October 25, 2011

My three weeks in Ghana

GloryanneAs part of their medical degree, Warwick students on the accelerated MB ChB programme get chance for some practical experience.

Here, Gloryann Aidoo - Micah, a second year medical student, tells us about her time in Ghana where she worked with Action for Rural Education (ARE) to help raise awareness about HIV/AIDS in rural communities where access to healthcare is very limited.

I spent two weeks in Twifo Praso (rural part of Ghana) and one week in the capital, Accra. During the first week, I was trained by ARE personnel in the effective delivery about HIV/AIDS to a community that was largely illiterate and non-English speaking. I also learnt a lot about the culture and the context within which the people were living, as well as visiting other ARE partner organisations within Twifo Praso.

I visited 4 separate remote villages where, together with other work experience students, I delivered a presentation to local villagers. Our presentation covered information about what HIV/AIDS is, how it can be transmitted, treated, and prevented. Special attention was paid to trying to reduce stigmatisation of HIV patients, as we learnt that this was a hugely significant barrier to testing in such communities. I also had the opportunity to observe district nurses conducting counselling and testing where one new diagnosis was made. During my time spent in a local district hospital, I came to appreciate the challenges of practicing medicine with very limited resources and personnel... honestly, it makes you very grateful for our NHS.

The third week was spent at the University of Ghana's Teaching Hospital, which is the largest of its kind in the whole of West Africa. The standard of care and availability of resources was a direct contrast to the district hospital I had visited in Twifo Praso. Additionally, I had the opportunity to spend time on the Paediatrics ward where I saw cases such as retinoblastoma, which I have learnt about in my lessons but never actually seen before. And there was the exciting moment when I observed two Caesarean-sections on the obstetrics and gynaecology ward.

I found it an awesome learning experience that has certainly triggered my interest in Obstetrics and Gynaecology - something I will explore further as a potential speciality and career option.

The entire placement experience was great but the part that stood out to me the most was the HIV/AIDS outreach work we did in the small villages. It was surprising to me that the settlements were so remote that some people had never even heard of HIV. I came away from our presentation, testing and counselling feeling like the work we did had made a real difference:

  1. People were more aware of HIV/AIDS, which is a serious problem in Africa
  2. People were open to the idea of getting tested despite stigma being a problem
  3. One diagnosis was made which meant that the affected lady could be started on appropriate treatment

All in all, this experience has given me practical experience and opened my eyes to a possible area of specialism that I may have otherwise not considered and I came home even more motivated to pursue my medical career and studies.

September 29, 2011

Primary Care Matters – but will we have enough GPs in the future?

Dr Teresa Pawlikowska, Associate Clinical Professor at Warwick Medical School, gives her views on why we still need to recruit medical students to General Practice.

Did you know that most people manage most sickness and illness symptoms themselves?

Nowadays, only 1 in 4 problems are taken to a GP and of those consultations, 5-10% result in a specialist referral. The World Health Organisation (WHO) has recently highlighted the fundamental importance of a country having a well developed primary care system in supporting the health of their citizens. However, countries such as Canada, the US and Australia are seeing recruitment to general practice and family medicine fall, which is causing widespread concern but thankfully, numbers are holding up in the UK.

A study, funded by the Canadian Institutes of Health Research, was set up to research an international comparison of students’ motivation to become GPs, and a team from Warwick Medical School, led by myself, was asked to join. The other centres involved in the study were McGill University in Canada, L’Universite de Rennes in France and Universidad Miguel Hernandez, Spain. Recruiting Warwick Medical School to this study was important as it has the largest graduate entry programme in the UK and so forms a good comparison for the graduate entry programmes of North America.

We looked at what both students and their teachers thought of a career in primary care in each medical school, and compared them internationally. We found that despite WHO’s repeated affirmation of primary care, it is only when academics and policy makers value family medicine and students experience family medicine as undergraduates, that they choose family medicine as a career. For example, in contrast to the UK, our French colleagues concluded that GPs were invisible in the undergraduate curriculum teaching there, so the development of positive role models really does matter. In this country, there is evidence that that improved pay, working conditions and job flexibility for GPs has proved an attractive incentive.

Another aspect of this research was that via the Undergraduate Research Scholarship Scheme (URSS), two students were given the opportunity to participate in the research. Not only did this mean the student developed research skills, but they were involved in writing up and presenting this work at several international meetings, including to Ministers of Health, and most recently to the 17th European meeting of the World Organisation of National Colleges and Academies of Family Medicine, which was attended by over 3,000 delegates. The feedback was that delegates from a variety of countries could identify with the results and see themselves in the country models presented.

So what we really want to see as an outcome is that the benefits and career opportunities afforded by specialising in General Practice should not be overlooked by our student cohorts… calling all GPs: step into the limelight please!

Dr Teresa Pawlikowska is the lead for the GP group involved in medical education.

She has presented the findings at several key international conferences including the World Association of Family Doctors Conference in Warsaw, Poland and the National Conference for GPs and Healthcare in Valencia, Spain. For further information please contact Dr Pawlikowska.

August 25, 2011

Cadaveric dissection for 1st year medical students

Grenada trip June 2011Christoher Parry, Daniel Lin and Matthew Boissaud-Cooke are first year medical students on the accelerated MB ChB programme at Warwick Medical School. Here is their recount of a trip to Grenada this summer….

A crisp early morning in late June saw a group of just 21 lucky medical students from the University of Warwick arrive at Gatwick airport in preparation for a bit of a busman’s holiday. After a long flight, we walked off the air-conditioned plane into a brick wall of heat and humidity with our feet firmly planted on the beautiful isle of spice in the Caribbean: Grenada. This was to be our home for the following five weeks … and where we would get our first opportunity for cadaveric dissection.

On arrival at St George’s University, we were quickly whisked off to the anatomy lab to meet Dr George E. Salter Jr. who gave us an introductory talk and instructions for our work which was to begin early the next morning. Before we knew it, we were assigned a cadaver and were instructed to dissect various regions of the body. Dr Salter demonstrated the importance of anatomical knowledge as he skilfully reflected the skin and superficial fascia saying: “it may seem as though I am whipping through the cadaver but in no way am I being cavalier in my approach.”

Seeing these fine-motor skills and the seemingly effortless use of surgical instruments – it was then that we began to learn and appreciate his brilliant surgical skills …. It was an opportunity that many students don’t encounter until after medical school.

Interestingly, we found numerous anatomical variations, including a three headed bicep brachii, highlighting that not everyone is like a Netter’s textbook diagram! Examining the cadavers also unearthed the sad reality of terminal disease with colorectal tumours and even mesothelioma being identified. We also overcame a significant boundary that can feel unnatural at first – that feeling of cutting into another person – but which has hopefully allowed us to better understand and cope with what lies before us as doctors and surgeons of the future.

Now on top of all the anatomy study, it would be remiss of us not to mention that an equally important task during our five weeks was to make the most of the Caribbean! We spent time on beautiful white-sanded beaches, snorkelling in turquoise waters, enjoying the local cuisine, trekking through break-neck areas of rainforest, jumping into waterfalls, deep sea fishing, scuba diving, driven about by rally-driving style taxi drivers and last, but not least, trying out the local rum punch – not bad for a first year med student!

But back to the important stuff …. Cadaveric dissection has given us an appreciation of anatomy that cannot be gained from textbooks or lectures. Our time in Grenada has given us a deeper understanding of the three-dimensional aspect of the human form and its clinical relevance. We were fortunate enough to have the “Hanno” Boon 2011 dissection Masterclass running alongside our dissection and provided us the opportunity to speak to and learn from an international group of dissectors and an insight into the world of clinical anatomy and research.

These experiences have left us with a new found confidence and even amongst a few, interests in pursuing anatomy-driven specialties. Our thanks goes to Professor Abrahams, Professor of Clinical Anatomy at Warwick, for an incredible opportunity; the late Dr Johannes Boon, a “shooting star in clinical anatomy” to whom the Masterclass was dedicated; Dr Loukas for allowing us to work in his department; Dr Salter for his time, patience, technical skills and infinite knowledge on anatomy. But above all, our utmost recognition and respect goes to those who were generous enough to donate their bodies for us to learn from. We are humbled by your gift - thank you.

More information on the MB ChB programme at Warwick Medical School

August 11, 2011

What medical students do in their spare time

Ever wondered what a typical student at Warwick Medical School gets up to? Launching a quarterly magazine aimed at medical students might not be the first thing that springs to mind …… and yet that’s exactly what a group of our doctors-in-training have done.

Ferdinand Daly Morris is one quarter of the founding team of MedQuarterly and here he takes us through exactly what MedQuarterly is and how it came about.

“MedQuarterly is a creation centred around medical education at all levels. Together the MedQuarterly team have worked tirelessly to produce an innovative and high quality resource aimed primarily at medical students, but also other junior health care professionals. It’s based upon a principle of providing readers with a wide variety of information that we, as students, all wished had been made readily available to us; information that we believe will better prepare us for survival and success in the world of medicine.

So what are we actually offering?

MQ is our FREE medical education magazine and the flagship component of the MedQuarterly project. Consisting of a variety of articles in every issue, each is targeted towards one of several categories including ‘educational’, ‘opinion’ and ‘how to..’. All are written by either junior doctors (to give a practical real world view), or medical students in collaboration with consultants or other registered professionals.

June saw the release of issue 2 and, with an ever increasing distribution, has been a tremendous success thus far. However if you haven’t yet managed to place your hands on a hard copy, we ‘technology natives’ have managed to make editions available online which can be viewed in either pdf or printer-friendly formats at your leisure on our website

In addition to this the website offers a wide variety of educational content including:

  • Information on more than 350 medical topics, equating to over 7500 pages of key notes. These range from orthopaedics to paediatrics and cover everything between! Significantly all are designed to be streamlined to the core IMPORTANT points, cutting out all the waffle and leaving you with the facts
  • Over 40 differentials tables designed to get you thinking in the right way whenever you are presented with a case (whether it be exams or on the wards)
  • Many more articles not found in the MQ publication (a database that is continually being adding to)
  • For the ‘visual learners’ amongst us you will now also find revision orientated mind maps, designed promote understanding of a variety of conditions and medical concepts
  • With a single click all this content can be converted into printer friendly formats and used to supplement your own notes. Try reading a topic online before a lecture and test its usefulness for yourself! They also make great revision aids as they have been specifically aimed at a level we believe most appropriate to support success
  • New this quarter we are launching our clinical skills environment – presented with a little more jazz than found elsewhere, but as always with a strong focus towards providing you with the key and most supportive points

Content in MedQuarterly is sourced from both local and international sources in attempt to create the most balanced and useful assortment of learning resources possible, and with more being added it is constantly evolving to best match your learning needs. If you would like to see anything added to the website that you feel would be of great benefit, please feel free to contact us, and as ever our team will endeavour to make this a reality (see website for contact details).

Any student is eligible to write for us, creating a strong peer-to-peer exchange of ideas and experiences. If you would like to see your own work published in MQ please visit the ‘write for us’ section of our website or to contact the team who run MQ email us at: info@medquarterly.co.uk.

We hope MedQuarterly proves useful to you all and wish you the best of luck in your careers”

Founders of MedQuarterly:

  • Ben Van Duren
  • Adam Zenkner
  • Ferdi Daley Morris
  • Evan Watts

August 05, 2011

Giving plaster casts the boot

Rebecca Kearney is a Research Physiotherapist and Mr Matthew Costa is an Orthopaedic Surgeon at Warwick Medical Schoolachillies_boot_2.jpg

Rupture of the Achilles tendon is a common injury in sportsmen and women. Raquet sports are a common cause but other ‘impact’ sports like athletics or football can overload the tendon - David Beckham was a recent high-profile victim. However, this injury can happen to anyone, even if they never do any sport at all and some of the cases we have seen have been caused just by walking upstairs!

Traditionally, people with a rupture of the Achilles tendon were treated in a plaster cast from the knee to the toes and were unable to put weight through their foot for up to three months. This allows the tendon to heal, but results in weakness of the muscles in the calf and stiffness in the joints around the ankle. Until recently, the average return to sporting activity was nine months and for many professional sports people it was a career-ending injury.

The research team here in the Health Sciences Division at Warwick Medical School has investigated different forms of rehabilitation that allow patients to walk immediately after their injury. We have been using walking-boots - like the ‘moon-boot’ that Wayne Rooney famously wore before the World Cup. These have allowed patients to return to their normal activities earlier than before and may even improve the healing of the tendon.

boot 1

The research is still ongoing, but we are very encouraged by the results of our pilot at University Hospital Coventry and Warwickshire where patients are showing quicker recovery times using these boots. We are currently investigating different types of walking-boot, to see which one allows the patients to return to normal activities sooner. One looks very much like a walking boot but the other looks quite futuristic with minimal support – yet it is incredibly effective in assisting healing whilst allowing a good measure of protected movement too.

We hope that this research will allow patients to return to work and leisure activities even more quickly, with the least chance of further injury to the tendon. Who knows, we could see the traditional plaster cast given the boot … well, it worked for David Beckham!

More information about WMS Achilles research by Matthew Costa and Rebecca Kearney

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