Choosing your Foundation School: Popularity

Last Tuesday the Foundation Programme website published the annual report (.pdf) of Applicants vs. Vacancies for the round of applications for FY1 starting August 2009, with comparisons to the previous 2 years. They're worth a look, people who applied last year will find them interesting, but they're essential reading for anyone who's interested in applying for FY1 in the UK this year!

There are no surprises, really. As has been the case for the past two years, the London deaneries have been oversubscribed, in most instances by over a hundred applicants. In fact, the only other deaneries which were oversubscribed were Northern Ireland, Oxford, Severn and South Yorkshire. The remaining 16 deaneries were all left with vacancies at the end of the count of first preferences, to varying degrees. The least popular deanery in terms of ratios was North Yorkshire, with a mere 47% of positions being filled first time round.

A telling proviso in the published document is that the data don't take into account the number of posts available in English deaneries following a revision to the numbers. This was undertaken after the submission of applications, though applicants were never told exactly how the numbers were revised - presumably the numbers were shifted to allow greater spill into the Wales and Scotland deaneries.

Prospective applicants are always told that ratios obtained in previous years are not necessarily an indication of the popularity of schools in the current round of applications. Still, I couldn't help make inferences last year, and I'm sure there will be many who'll do the same this year. If you're happy with avoiding the popular schools (i.e. the ones marked in red), then you stand a better chance of getting your first choice of Foundation School, as your first preference is likely to be undersubscribed. The problem with being a 'spillover' applicant is that your second preference will probably be close to, if not already, full, and you'll keep dropping down your preference list until you land in an empty post - with each drop you lose a bit of control over where you're going to end up.

This was my logic, at least. I was moving to a new country, and had no issue with moving to any deanery, really - no family and few friends in the UK to affect my choice. There were some deaneries which moved to the bottom of the list by nature of geography - N. Ireland has poor flight connections back to Malta, Scotland's a bit too far north, for my liking, and Wales... well, for some reason Wales made it to 5th from bottom. The ones that made it to the very top were there for academic reasons - East Anglia, Oxford and the London Deaneries (ha!) were in my top 6, with West Yorkshire, Severn and Trent quick to follow, all places with good postgrad training records, and reasonably close to travel hubs to boot. The middlegrounds were ranked rather randomly. Such was the disadvantage of applying as a foreigner.

People have different reasons for choosing different Deaneries, and their rationale would make for interesting if somewhat anecdotal reading. My advice is to speak to as many people as possible who have experience in different parts of the country, and see which place suits you best and, strategically, you're likely to get accepted into. Then it's a case of putting your back into your application form and hoping for the best. But that's best left for another post.

You need to fill in this form, Doctor.

There's a certain amount of trepidation involved in sitting for your final 5th year exams in June, knowing there's a house officer job waiting for you if you qualify. It's even more anxiety-inducing when you're sitting for your exams in Malta, and the job's waiting for you in the UK. Whether or not you uproot your life and go to live and work in another country is dependent on you getting through those last few exams, and once you do, it's a sigh of relief.

That is, until the post arrives the next day.

I am truly impressed by the amount of paperwork getting a job in the NHS entails. This is my first job in the UK - I'm new to the world of UK National Insurance numbers, I've only just gotten a bank account, and my accommodation request has finally been granted. This doesn't even begin to scratch the surface of the barrage of documents needed for GMC registration, forms to get your Trust ID, PACs access, doctor's mess subscription, and one hundred and one other things. I suppose it's all good training for the paperwork that is de rigeur in an FY1s daily chores.

A lot of duplication goes into these forms, and this could possibly be avoided by having a centralised data bank the NHS and other satellite organisations could dip into to autofill certain parts of the form (how many times do I need to tell them that I'm Caucasian?). Data Protection is always a hot issue, but on a secure enough server, such problems are skirted by eliciting online consent for each and every form to be autofilled. I'm sure it's an achievable concept.

Getting into a medical job isn't easy, and nobody is saying that it should be - security checks are well placed (though the NHS policy of not accepting non-UK virology results is a bit tough to accept). What it could be is more streamlined.

Once you're through the gates, then why should the paperbumf keep coming?

This post is syndicated at doc2doc.

October '09 Deadline for Preclinical Curriculum

So it's official: the proposal for the new curriculum for the pre-clinical segment of the Malta Medical School MD course has been approved to start as a pilot project in October 2009. That's right, this October. The new curriculum is finally on its way.

The Senate minutes would no doubt make interesting reading, if they were available for reading, that is. It transpires that the Programme Validation Committee (PVC) was quite impressed with the work the Medical School Curriculum Committee was doing, but wanted to see the full product before it would rubber stamp its approval - the Curriculum Committee has only finalised the pre-clinical section. This translates to 2 out of the proposed 5 years for course completion. While the Curriculum Committee knows where it wants to go, and is moving towards that goal, it's hard to imagine a fully integrated course being proposed, and even implemented, in a piece-meal fashion.

And yet, despite this 'judgement' from the PVC, the Senate has approved that the new intake of MD students be started along the lines of this 'new' curriculum, ostensibly without being sure what the rest of their course is going to look like. Meanwhile, the Curriculum Committee has been given a deadline of December 2009 to provide the entire proposal for validation by the PVC.

Having resigned from the Committee as I am no longer technically a medical student, I'm not up to date with the progress of the clinical segment. I was on the board when the pre-clinical segment was finalised, though, and I have to say that it looks very comprehensive. Each study unit (divided according to system e.g. cardiovascular, as opposed to department e.g. Anatomy) is integrated throughout the departments, and goes a long way to introduce a clinical aspect to the knowledge base as well as the way things are taught. Taking the cardio study unit as an example, over 68 specific objectives of the unit have been laid out, in plain English, along with a list of lectures, tutorials and a variety of independent learning activities which the student should endeavour to complete. If this document is provided to the students (and I believe it will be), it will provide an excellent road map of where they need to end up, and how they should get there.

However, there is a tiny snag in the excellence of all this, and this has been brought up by a number of students, faculty members and even committee members. The scope of this curriculum update is huge. It encompasses a radical upheaval in both the knowledge base students are expected to attain, as well as the teaching/assessment methods. But mostly, it's a brand new excercise in inter-departmental collaboration. What the Curriculum Committee is aiming for, and backed by the almighty Senate, is radically changing the way things run in the Biomedical Science departments, in essentially under 3 months. 3 summer months, holidays et al, during which they'll be training the notoriously-difficult-to-train teachers, breaking age-old departmental barriers, setting up infrastructure and formalising assessment policy. Oh yes, and the documentation. Can't forget the documentation.

It's a tall order. Let's just hope that the intake of 115+ 1st year medical students find it all ready when they come clamouring for their education.

GoogleBooks for the retired medical student.

As you can imagine, spending 5 years trudging through the murky mire that is medical school requires the purchase and reading thereof of quite a number of books. True to form, I've picked up a lot of books (especially over the past 3 years), and have been helped considerably by book loans from the Significant Other. And surprisingly, I've read most of them.

Unfortunately, that has left my shelves littered with such gems as 'ABC of Eyes', 'Lecture Notes in Clinical Anaesthesia', and myriads of MCQ/OSCE books. They're all very excellent books, most of them in very good condition. However, primarily as I'll be leaving the country, and due to the fact that I'm now thinking of narrowing my focus of study, there are a number of books that are clamouring for a new home. I don't want them to gather dust on my shelves, and would be sad to see the books thrown away when there's still a lot of use left in them.

Hence, I was hunting around for the best way of finding them a new home. I came across Google Books, which is an online repository of most books under the sun. Gloriously, Google provides you with the facility of compiling your own Library, and I said 'Ah-aaa! A clue!'. Since then, I've slowly been typing in ISBN numbers of books I'm no longer interested in keeping, categorising them according to topic, and adding little notes on their condition. The full list of my Books which are availabe can be found here.

Thus, Google's provided me with an easy, no-frills method of listing the books that I own (and that I want you to know that I own), compiling them into a list that looks professional and is of use for the page viewer (as there's even the option to click through to reviews of the books). Now it's just a case of broadcasting my Library page to the world.

Or linking to it from my blog. There's a permalink under my Twitter link in the sidebar. Good hunting!

H1N1, and Keeping our Heads

So it is finally here: H1N1 has hit the islands of Malta and Gozo. We've been told that it was a question not of 'if', but of 'when'. Probably, we've actually had H1N1 on the island for quite a while now, Malta being a haven for communicable diseases due to its size and population density, and the fact that people are coming and going, and intermingling with the home-crowd so effectively. But now, someone's decided to get swabbed, and all of a sudden, 'swine flu's hit Malta'.

Quite.

First of all, the Centres for Disease Control (CDC) discourage the use of the term 'swine flu', as this is essentially a different virus to the one that came out in the 1918 swine flu pandemic. Moreover, it is now basically a human-to-human virus in most countries. Hence, we're now supposed to call it H1N1, and that's it. Although this sadly makes all pig jokes redundant, it also makes the latest Daphnicle redundant. A little byproduct of happiness there, then.

Secondly, you've got to love the comments and commenters on the timesonline.com - a treasure trove of rationality if there ever was one. The media, and the people who subscribe to it, have turned this outbreak into an apocalypse when in reality, this is just another flu outbreak - the same that happens year in, year out every December through February. True that it's purported to be a novel virus, but it's a novel virus every year - that's why we keep getting sick. Hence, all this obsession with finger-pointing at tourists and insistence on cancellation of concerts and mass is a bit over the top. Yes, people are going to keep getting it, and the numbers are set to explode, but it'll have to get worse before it can get better. Later, once people have gotten it and gotten over it, there will be something called 'herd immunity', and the numbers will drop substantially.

What people need to bear in mind before embarking on their reverie of doomsaying is that at the end of the day, this is a flu virus. Yes, there have been fatalities, but these, like in most flu infections, are in the previously unhealthy, or the very young. Also, what must be borne in mind is that this virus seems to have a predeliction for the younger sector of the population which, in most cases, should represent the country's pinnacle of fitness. So we really need to check ourselves - while the pandemic is a reality, it needs to be tackled rationally. People need to stay informed.

On a personal note, I'm just back from Spain (no, I'm not sneezing or growing a snout or whatever), and I loved it. Excellent culture, wonderful food and essentially a glorious place. Highlight of the trip was the U2 concert in Nou Camp. Nothing like 90,000 shouting, clapping, stomping Mediterraneans belting out Vertigo. Absoloutely nothing.

Same Theory, More Practice.

The latest edition of Academic Medicine has published an interesting article (abstract) relating the characteristics of medical internship with the student's end-performance in final examinations. Unsurprisingly, the overall feel is that the more involved a student is in their clinical attachments, the better they are likely to perform in subsequent assessments. What is interesting is that the investigators broke down the clinical exposure into different characteristics, and each has its own weight on eventual student outcome.

What needs to be borne in mind before delving deeper into analytics is that the journal is an American one, and the article takes into account data collected from 17 medical schools, all of which were American. Vitally, the American medical school system is quite drastically different from Maltese and English systems, in that they heavily emphasise clinical exposure in their final 'internship' year, where students essentially take on the role of junior doctors. This contrasts with the experiences I had in medical school, where while students were on the wards, talking to and examining patients, it was more of an observer status that we had; we were not directily involved in patient care.

And the reason why I make this distinction is that the one characteristic that blew the others out of the water in terms of prognostication was the number of patients the student was directly caring for, and the quality of care given.

It is hard for us to draw any conclusions as to whether their system is better than ours, simply because this one study only involves US schools, and their students' performance, but I would hazard the conjecture that students on this side of the pond would also benefit from being directly involved in patient care.

This would not entail too much effort to implement, as this is not to suggest that the student takes over the role of the junior doctor. Instead, it could require something along the lines of picking up a patient from beginning to end, from clerking, through treatment, to discharge, presenting to the firm and suggesting management. This would take a bit more organisation from the student's as well as the faculty's end, but it is not unattainable. The OBGYNs have already set the ball rolling in this direction, and the Head of Department tells us that our performance has improved as a result.

As more and more evidence comes crashing in that students on the wards means better doctors on the wards, can we really afford to be left behind, just because 'that's how the guys before us did it'?

Jubilation, and the End of the Beginning.

This post has been a long while in coming, some 5 years in fact, but I'm very happy to say that my undergraduate course at university is now over. I've finished my MD, passed my final exams, and am now on the list for degree conferment in November of this year. As you can imagine, I'm very happy, if not a little relieved.

This means, of course, that a significantly long chapter of life is now complete - ever since getting into the science programme in secondary school, I've been working towards the end of my MD. That is to say, throughout secondary and sixth form, I'd been putting myself into a position to be able to work towards an MD: I hadn't really decided to take up the course until I got my A-level results. But that's neither here nor there - it's been a long slog, but a happy one.

Unlike the fairy tales of yore, this chapter doesn't end with a bland and indeterminate 'happily ever after', but instead refers you to the next volume. Closure of one chapter entails the beginning of a new one, bigger and better than the one before (and certainly more complex). I'm on a break now, and am off abroad on holiday to really complete the celebrations, but come July, I'll be starting a job as a junior doctor in East Anglia, UK. It's a new lifestyle, a new country, and a new beginning. It is, as you can imagine, terribly exciting.

Meanwhile, this blog should serve as a bridge for these two chapters and, hopefully, many more to come. It's going to undergo a change in both design, content, and frequency of updating (hope springs eternal!), to match the expanding horizons of this coming chapter. Here's hoping the readers stick to their guns and join in on the coming voyage!