, and presumably have a deadline by which to accept or refute the job offer. I remember it well - I can't believe it's already a year on since I had to go through that ordeal.

It was a bittersweet time. You're really happy, because you've gotten a guaranteed job (pending qualification, of course), but aside from the fact that accepting it means taking up a new life far from home, there's always a nagging feeling of 'is it really worth the hassle?'

I think that need for self-affirmation is compounded by the fact that few people get their first choice in rotas. It's unfortunate, but the fact is that as Maltese medical students, we just don't seem to do as well in our job application for F1 as our contemporaries over in the UK. Perhaps we don't answer the questions appropriately, or we just don't put our heart into it. For whatever reason, most of us will score a middle grade, and will rarely excell at these 'blank box' applications, and so we tend to get jobs that are lower down on our preference list. This tends to mean that a number of the posts are outside of teaching hospitals. Students accepted to East Anglia, in particular, tend to find a job rotation which gives them one job in a teaching hospital, and 5 in a district. I was a bit dismayed when I found out that was my lot, but I quickly changed my tune.

True that perhaps the most exposure's to be had in a teaching hospital such as Addenbrooke's and the like, but there's a lot to be gained from working in a DGH. No matter where you work, consultants are extremely well qualified people, and by and large have a vested interest in teaching and mentoring you. You're more likely to build a lasting relationship in a DGH, simply because things go at a slower pace, and you have more time on your hands to cultivate these sort of relationships. You have the opportunity to focus your efforts on all-important extra-curricular projects such as audits, research and teaching. From my experience in Addies, you DO have time for these, but you're stretched incredibly thin by your day-to-day job. Certainly at FY1 level, DGH's give you much more time to build on your portfolio.

Then there's the life-aspect. We're all here to work, to an extent, so perhaps a social life is a secondary objective to most of us. However it'd be a tall order to spend all your time in the UK without socialising. So far, I've found that being in a DGH comes with a greater sense of community, and while you don't have to go out each and every time there's a do at the pub, you know you're welcome if you turn up. There's less cliques, believe it or not.

Then, there's the accessibility to teaching hospitals. What? Accessibility, I hear you ask? Well, yes. Just because you're not based in a teaching hospital doesn't mean you're banned from it. In your one rotation there, build up as many contacts as you can. Most consultants will carry out clinics in neighbouring DGHs, so you can sit in on a clinic and build up a tie with the specialty of your choice. Who knows, you might be asked to run an audit, give a presentation, or attend a conference. There's a lot to be said for working in a DGH.

Loads of people have asked me how I'm getting on in the UK, and the answer's always been a sincere 'great'. I miss home, of course, if anything for the atmosphere, the friends and family. I've never worked in Malta, so can't draw any comparisons. What I can say is that working in the UK's been a pleasure from the get-go, even though it has been keeping me busy. 6 months down the line and I'm about to get my second audit underway, am on an antibiotic steering committee, have a regular teaching session and have completed a good part of my ePortfolio, amongst other things. All are good ticks in the box for when it comes to CT1 applications. Do I feel I've been left behind because I'm in a DGH? Nope.

The underpinning moral of this (ridiculously long) prose is that what you get out of somethingis directly proportional to that which you put in it. Wherever you work, be it Malta, UCL or the Shetlands, make the most of it, and it will make the most out of you.

Letting loose the Viper.

One of my favourite commentators on all things Maltese (and not) made a very poignant observation this morning in his Facebook stream; the national newspaper's editorial has finally made mention of the online fiasco that's been gripping the country for the past few weeks.

Whether you admit it or not, it's impossible not to be mesmerized by the goings-on between magistrate and columnist, played out primarily on the latter's blog. As she wastes no time in pointing out, her site's hit count has gone through the roof, suggesting that loads of people have been visiting her blog, and re-visiting in the hope of a new episode of the never-ending saga. It's surprising, then, that such a popular issue (current affair, if you like) has been broad-sided by the premier local newspaper. The editor claims that it's because his paper is not a tabloid, and is 'above' the slanging match. That may be so, but it's still newsworthy, for a variety of reasons.

The columnist everyone loves to hate, Ms. Caruana Galizia, has struck a chord with many a sector of the public (both at home and those abroad, such as myself). She's shown everyone that there's no respite for those in the public eye - magistrates can't even post birthday party pictures online as that's the public domain - any Tom, Dick or Harriet can take a pot shot at them, in any forum, with close to little chance of retribution. Reverberations there may be, and knuckles rapped, but it's all fair when it comes to those in public office, it seems.

My views differ slightly - just because people are in public office, they shouldn't be disallowed the freedom of social networking. These people are humans too, and need to connect. Just like no-body should upload photos of themselves in compromising situations, they shouldn't either, but there's no harm in a couple of group shots. So what if you run in certain circles - magistrates are not supposed to be hermits with no social ties whatsoever. Some people forget that just as they have the need to commentate and interact, so do those in the public eye. Just as no-one is above the law, no-one is above humanity.

Was Daphne right in airing everyone's laundry? Maybe. Did she have any ulterior motives? Possibly. What gets my goat (and yet is so very addicting) is that she has now taken a very personal and possibly rude approach to writing her blog. Persecuting members of the judiciary simply on their taste in birthday cakes smacks of someone who is, quite simply, out for the sensationalism of it all. Perhaps even more entertaining, of course, are the lackeys that comment in agreement and support. It makes excellent bed-time reading, either way you look at it.

The net widens, of course, and now Daphne's taking shots at Lydia Abela, Marlene Mizzi, Sharon Ellul Bonici et cetera. Some fair comment is to be found, but most of the short posts are simply sniping shots, casually taken. Our columnist is simply flexing her muscles, just to remind us what a viper she can be, especially when election time rolls around. As always, she puts on quite the display at that time of year. Blue plumage, of course. She's done it before, and she'll do it again.

This is merely a prodrome.

Plenty Noise and Feedback.

Leafing through my RSS feeder this morning as I do every day, I came across an article published by the online branch of the Insiter. It briefs readers on the latest report issued by KSU's education commission; a report detailing students' feedback on the entire examination experience.

The report(.pdf), which can be found online in KSU's document treasure trove, systematically deals with all of the students' suggestions and complaints relating to exams. It tackles mundane issues such as timely issuing of timetables, as well as the more serious issues of plagiarism and anonymity. It is perhaps a measure of students' insight (or lack thereof) from being on the ground that the mundane is given more emphasis than the celestial. It's just the way that it works: day-to-day issues are simply more important than ideologies and principles. Nonetheless, both are tackled, and by large, are tackled well.

The content of the report is quite inoffensive, and makes no demands which are unreasonable. Comments dealing with appropriate invigilation and matching of assessment with learning material are particularly well-placed, and the hounds of war presenting the report would do well to place emphasis on these particular points. What is noteworthy about the whole report is not just its content, however, but its very existence.

KSU have always been good at drafting and publishing reports. I have been on a number of boards, and have seen some good reports on a variety of subjects make it to the noticeboards, and then fester away with nary a care. It's not the fault of the students - unfortunately, students in these sort of organisations are birds of passage, and once their term ends they focus on their finals, and they are students no-more. Reports are done, filed away, and then repeated in essence by next year's committee. A greater element of continuity would help reports such as these do what they're intended to do, and change the status quo.

That's not to say that nothing changes, though. While university administration is notoriously resistant to change, there are a number of people who are interested in what students have to say, and will pick up a good idea when they see it. Professor Vella, pro-rector, started off a feedback system of his own (praised in the report). Dr. Lauri, pro-rector, is one of the bastions of student liaison. The list is long, and the medical school has its own stars, of course,but as usual, the do-gooders are eclipsed by the stalwarts. These reports do well in the hands of the right people, but also have a tendency to fall upon decidedly deaf ears.

It's my understanding that a separate feedback session's been held by the MMSA specifically for medical students in the first year, following the start of the new curriculum. There's a lot that's good and a lot that's bad with it, and that's been made evident from the type of feedback that the students are giving. The team behind the evidence gathering have drafted a very comprehensive report, and it's been distributed firstly to a small group of educators, and, following suggested editing, is pegged for wider dissemination. I'm not sure how happy I'd be to let the target audience edit a feedback report, but as long as the bulk of the data gets out there, and is listened to, then the aim of the project will be reached.

Student input, while given from a particular perspective, is vital for any educational institution, and if collected and presented well, will make the entire educational experience more worthwhile for all.