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JAN - FEB<br />
<strong>2014</strong><br />
Volume 127, Est. 1872<br />
Guy’s, King’s<br />
College and St<br />
Thomas’ Hospitals<br />
FREE on Campus<br />
gktgazette.org.uk<br />
Inside:<br />
Dry <strong>Jan</strong>uary<br />
Temporary teetotalers<br />
London Student Protests<br />
ULU Closure, 3 Cosas & Cops off Campus<br />
<strong>GKT</strong> Christmas Comedy Revue<br />
Exclusive Pictures and an interview with the cast<br />
and much more
awith online MCQs and C<br />
ses<br />
with self-test and images<br />
with self-test<br />
with self-test<br />
MCQs and flashcards<br />
Anaesthesia<br />
at a Glance<br />
Julian Stone<br />
William Fawcett<br />
Obstetrics and<br />
Gynecology<br />
at a Glance<br />
Fourth Edition<br />
Errol Norwitz<br />
John Schorge<br />
<strong>GKT</strong><br />
GAZETTE<br />
Established 1872<br />
Haematology<br />
at a Glance<br />
Fourth Edition<br />
Atul B. Mehta<br />
A. Victor Hoffbrand<br />
Medical<br />
Genetics<br />
at a Glance<br />
Third Edition<br />
Dorian J. Pritchard<br />
Bruce R. Korf<br />
The<br />
Foundation<br />
Programme<br />
at a Glance<br />
Edited by<br />
Stuart Carney<br />
Derek Gallen<br />
Ophthalmology<br />
at a Glance<br />
Second Edition<br />
<strong>Jan</strong>e Olver<br />
Laura Crawley<br />
Gurjeet Jutley<br />
Lorraine Cassidy<br />
Oncology<br />
at a Glance<br />
Graham G. Dark<br />
Medical<br />
Sciences<br />
at a Glance<br />
PRACTICE WORKBOOK<br />
Jakub Scaber<br />
Faisal Rahman<br />
Peter Abrahams<br />
Physiology<br />
at a Glance<br />
Third Edition<br />
Jeremy P. T. Ward<br />
Roger W. A. Linden<br />
Vol. 128, Issue 1. Number 2581.<br />
ISSN: 0017-5870<br />
<strong>Web</strong>site: www.gktgazette.org.uk<br />
Email: editor@gktgazette.org.uk<br />
Medical<br />
Sciences<br />
at a Glance<br />
Edited by Michael Randall<br />
<strong>GKT</strong> <strong>Gazette</strong>,<br />
Room 3.7, Henriette Raphael House,<br />
Guy’s Hospital, London,<br />
SE1 1UL<br />
The opinions expressed are those of the authors<br />
and do not neccessarily represent the views of<br />
the Hospitals, the University, or the <strong>Gazette</strong>.<br />
All rights reserved.<br />
Front and back cover photos courtesy of Charlie Ding<br />
The at a Glance series<br />
The market-leading at a Glance series is used world-wide by medical students, residents, junior doctors and health professionals for its<br />
concise and clear approach and superb illustrations. Each topic is presented in a double-page spread with clear, easy-to-follow diagrams,<br />
supported by succinct explanatory text. Covering the whole medical curriculum, these introductory texts are ideal for teaching, learning and<br />
exam preparation, and are useful throughout medical school and beyond.<br />
www.ataglanceseries.com<br />
<strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>GKT</strong> <strong>Gazette</strong> 3
Contents<br />
6<br />
7<br />
9<br />
16<br />
28<br />
Editorial<br />
Issue highlights and updates from the<br />
<strong>Gazette</strong> team<br />
Letters<br />
Shields swapped<br />
News<br />
Dry <strong>Jan</strong>uary,<br />
No more Cambridge transfers<br />
and more<br />
Features<br />
Exclusive interview with Christmas<br />
Show cast,<br />
London student protests<br />
Arts & Culture<br />
New year, new music,<br />
Females in film<br />
36<br />
44<br />
54<br />
56<br />
History<br />
Thomas Addison,<br />
Guy’s at war: The home front<br />
Research<br />
Drugs for respiratory disease in development,<br />
King’s role in fighting antibiotic resistance<br />
Dental<br />
Foundation interview process<br />
Nursing & Midwifery<br />
Out and proud: Life as an LGBT nurse<br />
Healthcare for the homeless<br />
Book Reviews<br />
Oxford Assess and Progress: Medical Science,<br />
Slow Man by J.M. Coetzee<br />
Careers<br />
Aussie elective tips,<br />
Ethical judgement and the SJT<br />
Obituary<br />
Bill Sheeran<br />
Sport<br />
Dental sports day,<br />
KCL vs Cambridge boxing<br />
62<br />
66<br />
73<br />
75
EDITORIAL<br />
LETTERS<br />
Letters to<br />
I<br />
would like to start this<br />
issue by raising a glass<br />
(of water) to those of<br />
you who have stuck to soft<br />
drinks for Dry <strong>Jan</strong>uary,<br />
an awareness-raising<br />
campaign organised by<br />
Alcohol Concern which<br />
I’m happy to recommend<br />
supporting. Find out more<br />
about what the temporarily<br />
teetotal members of<br />
the Medical Students’<br />
Association has been doing<br />
for this cause in the News<br />
section.<br />
I am also keen to draw your<br />
attention to a feature on<br />
recent student protests in<br />
London – misrepresented<br />
by many other media outlets<br />
- and to two articles on<br />
research projects at King’s<br />
that I hope will translate<br />
into new therapies for two<br />
areas of significant unmet<br />
need, antibiotic-resistant<br />
bacterial infections and<br />
obstructive airway diseases.<br />
Also featured in this edition<br />
is an exclusive interview with<br />
the team behind December’s<br />
excellent Comedy Revue,<br />
accompanied by previously<br />
unreleased photos taken<br />
by our talented staff<br />
photographer, Charlie Ding.<br />
To further challenge the<br />
misconception that students<br />
on clinical and scientific<br />
courses are one-trick ponies,<br />
we also have articles on art,<br />
film and music as well as<br />
some creative writing in the<br />
Arts & Culture section, and<br />
fittingly given the passing<br />
of Guy’s Dentist and boxing<br />
enthusiast Bill Sheeran, the<br />
Sports section has reports<br />
from the College boxing<br />
team and the Dental Society<br />
sports day.<br />
In other matters, I’m<br />
pleased to announce that<br />
the memorabilia we sell<br />
are now available at a cash<br />
shop kindly hosted by Bill<br />
Edwards at the Gordon<br />
Museum on Guy’s Campus,<br />
as well as through mail<br />
order. Our new website<br />
(www.gktgazette.org.uk)<br />
is now running smoothly<br />
and will soon host an<br />
online shop and the <strong>Gazette</strong><br />
archives in their entirety.<br />
Lastly, I’d like to say a huge<br />
thank you to everyone<br />
who has helped get this<br />
publication back up and<br />
running. In particular<br />
I’m very grateful to our<br />
team of students, many of<br />
whom have balanced their<br />
studies and part-time jobs<br />
with hours of work on the<br />
<strong>Gazette</strong>. I’m also indebted<br />
to supportive members of<br />
staff, including our trustees,<br />
as well as our subscribers,<br />
the Friends of Guy’s<br />
Hospital, King’s College<br />
London and our advertisers<br />
for their continued support.<br />
Cheers,<br />
Simon Cleary<br />
Editor, <strong>GKT</strong> <strong>Gazette</strong><br />
editor@gktgazette.org.uk<br />
Photos from left to right: Silent UK, King’s College London and Bing<br />
the <strong>Gazette</strong><br />
The <strong>Gazette</strong> always invites its readership to interact with<br />
our writers. See an article you like Want to disagree<br />
vehemently with the opinions of one of our contributors or<br />
writers Please let us know! Send all correspondence to<br />
editor@gktgazette.org.uk, and you will see it in the next issue of the <strong>Gazette</strong>.<br />
Dear Editor,<br />
It is good to see<br />
the old <strong>Gazette</strong><br />
back on its feet<br />
again after the unfortunate<br />
hiatus last year. Well done<br />
for this but unfortunately I<br />
write to you on a somewhat<br />
less congratulatory note. As a<br />
Guy’s alumnus, now working<br />
at King’s College Hospital<br />
I have an appreciation and<br />
commitment to two of the<br />
different hospitals which now<br />
make up this fine medical<br />
school. I proudly wear my<br />
Guy’s hospital cufflinks<br />
to this day and like many<br />
alumni, the sight of those<br />
three lions evokes more<br />
feeling in me than those on a<br />
football shirt ever could.<br />
While it gets less airtime, I<br />
also feel attached to the crest<br />
of King’s College Hospital,<br />
having provided my services<br />
there for the best part of 15<br />
years. I am deeply saddened<br />
to see that the logo for your<br />
publication, as well as the<br />
<br />
Above: The shield swap<br />
merchandise in your shop<br />
bears the crest of King’s College<br />
London as one of the<br />
trio, rather than the hospital<br />
crest which should rightfully<br />
be there in its stead.<br />
I choose not to get upset<br />
about the KCL, <strong>GKT</strong> dichotomy<br />
for its own sake (though<br />
I do rather enjoy attending<br />
the Macadam Cup), it strikes<br />
me as odd that a historic and<br />
high quality publication such<br />
as the <strong>Gazette</strong> should get its<br />
heraldry so obviously wrong.<br />
Please sort it out.<br />
Yours,<br />
Dismayed of Denmark Hill<br />
6<br />
<strong>GKT</strong> <strong>Gazette</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong><br />
<strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>GKT</strong> <strong>Gazette</strong> 7
LETTERS<br />
NEWS<br />
Dear Dismayed,<br />
The image of the<br />
hospital shields<br />
that we currently use was<br />
given to me by someone at<br />
the King’s College London<br />
image library when I was<br />
starting at the <strong>Gazette</strong> as<br />
a layout editor a few years<br />
ago. I must confess that I<br />
was oblivious to the replacement<br />
of the hospital shield<br />
with that of the college<br />
when I moved to the newer,<br />
higher reolution image but<br />
the shield swap has since<br />
been pointed out to me on a<br />
couple of occasions.<br />
A trustee of the <strong>Gazette</strong><br />
has explained this to me<br />
– apparently, when the<br />
College corporate image<br />
department requested pictures<br />
of the shields for the<br />
production of high-quality<br />
vector images, no image of<br />
the King’s College Hospital<br />
crest was to hand. I also<br />
have (completely unfounded)<br />
suspicions that the designer<br />
did not want to try<br />
and tackle the hospital’s<br />
shield-within-a-shield, and<br />
that there might have been<br />
a brand-strengthening motive<br />
to use the current image<br />
on the part of the College.<br />
I’ll see whether anyone on<br />
our team can draw up a<br />
high-quality shield and welcome<br />
readers to send in any<br />
good-quality images of the<br />
crest in question.<br />
Best wishes,<br />
Simon<br />
Editor, <strong>GKT</strong> <strong>Gazette</strong><br />
Medical Students Sober Up for<br />
‘Dry <strong>Jan</strong>uary’<br />
Photo Courtesy of Charlie Ding<br />
The <strong>GKT</strong> <strong>Gazette</strong><br />
Invites Companies to Use Our<br />
Advertising Space<br />
For more information, contact<br />
advertising@gktgazette.org.uk<br />
Katie Allan<br />
MBBS4<br />
Although medical<br />
students might not<br />
be best known for<br />
their sobriety, a group from<br />
<strong>GKT</strong> have pledged to abstain<br />
from alcohol for a month,<br />
as part of a nationwide<br />
fundraising campaign.<br />
The Medical Students’<br />
Association (MSA)<br />
assembled a team to<br />
participate in Dry <strong>Jan</strong>uary,<br />
a charity campaign in which<br />
participants are sponsored<br />
to stay ‘dry’ for the month<br />
of <strong>Jan</strong>uary. The team of 38<br />
participants is comprised<br />
mostly of medical students,<br />
although they are joined by<br />
Sebastiaan Debrouwere, the<br />
president of King’s College<br />
London Students’ Union.<br />
The sponsorship money<br />
they raise will be donated to<br />
Alcohol Concern, a national<br />
charity which campaigns to<br />
raise awareness of alcohol<br />
misuse, and reduce the<br />
effects of its harm.<br />
In addition to fundraising<br />
for Alcohol Concern, the<br />
MSA have pledged to donate<br />
an extra £10 to the <strong>GKT</strong><br />
Raising and Giving (RAG)<br />
charities for each student<br />
that successfully completes<br />
the challenge. Should any<br />
of the participants fail to<br />
abstain on any occasion<br />
during the month, they<br />
are invited to continue the<br />
challenge regardless, but add<br />
a £20 ‘tipple tax’ to the total<br />
sponsorship to make up for<br />
it!<br />
The MSA have also<br />
supported the campaign by<br />
hosting a range of alcoholfree<br />
events during <strong>Jan</strong>uary,<br />
including a meal exclusively<br />
8<br />
<strong>GKT</strong> <strong>Gazette</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>GKT</strong> <strong>Gazette</strong> 9
NEWS<br />
NEWS<br />
for the Dry <strong>Jan</strong>uary team,<br />
and an evening of bowling<br />
open to all students.<br />
Dry <strong>Jan</strong>uary is a nationwide<br />
initiative, which the<br />
MSA committee decided<br />
to promote specifically<br />
amongst medical students.<br />
‘The MSA is proud to be<br />
taking part in Dry <strong>Jan</strong>uary.<br />
As well as raising money,<br />
we are hoping to promote<br />
alcohol awareness on Guy’s<br />
Campus and encourage<br />
students to moderate their<br />
alcohol consumption’ said<br />
Juliet Laycock, the president<br />
of the MSA. ‘The team<br />
are noticing the positive<br />
benefits of abstaining,<br />
including increased energy<br />
levels, more time for other<br />
activities, and more pennies<br />
in our pockets!’<br />
Hospital Trust Staff Banned from<br />
Smoking in Uniform<br />
Simon Cleary<br />
Editor<br />
Guy’s and St Thomas’<br />
Hospitals NHS Trust<br />
is among the first<br />
in the country not only to<br />
ban staff from smoking on<br />
hospital grounds but also<br />
to prohibit employees from<br />
lighting up anywhere in<br />
public if they are in uniform<br />
or have an ID showing.<br />
Hospital Trust staff will face<br />
disciplinary action and could<br />
potentially be dismissed if<br />
they break the new rules.<br />
In an interview with the<br />
Evening Standard, director<br />
of workforce Ann Macintyre<br />
said “Yes, they can [be<br />
dismissed], but we would<br />
want to avoid that where<br />
possible – we pride ourselves<br />
on being a good employer.”<br />
Photo Courtesy of Charlie Ding<br />
A Wednesday night in Guy’s Bar seen in <strong>Jan</strong>uary<br />
Photo Courtesy of Charlie Ding<br />
The new anti-smoking rules,<br />
which apply from 1 <strong>Jan</strong>uary<br />
<strong>2014</strong>, were introduced as a<br />
response to new guidelines<br />
from the National Institute<br />
for Health and Care<br />
Excellence published last<br />
year, which recommended<br />
the removal of smoking<br />
shelters and enforcing a<br />
blanket ban on smoking on<br />
all NHS sites. According to<br />
a press release from Guy’s<br />
& St Thomas’, managers will<br />
now try to legislate against<br />
patients and visitors lighting<br />
up on all sites run by the<br />
Trust.<br />
10<br />
<strong>GKT</strong> <strong>Gazette</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>GKT</strong> <strong>Gazette</strong><br />
11
NEWS<br />
Students Raise over £6000 for RAG<br />
Charities at ‘Jingle Rag’<br />
Katherine Leung<br />
MBBS2<br />
On Friday 6th<br />
December, the <strong>GKT</strong><br />
Raising and Giving<br />
(RAG) society held its first<br />
street collection day of the<br />
year, Jingle RAG. Armed<br />
with free breakfast for<br />
the earliest RAGgers and<br />
Michael Buble’s Christmas<br />
album, the RAG team set<br />
up in Boland House at<br />
6am. Throughout the day,<br />
students collected all over<br />
London for our chosen<br />
RAG charities (The Evelina<br />
Children’s Hospital, Guy’s<br />
and St. Thomas’ Cancer<br />
Unit, Medicinema, and the<br />
Multiple Sclerosis Society)<br />
as well as selected KCLSU<br />
charities. In total more<br />
than 70 buckets were taken<br />
out with each one raising<br />
an impressive average of<br />
£70! The day also saw a<br />
performance by King’s very<br />
own a cappella group, All<br />
the King’s Men, who sang<br />
outside St. Paul’s Cathedral.<br />
After a long day of frantic<br />
coin counting, a grand total<br />
of £5,435 was raised from<br />
donations from the general<br />
public. With some of the<br />
proceeds from that night’s<br />
Christmas Party in Guy’s Bar<br />
also supporting the charities,<br />
the day raised an incredible<br />
total of more than £6000.<br />
Jingle RAG was only the start<br />
of this year’s fundraising<br />
efforts – RAG are back with a<br />
whole week of events starting<br />
on <strong>Feb</strong>ruary 1st. In return for<br />
students’ bucket collecting<br />
efforts, the RAG committee<br />
will be hosting an event every<br />
day of the week. This year<br />
they’ll include the legendary<br />
RAG raid, <strong>GKT</strong>ake Me Out,<br />
a very special Pub Quiz, and<br />
to top the week off, an interdegree<br />
University Challenge<br />
featuring everyone’s<br />
favourite lecturers.<br />
The RAG committee are<br />
always looking for new faces<br />
to join in the fun – follow<br />
RAG on Facebook (fb.com/<br />
groups/RAG.<strong>GKT</strong>) and<br />
Twitter (@<strong>GKT</strong>RAG) to keep<br />
up to date with the society.<br />
No More Cambridge<br />
Transfers<br />
Joshua Getty<br />
MBBS4<br />
The path from Cambridge<br />
to London has been well<br />
trodden over the last 60<br />
years, with many Cambridge<br />
students joining <strong>GKT</strong> for<br />
the clinical years of their<br />
medical training. Yet from<br />
this September, medics<br />
beginning their studies will<br />
no longer be able to transfer<br />
to a London medical school.<br />
In a move celebrated<br />
by Cambridge’s Clinical<br />
Student Society, Cambridge<br />
University has expanded<br />
its clinical school to<br />
accommodate all preclinical<br />
medical students for the final<br />
3 years of the programme.<br />
The Oxford University<br />
transfer scheme will<br />
continue unaffected.<br />
NEWS<br />
Notable<br />
Cambridge<br />
Transfer<br />
Alumni<br />
Eric Hanson<br />
Trinity College – St Thomas’<br />
First New Zealander to become<br />
a specialist in anaesthetics<br />
David Owen<br />
Sidney Sussex College – St<br />
Thomas’<br />
British Foreign Secretary from<br />
1977-1979<br />
Phil Hammond<br />
Girton College – St Thomas’<br />
GP, comedian and health service<br />
commentator<br />
David Nutt<br />
Downing College – Guy’s<br />
Neuropsychopharmacologist<br />
and government advisor before<br />
Equasy controversy<br />
Photograph courtesy of Katherine Leung<br />
Registered charity no. 803716/SC038827<br />
12<br />
<strong>GKT</strong> <strong>Gazette</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong>
NEWS<br />
Government Report Calls for<br />
Greater Disclosure of Trial Data<br />
and Questions Tamiflu Evidence<br />
Lucy <strong>Web</strong>b<br />
Intercalated BSc<br />
For over a year now,<br />
the AllTrials campaign<br />
has tried to expose<br />
to us how pharmaceutical<br />
companies have withheld<br />
‘unfavourable’ clinical<br />
trial data, despite the<br />
implications that this may<br />
have for patient care and<br />
clinician confidence in the<br />
medicines they prescribe.<br />
The campaign’s aim is to<br />
ensure the publication of the<br />
methodology and results of<br />
all clinical trials and finally<br />
the government are getting<br />
on board.<br />
‘The majority of<br />
Roche’s Phase III<br />
[Tamiflu] treatment<br />
trials remain unpublished<br />
over a decade<br />
after completion.’<br />
Parliament’s Public<br />
Accounts Committee has<br />
given their report on results<br />
being withheld. The report<br />
specifically addresses the<br />
clinical trial information and<br />
stockpiling of Tamiflu, an<br />
antiviral drug indicated<br />
in reducing rates of<br />
complication in influenzae A<br />
and B infection by its action<br />
as a neuraminidase inhibitor<br />
preventing release of the<br />
virus from the host cell.<br />
Tamiflu was stockpiled by the<br />
Department of Health (DoH)<br />
in anticipation of the swine<br />
flu pandemic at a cost of<br />
£424 million, but the efficacy<br />
of the antiviral is contested,<br />
largely due to the fact<br />
clinical trial data have been<br />
withheld. Stockpiling of the<br />
drug took place in line with<br />
World Health Organisation<br />
(WHO) recommendations,<br />
though the data upon which<br />
Photograph courtesy of Charlie Ding<br />
these recommendations<br />
are based has been called<br />
into question. The British<br />
Medical Journal’s Tamiflu<br />
Campaign has a ‘bottom line’<br />
stating:<br />
-“WHO recommends<br />
Tamiflu, but has not vetted<br />
the Tamiflu data.”<br />
-“The majority of Roche’s<br />
Phase III treatment trials<br />
remain unpublished over a<br />
decade after completion.”<br />
-“In Dec 2009, Roche<br />
publicly<br />
promised<br />
independent scientists<br />
access to “full study reports”<br />
for selected Tamiflu trials,<br />
but to date the company<br />
has not made even one full<br />
report available.”<br />
To compound this woeful<br />
state of affairs, a £74 million<br />
stockpile of Tamiflu was not<br />
kept refrigerated, or at least<br />
the records to prove that<br />
it had been were not kept.<br />
The whole stockpile was<br />
therefore destroyed.<br />
General recommendations<br />
from the government’s<br />
report include ensuring<br />
that all clinical trials are<br />
registered and that all results<br />
and methodology are made<br />
available to all including<br />
NEWS<br />
Author of almostadoctor.co.uk<br />
Named a ‘Top Medical Innovator’<br />
Lewis Moore<br />
MBBS4<br />
Dr Tom Leach, a<br />
recent graduate of<br />
Manchester medical<br />
school and founder of the<br />
website ‘almostadoctor.com’<br />
was recently named in a list<br />
of top medical innovators<br />
published by Health Services<br />
Journal (HSJ).<br />
While at medical school,<br />
Tom’s notes were shared<br />
widely among his fellow<br />
students and he decided<br />
to extend his audience<br />
further by posting them<br />
online. Since then the site<br />
has grown significantly in<br />
doctors and auditors.<br />
Information should<br />
be shared between the<br />
Medicines and Healthcare<br />
products Regulatory<br />
Authority and the National<br />
Institute for Health and<br />
Clinical Excellence to ensure<br />
that clinical care in the UK is<br />
based on the latest evidence.<br />
Regarding Tamiflu,<br />
following a complete review<br />
of the drug by the Cochrane<br />
Collaboration, the evidence<br />
with regards to efficacy<br />
should be re-evaluated.<br />
both readership and content<br />
and is now used by medical<br />
students around the world.<br />
While the prominent banner<br />
ads can be annoying, the<br />
site’s content is extensive<br />
and is thought to be of a<br />
high quality. In a recent<br />
interview with The Bolton<br />
News Dr Leach was quoted<br />
as saying, “It’s like the<br />
Wikipedia of medicine, with<br />
doctors as editors to verify<br />
the content”. Along with<br />
the refreshingly concise<br />
notes, the site contains other<br />
materials such as mind<br />
maps, flashcards, reviews<br />
of books and apps and a<br />
collection of blogs sharing<br />
The future path may well be<br />
difficult, but it is imperative<br />
that we keep up the pressure<br />
to ensure that all trial<br />
data is recorded and made<br />
available for analysis. The<br />
recommendations made by<br />
the report are an important<br />
first step towards clinical<br />
trial transparency and<br />
ensuring that optimum care<br />
is delivered to patients.<br />
Photograph courtesy of Charlie Ding<br />
often humorous stories and<br />
thoughts from Dr Leech and<br />
other contributors.<br />
Other top innovators<br />
mentioned by HSJ include<br />
Sir Bruce Keogh, Medical<br />
Director of the NHS and<br />
Ben Goldacre, founder of the<br />
AllTrials campaign.<br />
14<br />
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FEATURES<br />
Photograph courtesy of Charlie Ding<br />
Case 1<br />
A<br />
25 year old woman presents to the<br />
Emergency Department with 2 day<br />
history of breathlessness and audible<br />
wheeze.<br />
A. Airway patent<br />
B. Respiratory Rate 22 breaths per<br />
minute Oxygen Saturation 92%<br />
C. Capillary refill 2 seconds<br />
Pulse 100 bpm<br />
BP 120/80<br />
D. Temp. 37 °C<br />
Is Clinical Medicine<br />
a Dying Art<br />
Zoya Arain MBBS4<br />
The history and clinical examination form the<br />
backbone of the assessment and examination<br />
of every patient. However with the exponential<br />
development of imaging and plethora of<br />
sensitive laboratory tests that have become<br />
available over the recent decade, has the reliance<br />
upon these resources by the modern<br />
doctor occurred at the expense of these hardwon<br />
essential skills Are we witnessing the<br />
death of clinical medicine as we know it<br />
There is growing concern that the quality of<br />
examination skills is fast declining. One US<br />
study evaluated the inability of intensive<br />
care staff to correctly determine the jugular<br />
venous pressure (JVP) on intensive care patients<br />
from examination alone, without resorting<br />
to invasive central venous access. The<br />
surprising finding of this study was that medical<br />
students performed far better than more<br />
senior staff in identifying this parameter.<br />
One explanation could be that medical students<br />
had simply practised more, having<br />
attended weekly cardiology ward rounds<br />
during which they were expected to evaluate<br />
the JVP of all patients.<br />
Another group, Noel et al, produced videotapes<br />
with deliberate mistakes in history<br />
taking and examination such as palpating<br />
the thyroid gland in the wrong place, and not<br />
asking a patient with a history of diarrhoea<br />
about blood in stools. These fundamental errors<br />
were missed by many of the senior medical<br />
faculty asked to critically review the tapes.<br />
The authors raised the question “are clinicians<br />
replacing instead of augmenting their<br />
diagnostic armament”.<br />
“Are clinicians replacing<br />
instead of augmenting their<br />
diagnostic armament ”<br />
This problem may be less applicable in the<br />
UK than the US, as fellowship examinations<br />
assess the clinical skills of trainee doctors at<br />
every career stage up until becoming a consultant.<br />
The training system in the US lacks<br />
an equivalent.<br />
Although one facet of the problem is that<br />
clinical skills are not being performed to the<br />
standard that they could be. Another point<br />
to address is whether there is an inherent<br />
insensitivity of the clinical examination at its<br />
best in identifying a clinical sign<br />
Despite many attempts to elicit the diagnostic<br />
sensitivity and specificity of many diagnostic<br />
bedside tests against the relevant<br />
gold standard, the results may be unreliable<br />
as these studies often do not account for important<br />
variables such as the varying degree<br />
of experience between trainee doctors and<br />
experienced staff, making interpretation of<br />
their findings difficult. However, one study<br />
which evaluated the sensitivities of elements<br />
of the respiratory exam in correctly identifying<br />
pneumonia, found that although the<br />
individual sensitivities of each stage in the<br />
examination were low, in combination the<br />
cumulative probability of correct diagnosis<br />
was much higher. For instance given that the<br />
pretest probability of pneumonia in a patient<br />
with an acute onset of cough is 10%, a finding<br />
of asymmetrical chest expansion would subsequently<br />
increase the odds to 47%.<br />
The authors suggested changing our approach<br />
to applying the physical examination.<br />
Although the uncertain sensitivity of the<br />
physical examination would argue against<br />
its usefulness in screening the asymptomatic<br />
population for disease; which requires a high<br />
sensitivity not met by many respiratory signs,<br />
it remains valuable in the acute setting where<br />
positive findings increase the likelihood of<br />
diagnosis as shown in the above example.<br />
However, our over reliance on diagnostic<br />
tests may have other consequences, Dr. Wes<br />
Spence, identifies the problem of incidentalomas;<br />
incidental clinical findings, unrelated to<br />
the principle presenting complaint with unknown<br />
significance. He says “medicine hasn’t<br />
caught up with the decline in pathology, our<br />
investigations seek even smaller needles in<br />
an even bigger haystack of wellness. Incidental<br />
findings can incur unnecessary anxiety for<br />
the patient, and also accrue substantial cost<br />
in sparking further investigations; cost is an<br />
important consideration in the business of<br />
healthcare. NHS Scotland reported a spend<br />
of over £178 million on radiology over the<br />
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FEATURES<br />
FEATURES<br />
past decade, including CT, MRI and Ultrasound<br />
with £246 million additionally spent<br />
on laboratory tests.<br />
This trend looks to continue with specialised<br />
diagnostic tests becoming increasingly available<br />
in the primary care setting.<br />
To slow the veritable decline in clinical ability<br />
and the mounting expense of health technology,<br />
it is important to identify the principle<br />
driving force underlying the excessive use<br />
of diagnostic tests. One aspect to consider is<br />
whether patients expectations from doctors<br />
has changed with the advent of new technology<br />
with fear of litigation considered to<br />
be an important factor in resorting to ancillary<br />
diagnostic tests. Additionally, the ‘volume-based<br />
reimbursement’ culture of current<br />
medical practice, means that a doctor is<br />
little accredited for picking up subtle physical<br />
signs after a lengthy examination, with more<br />
patients after a bang for their buck. However,<br />
one study suggests that despite the increasing<br />
utility and availability of new tests and investigations,<br />
a patient’s expectations from a consultation<br />
have little changed, with 90% who<br />
still expect a routine physical examination in<br />
their consultations, involving measurement<br />
of blood pressure, and examination of their<br />
heart, lungs, abdomen and reflexes.<br />
Therefore is this trend simply a product of<br />
a doctor’s lack of confidence in their clinical<br />
experience when making decisions, as Spence<br />
colourfully puts it,“ has evidence-based<br />
medicine pecked the last flesh from the bones<br />
of medical opinion”.<br />
“A doctor’s role is neither to investigate nor<br />
to follow guidelines but to interpret, and often<br />
ignore, them—that is, to short circuit<br />
the mechanised medical machine for the<br />
benefit of patients”.<br />
I Predict<br />
A Riot!<br />
on police management of protests. Kettling,<br />
a police method of containing demonstrators<br />
in a small area to maintain order, came under<br />
scrutiny when both police and activists were<br />
injured. After 153 people were arrested, all<br />
demonstrations must now adhere to public<br />
safety guidelines to ensure police collaboration.<br />
Since 2010 many student demonstrations<br />
have taken place. The recent decision to close<br />
the University of London Union (ULU) as a<br />
student led organisation and replace it with a<br />
management run services centre, motivated<br />
many students to express their dissatisfaction<br />
by protest. Similarly, the 3 Cosas campaign<br />
has organised strikes and protests to<br />
pressurise the University of London (UoL) to<br />
bring sick pay, holidays and pensions of outsourced<br />
workers in line with those of its employees.<br />
Although these disputed issues are<br />
supported by MPs, students and unions, few<br />
protests have caught the attention of the national<br />
media; perhaps as uttering the words<br />
“student protest” often results in eye rolling<br />
amongst the great British public.<br />
Increasing radiology activity in Scotland over the last four years.<br />
Source: Audit Scotland, Nov. 2008<br />
Kate Anstee<br />
Biomedical Science BSc 2 nd Year<br />
November 2010 saw thousands of<br />
students, staff and unions marching<br />
through the streets of London<br />
in protest of the prospective rise in tuition<br />
fees. Clearly this protest made no difference<br />
to the government’s education plans, but it<br />
was ground-breaking in changing legislation<br />
However, on 4th December 2013 the media<br />
was drawn to a student occupation of Senate<br />
House, University of London. These students<br />
demanded the management took notice of<br />
the 3 Cosas campaign and their views on the<br />
ULU closure, privatisation of student loans<br />
and outsourcing university accommodation.<br />
Instead, disapproving management of UoL<br />
brought in police to forcefully remove offenders.<br />
Chaos ensued; 3 students were arrested,<br />
a video of a policeman punching a student<br />
protester went viral and UoL filed an injunction<br />
against occupying some of its premises.<br />
The spark had been lit.<br />
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FEATURES<br />
FEATURES<br />
The following day approximately 200 students<br />
gathered in a new found fury to reaffirm<br />
requests of the previous day and demand<br />
their right to protest on campus without police<br />
presence. According to one student, the<br />
initial idea of the “Cops Off Campus” demonstration<br />
had been to march around the campus,<br />
brandishing placards and chanting, but<br />
this plan was thwarted with an intimidating<br />
police presence surrounding UoL buildings.<br />
“Snap decisions were made to keep moving<br />
and prevent police kettling” she explains,<br />
“this sense of chaos forced us to choose to<br />
march on Euston Road, where other protests<br />
have been before.” Seemingly spiralling out<br />
of control; traffic held up by protesters, police<br />
helicopter observing from above and a few<br />
trouble makers throwing bins to form road<br />
blocks, was not only against the public safety<br />
guidelines but produced an adrenaline –infused<br />
atmosphere of confusion. As the protesters<br />
tucked back into the side streets, the<br />
police began kettling outside Euston Square<br />
station. Again this protest affected innocent<br />
bystanders: another student tells of a patient<br />
on his way to A & E and a medical student on<br />
his break contained within the kettle metres<br />
away from University College Hospital.<br />
As scenes of pandemonium continued with<br />
one peaceful student protester suffering<br />
head injuries from police knocking him to<br />
the ground, a member of the press being illegally<br />
arrested and fights breaking out between<br />
violent protesters and police, some<br />
kettled students managed to escape and flee<br />
the demonstration. One unfortunate student,<br />
who wishes to remain anonymous, describes<br />
how she was “tackled to the ground by a police<br />
officer” as she attempted to run and had<br />
two other failed escapee students thrown on<br />
top of her.<br />
“My behaviour within the protest was non-violent<br />
and should not have been met with<br />
such brutal policing,” she states. “It suggests<br />
the police treated all students as aggressive.”<br />
When UoL declared disruption on their land,<br />
she was one of the 37 students arrested for<br />
breach of peace; one student was arrested for<br />
assault. Arrestees were bundled in a police<br />
van and driven around central London for<br />
hours, in a police attempt to calm the situation<br />
and eventually decide on the fate of these<br />
detained students. Ultimately, all were re-arrested<br />
for affray and taken to police stations<br />
outside central London where they spent<br />
the night. Following confiscation of mobile<br />
phones and no interviews, all were released<br />
on bail with what were deemed “ridiculous<br />
conditions” such as not being permitted to<br />
assemble in groups of 4 or more people; an<br />
unfortunate circumstance, if not unrealistic<br />
for a student.<br />
After the condemnation of police management<br />
of these protests, a large national<br />
demonstration was organised for 11th December<br />
2013. Over 3000 students turned up<br />
to show their support. Although the majority<br />
of students remained peaceful, a few masked<br />
individuals took the opportunity to throw<br />
smoke bombs, set fire to bins and break into<br />
Senate House. Another group was witnessed<br />
burning the injunction preventing occupation<br />
of University of London premises. Since<br />
none of this behaviour motivated any police<br />
presence, the protest took the opportunity<br />
to convey their dissatisfaction to the city,<br />
causing disruption as they marched along<br />
Kingsway. It was only after stopping outside<br />
the Royal Courts of Justice that police cautiously<br />
began to intervene with the use of police<br />
sirens and officers walking alongside the<br />
demonstration to gently guide the protesters<br />
on the unplanned route, eventually ending 4<br />
hours later back at Senate House.<br />
Photograph courtesy of Oscar <strong>Web</strong>b<br />
Many protesters were pleased to have revived<br />
the student movement with the biggest<br />
student response since 2010, but most<br />
also condemn the actions taken by UoL and<br />
the inconsistency of police management at<br />
demonstrations. In hindsight, however, if<br />
it were not for the police mis-handling the<br />
initial occupation of Senate House, not only<br />
could the occupiers have spent their Christmas<br />
holidays in a university building, but<br />
also the protests would not have achieved the<br />
same amount of coverage from the national<br />
media. In reaction to December’s inferno of<br />
protesting, the fight against the establishment<br />
begins again on 22nd <strong>Jan</strong>uary <strong>2014</strong>. There is<br />
an expectation for lessons to be learned by<br />
University management, police and students,<br />
which maybe for once will allow the public<br />
to hear the student voice and not merely the<br />
bedlam that surrounds it.<br />
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HISTORY<br />
Behind the Christmas Show<br />
Joshua Getty MBBS4<br />
Joshua Getty When did you start coming<br />
up with the sketches<br />
Alex Warren I remember starting to write<br />
sketches all the way back last <strong>Jan</strong>uary when<br />
I scribbled down Jeremy Kyle meets Joseph<br />
and Mary, then coming back to it in the<br />
Autumn and turning it into an actual sketch.<br />
The best thing about the Christmas show<br />
is that there are so many different minds,<br />
which are all warped in a slightly different<br />
way, so you get lots of different inputs and<br />
these things grow and grow.<br />
Lucy <strong>Web</strong>b Absolutely and for one of the<br />
first times since I’ve been involved there<br />
actually was a theme running through the<br />
show.<br />
JG Plus you have the recurrence of special<br />
characters Despo [Papachristodoulou] and<br />
[Stewart] Paterson, who are never absent.<br />
AW Yeah, I think it’s excellent that we<br />
have a faculty here who are so comfortable<br />
FEATURES<br />
interacting with the students and are so<br />
respected by the students that we feel able to<br />
imitate them in increasingly offensive way.<br />
After all, imitation is the greatest form of<br />
flattery…<br />
JG Lucy this year you were backstage<br />
manager, so when did you decide to do the<br />
job<br />
LW Well that came about because Vat<br />
[Ljungqvist] is the producer and we were<br />
both contemplating producing last year but<br />
we came to the agreement that he would<br />
go on and produce and I would act as stage<br />
manager and he did an incredible job this<br />
year. I first got involved in the Christmas<br />
show a few years ago because a few of the<br />
rugby girls were involved and they asked if<br />
any of us wanted to join in, so I started in my<br />
second year and then just gradually got more<br />
involved then stage managed this year for the<br />
first time, which I’m not going to lie was quite<br />
stressful at times!<br />
For many at <strong>GKT</strong> the Christmas show is one of the highlights of the year, with wit, humour<br />
and chaos all rolled up into one show for three nights in the Greenwood Lecture Theatre.<br />
When asked to sum up the show, words like nakedness, crazy, fun, outrageous and raucous<br />
are often used. But what is the Christmas Show to those involved<br />
To Alex Warren, this year’s director, it is “the last bastion in irreverent comedy in today’s<br />
politically correct world and somehow it manages to do so whilst raising significant sums<br />
for charity.”<br />
This conjures up images of a rebellious group of students putting on an underground sketch<br />
show, but the Christmas Show is embraced by staff and students alike and far from being<br />
an outlying group of individuals, it is a mammoth collaboration with an extensive cast and<br />
crew before even adding the dancing girls and boys to the mix.<br />
To find out more the <strong>GKT</strong> <strong>Gazette</strong> sat down with Alex Warren and Lucy <strong>Web</strong>b (this year’s<br />
stage manager) on a cold <strong>Jan</strong>uary evening in a quiet corner of the Thomas Guy Club.<br />
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FEATURES<br />
AW Yeah this show was probably the most<br />
stressful backstage we’ve ever had.<br />
LW The more stressful it became the more<br />
smoothly it ran though, it was really weird!<br />
AW It was such an excellent team, not just<br />
backstage but also with the tech with light<br />
and sound and they were just incredible. Lara<br />
[Staffurth] and I were being typical directors,<br />
shouting orders and screaming that we were<br />
cutting sketches so go and make it happen.<br />
LW I know, this was on the Wednesday<br />
and we had less than 30 seconds notice that<br />
the next six sketches were cut and we were<br />
frantic.<br />
AW Although I was upset that we had to cut<br />
sketches and stuff, I remember walking away<br />
from that Wednesday feeling great as you’re<br />
working with such a good team of people so<br />
when there’s a crisis like that you know that<br />
they’ve got your back.<br />
JG The great unpredictable element of the<br />
Christmas show is the audience, though in<br />
a way it’s all very predictable as you will get<br />
huge amounts of heckling, so how do you<br />
react to that<br />
Photographs courtesy of Charlie Ding<br />
Christmas Show ‘13 Snog-<strong>Web</strong><br />
AW The Wednesday night audience was<br />
certainly worse than any of us have ever had<br />
before. I think the Christmas show is not<br />
something critically appreciated, at least not<br />
on a Wednesday night, so you roll with the<br />
punches and a lot of the comedy comes with<br />
the interactions with the audience.<br />
JG The snogcam always seems to be your<br />
best weapon for that.<br />
AW The snogcam is a great equaliser.<br />
LW It’s the big saviour as it’s the only thing<br />
that will make everyone in the audience shut<br />
up, even if only for 20 seconds as it just gives<br />
us a bit of quiet backstage so we can organise<br />
because at times it is difficult to hear what’s<br />
going on, particularly on a Wednesday night.<br />
AW backstage do such a good job as well<br />
because whenever they have everything<br />
under control a group of drunken third year<br />
girls will arrive screaming that each of them<br />
needs their hat and to have their cane ready<br />
and they do a great job.<br />
JG Speaking of the dancing girls, how on<br />
earth do you manage them<br />
LW Well there’s a routine that happens in<br />
terms of bringing them down and getting<br />
them ready backstage but what I personally<br />
find very useful when they’re in the wings<br />
and won’t shut up is you just threaten to<br />
not let them on stage because usually they<br />
believe you.<br />
AW The lead dancing girls were very good<br />
with us and they were trying their best not<br />
to get in the way. There was drama, which is<br />
inevitable, but it was controlled drama that<br />
we could deal with. But yes, sometimes it is<br />
a challenge having 68 intoxicated breasts on<br />
your hands.<br />
FEATURES<br />
LW That’s something you’ll never say again.<br />
AW Well you haven’t seen the plan for my<br />
elective…<br />
JG How about the dancing boys I know<br />
there was a little bit of controversy over the<br />
prison story in their sketch…<br />
AW I think that’s a strength of the dancing<br />
boys (though I’m slightly biased as I had a<br />
cameo) they had a narrative going throughout<br />
their dance. I think lots of people have said<br />
it’s the best dancing boys they remember.<br />
LW I think that the dancing boys this year<br />
really were fantastic, as usual they’re a little<br />
bit more difficult to organise backstage but<br />
that’s just what they do.<br />
JG One of the best photos from backstage<br />
that I saw was of the snogweb.<br />
LW ah the snogweb.<br />
JG who came up with that<br />
LW that’s a tradition!<br />
AW That goes back at least as far as the<br />
cast can remember. I have to say that this is<br />
something Lucy’s department has to handle<br />
because what I’ve never understood is how<br />
so many of the backstage crew manage to get<br />
involved with the snogweb…<br />
LW We just feel underappreciated so we like<br />
to appreciate each other, that’s all it is…<br />
JG So what was the highlight of the show for<br />
you guys<br />
AW God what a question. My personal<br />
highlight of the Christmas show had to be<br />
being in the Blue eyed maid on the Thursday<br />
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HISTORY<br />
HISTORY<br />
Photographs courtesy of Charlie Ding<br />
night with the cast, those of them who hadn’t<br />
passed out.<br />
LW There were very few of us left by the end<br />
of the night.<br />
AW Having the lecturers company on the<br />
Thursday night was a lot of fun. Also the<br />
Friday night curry when we all got together,<br />
I was just on a high and hadn’t really settled<br />
that it was all done. This year we probably<br />
had the biggest team we’ve ever had, both on<br />
and off the stage but we still really felt like a<br />
unit and made friends. It is something of a<br />
family, as my predecessor said.<br />
LW I definitely do and the longer you’re in<br />
it the more you feel like part of the family<br />
but this year even the people who were fresh<br />
in the cast and in the crew, everyone was<br />
together for everything. But this year more<br />
than any other year for me personally it felt<br />
like family. I was absolutely gutted when the<br />
week ended.<br />
AW Every time I hear You Make Me by<br />
Avicii, the opening song to the show, which<br />
I traditionally spend jumping up and down<br />
outside the foyer to psych myself up, I still get<br />
that little heart palpitation.<br />
LW I always look round for other people in<br />
the cast and crew if it comes on in Guy’s Bar.<br />
AW we find each other, get together in a<br />
circle and jump up and down.<br />
JG Another great aspect is that you do have<br />
such a range of years involved.<br />
AW Yeah it’s very important because you<br />
have to think about the future as people<br />
aren’t going to be around. This year we lost<br />
an excellent crop. I only started the show last<br />
year and this year I was directing, luckily we<br />
had Lara who has been around a bit longer<br />
as well.<br />
JG Plus there’s quite a lot of fourth years<br />
involved, will they be there next year<br />
AW A lot of them have said they’re definitely<br />
not going to be in the show but we know<br />
how hard it is to stay away. Actually that’s<br />
something that behind the scenes we take<br />
very seriously and certainly towards the end<br />
of the process we made a point of involving<br />
a lot of the young members so they’re ready<br />
next year.<br />
LW I know that as you do in the cast, you<br />
gradually give them more. So we have a<br />
couple of fantastic people in the second year<br />
as members of the crew, so this year we made<br />
sure they know how to run a really tight ship<br />
which is important since we’re losing some<br />
really experienced members of the crew to<br />
either graduation or final year.<br />
JG Are you two going to stay involved next<br />
year<br />
LW absolutely, I don’t intend to leave until<br />
I can’t cope with the stress of medicine<br />
anymore.<br />
AW I certainly have every intention to<br />
LW I just want to say how much I enjoy it,<br />
there’s nothing like the stress or the fun of<br />
the Christmas show<br />
AW People take the piss out of us for never<br />
going on about anything else but I must say<br />
you can’t understand unless you’ve been<br />
on or behind that stage, the sheer physical,<br />
emotional and sexual effort that goes into<br />
every one of those three nights.<br />
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ARTS & CULTURE<br />
ARTS & CULTURE<br />
New Year, New Music<br />
Morolake Segun-Ojo<br />
MBBS4<br />
CHLöE HOWL<br />
Howl has been waiting in the wings since<br />
2010 developing her indie pop chops. Now 19<br />
years old, she’s coming of age supporting Ellie<br />
Goulding on tour, and working on her debut<br />
album with Grammy Award winning writer<br />
and producer, Eg White who’s worked with<br />
the likes of Adele and Duffy. Howl contrasts<br />
her mature vocals, with her youthful musical<br />
identity, taking a realistic view of the ‘gross’<br />
(in her own words) adolescent experience.<br />
Her currently released singles ‘No strings’ and<br />
‘Paper Heart’ are upbeat tasters of her album<br />
with soulful aspirations.<br />
His R&B influenced vocals have already featured<br />
on Disclosure’s ‘Latch’ and Naughty<br />
Boy’s 2013 number 1 single ‘LaLaLa’. Now<br />
Smith is stepping out on his own and taking<br />
centre stage on tracks ‘Lay me down’ and ‘Nirvana’<br />
(available for download) which showcase<br />
his exceptional voice with wide appeal.<br />
Smith’s debut album ‘In The Lonely Hour’ is<br />
to be released in May, but in the meantime<br />
look out for his next single money on my mind<br />
released in <strong>Feb</strong>ruary.<br />
Sam smith<br />
Photo Courtesy of Rebecca Trenear<br />
The soundtrack to the new year is in. If you haven’t heard of<br />
these upcoming acts you will soon, so why not get ahead of the<br />
curve<br />
His R&B influenced vocals have already featured<br />
on Disclosure’s ‘Latch’ and Naughty<br />
Boy’s 2013 number 1 single ‘LaLaLa’. Now<br />
Smith is stepping out on his own and taking<br />
centre stage on tracks ‘Lay me down’ and ‘Nirvana’<br />
(available for download) which showcase<br />
his exceptional voice with wide appeal.<br />
Smith’s debut album ‘In The Lonely Hour’ is<br />
to be released in May, but in the meantime<br />
look out for his next single ‘Money on my<br />
Mind’ released in <strong>Feb</strong>ruary.<br />
BANKS<br />
This Los Angeles musician likes to keep a low<br />
profile, for a long time only sharing her music<br />
on Soundcloud and avoiding social media.<br />
Unfortunately for BANKS the buzz around<br />
PBR&B or hipster R&B has slowly been intensifying,<br />
and she might just be the girl to<br />
bring it to the forefront. BANKS finally let us<br />
in on the dark dulcet tones of her inner musings,<br />
with the 2013 release of her stirring EPs<br />
‘Fall Over’ and ‘LONDON’. The singer garnered<br />
more attention after supporting The<br />
Weeknd on tour. So now the secret is out,<br />
have a listen to her standout tracks ‘This Is<br />
What It Feels like’ and ‘Waiting Game’.<br />
George Ezra<br />
Within a year of leaving home to study music<br />
in Bristol, Ezra instead found himself hitting<br />
the road with his guitar and a few freshly<br />
penned tunes. It’s true, on paper he sounds<br />
like a character featuring in a Bob Dylan song<br />
(a big influence for Ezra), and his talent has<br />
often been fabled by music columnists since<br />
his performance at Glastonbury last year.<br />
Ezra’s folk rock sensibilities and distinctive<br />
course vocals make for an interesting narrative,<br />
as he draws inspiration from an English<br />
upbringing with American acoustic score.<br />
Listen to some melodious tales from the well<br />
travelled musician in his tracks ‘Budapest’<br />
and ‘Benjamin Twine’.<br />
28<br />
Sam smith<br />
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ARTS & CULTURE<br />
Women’s Parts:<br />
The Bechdel Test<br />
Sabina Checketts MBBS5<br />
Have you heard of the Bechdel test If<br />
not, then you are not the only one.<br />
Until a friend mentioned it recently,<br />
I’d never heard of it either. The Bechdel test<br />
is an uncomplicated way of assessing gender<br />
bias in works of fiction, although it has<br />
been mainly applied to films and television.<br />
The test was named after Alison Bechdel who<br />
drew a cartoon about it in 1985, after her<br />
Source: Alison Bechdel, 1985<br />
friend Liz Wallace came up with the idea.<br />
To pass the Bechdel test, a film has two have:<br />
1. At least two named female characters<br />
2. Who have a conversation with each<br />
other<br />
3. About something other than a man<br />
Simple right Well, no actually, especially if<br />
you look at many recent productions from<br />
the illustrious Hollywood. A surprising number<br />
of films fail the test, particularly if you<br />
look at recent blockbusters. Those that fail<br />
include: all The Star Wars films, the complete<br />
Lord of the Rings trilogy, The Hobbit 1 & 2,<br />
Avatar, all but one of the Harry Potter series,<br />
The Social Network (irony anyone), Pulp<br />
Fiction, Run Lola Run and even When Harry<br />
Met Sally despite its strong female lead. You<br />
can find many, many other examples if you<br />
look further. In fact there is a database website<br />
online that does just that, called ‘bechdeltest.com’.<br />
The Oscars are touted as representing the<br />
“best of the best” for each year. If one uses<br />
the Bechdel test to analyse the six films up<br />
for Best Picture 2013, only three would pass,<br />
Zero Dark Thirty, Les Miserables, and Silver<br />
Linings Playbook, while the three that<br />
fail are Lincoln, Life of Pi and Django Unchained.<br />
A study from the US-based Centre of Study<br />
of Women in Television and Film found that<br />
of the top 100 US films in 2011, women accounted<br />
for only 33% of all characters and<br />
for only 11% of all protagonists. They suggest<br />
that “Hollywood thinks that films with male<br />
characters will do better the box office” and<br />
that this may be due to male domination of<br />
most aspects of film production such as writing,<br />
production and direction. A different<br />
study from Annenberg Public Policy Centre<br />
at the University of Pennsylvania found that<br />
over the last 60 years the ratio of male to<br />
female characters in films has remained at<br />
about two to one.<br />
ARTS & CULTURE<br />
Recently I went to a panel discussion at a<br />
well-known London theatre in which the<br />
Bechdel test was mentioned; the panel consisted<br />
of actors, playwrights, producers and<br />
directors. Ironically but perhaps accurately<br />
reflecting the current state of theatre, the<br />
panel only included one woman, who was an<br />
actress and came across as having been included<br />
as the ‘pretty face’ on the panel.<br />
In recent times, a number of cinemas in<br />
Sweden have introduced the Bechdel test as<br />
a way for audiences to analyse the gender<br />
portrayal in their films. One Swedish cable<br />
channel even has a ‘Super Sunday’ where<br />
they will only show Bechdel A-rated films.<br />
The Swedish Advertising Ombudsman reprimands<br />
companies whose adverts reinforce<br />
gender stereotypes, such as including scantily<br />
clad women for no good reason. Mentioning<br />
no names but it is not hard to call<br />
to mind adverts, not to mention most music<br />
videos, which fail on this very simple point.<br />
Perhaps the rest of Europe will follow Sweden<br />
in time. The Bechdel test has been criticised<br />
as a blunt tool but perhaps its simplicity<br />
allows it to easily raise gender bias issues<br />
that go unnoticed all too easily.<br />
It is not only in film that gender bias occurs.<br />
Historically shameful for King’s is the<br />
fact that University College London was the<br />
first British university to allow women to<br />
attend their degree courses in 1878 while<br />
King’s College London followed suit in 1882.<br />
However UK universities did not let women<br />
‘matriculate’ i.e. become members of the<br />
university until much later. Oxford began<br />
in October 1920 while Cambridge followed<br />
much later in December 1947 along with<br />
other universities at various times.<br />
In science, there exists the Finkbeiner test<br />
for articles on women. To pass, a story cannot<br />
mention:<br />
1. The fact that she is a women<br />
2. Her husband’s job<br />
3. Her child-care arrangements<br />
4. How she nurtures her underlings<br />
5. How she was taken aback by the com<br />
petitiveness in her field<br />
6. How she’s such a role model for other<br />
women<br />
7. How she’s the “first woman to…”<br />
Medicine should apply a similar test for female<br />
doctors and other healthcare workers.<br />
It seems apt to end by paraphrasing George<br />
Orwell, “All people are equal, but some people<br />
are more equal than others.”<br />
A metaphor for ‘modern’ feminism<br />
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ARTS & CULTURE<br />
Keats’<br />
Corner<br />
Keats’ Corner is our section dedicated to pieces of poetry and creative writing<br />
from authors in the <strong>GKT</strong> community. Feel free to send in any poetic works<br />
or other short pieces of prose to editor@gktgazette.org.uk.<br />
The Ward Round<br />
“ Eight Fifty-three, perfect!” I mused,<br />
passing the morning drunks in the<br />
park by the train station. “Seven<br />
whole minutes!” I knew by now the protocol<br />
to the daily ward round. Turn up at nine<br />
sharp, not five minutes before, for fear of<br />
being designated team coffee boy, not a<br />
minute after for my imagined dread of the<br />
consultants’ wrath.<br />
One must contemplate morality when<br />
hundreds of doctors pass these drunkards<br />
every morning and do nothing whilst having<br />
the knowledge that patients are waiting<br />
inside to be treated for cirrhosis and other<br />
such complaints.<br />
The hospital! After entering that emotionally<br />
sterile field the dutiful medical student in me<br />
carefully printed off the patient list. I arrived<br />
on the ward with a few precious moments<br />
to catch my breath as the other members of<br />
the team, faceless registrars and arrogant<br />
Max Coupe-King MBBS4<br />
house officers, assembled. I reached for my<br />
heavy silver pocket watch but did not have<br />
to complete the instinctive action. Doctor<br />
Numen strode down the corridor towards<br />
us fixing each of us simultaneously with his<br />
expectant stare. Those eyes reminded me<br />
perfectly of how a teacher would scrutinise<br />
you in class when asking you questions he<br />
knew you did not know the answer to.<br />
Already the sheep started to bleat!<br />
“G-g-good morning, Doctor Numen”, one<br />
of the more junior doctors almost yelled.<br />
“Here’s your coffee, sir”, chirped another<br />
student. “Fascinating paper you wrote on<br />
squamous cell carcinoma.”<br />
The words themselves did not bother me; I<br />
have no quarrel with general pleasantries or<br />
compliments. What I could not stand was<br />
the desperate cry for attention that seemed<br />
integral to my contemporaries on an atomic<br />
level. They seemed to revel in every glance,<br />
every word spoken to them, by the senior<br />
physician. Numen took a deep breath and<br />
silence reigned, “Twenty-two items on<br />
today’s list, lets begin.” He rumbled.<br />
At this point the ward, with its rows of beds,<br />
always seems to transform itself in my mind<br />
into some benign scene. Last week we might<br />
have been strolling down a supermarket aisle<br />
with our shopping lists, stopping only to<br />
peruse certain groceries; never looking at any<br />
too closely, not wanting to see the blemishes<br />
that we do not have to. Today we were<br />
marching behind Numen between shelves<br />
upon which the supporting cast of patients<br />
joined us as randomly organised novels in a<br />
second hand bookshop. Doctor Numen led us<br />
past countless tales. Some old tomes, leather<br />
bound and layered with dust that had been<br />
here for so long they had nowhere else to be;<br />
others, short and brightly coloured, with so<br />
much potential. We could not pick them all<br />
out! We had our reading list.<br />
Arriving at the first patient, we arranged<br />
ourselves around her bed. We had all seen her<br />
before, a fiery haired adolescent. In fact she<br />
was in and out of here quite often. I looked<br />
at her where she laid, a turquoise paperback<br />
entitled “Amy Summer”, only 15 chapters<br />
long. The pages holding stories of the<br />
mucous filling her lungs, the accompanying<br />
chest infections, and the hospital visits. The<br />
juvenile prose telling a tale of more hardship<br />
than ought to be expected from such a small,<br />
innocent looking blue book.<br />
“Well, well what have we here…back again<br />
so soon…tut tut”, muttered Doctor Numen<br />
before rattling, “Acute pneumococcal<br />
infection with a medical history of cystic<br />
fibrosis, dullness over the right apex…<br />
shortness of breath, reduced oxygen<br />
saturation, non cyanotic, afebrile…you there<br />
boy! What is to be done”<br />
ARTS & CULTURE<br />
I froze! Then managed to stammer a long list<br />
of every antibiotic I could remember, longing<br />
for the multiple choice answer for which the<br />
examinations had prepared me.<br />
“Nonsense! Nurse, lets have this patient<br />
on 4 litres of oxygen…and start a course of<br />
Moxifloxacin.” Stated the House Officer.<br />
I smiled grimly, almost apologetically, at<br />
the girl in the bed. Her blank eyes sparkled<br />
for a moment as though I were the only<br />
person who had looked at her all her life. I<br />
wondered briefly what else was contained<br />
in those 15 fleeting chapters but Doctor<br />
Numen was already striding on to the next<br />
bed “Onwards!” I rushed after the rest of the<br />
team.<br />
Doctor Numen’s voice could already be<br />
heard through the thin, pale blue, curtains<br />
surrounding our next ‘case’. “As we can see,<br />
Miss Rivers has deranged liver function…”<br />
I thrust my way through to join the austere<br />
group encircling the woman with yellow eyes.<br />
“Jaundice…Notice her thin papery skin…<br />
Hand tremors”. Numen’s comments were<br />
met with affirming nods or vocalisations of<br />
interest from the other doctors who stood,<br />
bent forwards, looming over the shrunken<br />
body that made the single bed look like a<br />
double. The crowd of white coats began<br />
to babble about clinical tests, diagnosis,<br />
treatment, and management plan. Only<br />
picking up the odd phrase amidst this sea<br />
of incoherent jargon I wondered what the<br />
patient herself must have been feeling. Like a<br />
book she had been picked off the shelf by this<br />
vagabond rabble of white coats. This book was<br />
not to be read however. Just a quick glance<br />
at the cover would do before lackadaisically<br />
placing it back on the shelf. Someone else, a<br />
nurse perhaps, may have read the blurb but<br />
no one here would even glance at the fifty or<br />
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ARTS & CULTURE<br />
so chapters that filled the space between the<br />
thin leather bindings. “How can we care for<br />
somebody if we don’t care about them”<br />
I had drifted off again. This thought<br />
process distracting me from what was fast<br />
becoming a mundane process of pathological<br />
examination. I may as well have been back in<br />
the museum with the pickled specimens of<br />
fibrosed lung or cirrhotic liver. These things<br />
were much easier to comprehend when seen<br />
through formaldehyde and transparent<br />
containers rather than hidden within a sack<br />
of flesh. At least the plexiglass could not ask<br />
inconvenient questions! Better to know just<br />
the facts and not become concerned with<br />
Painting courtesy of Ellen Wood<br />
the life behind them. Was this from fear of<br />
final acknowledgement of what we already<br />
knew That each of these people, hidden<br />
behind their malignancy, was penning their<br />
own narrative and that, at any moment, their<br />
story may steer dramatically away from that<br />
desired climax. Perhaps, even worse, that the<br />
pen may be snatched from their hand, their<br />
story ending suddenly mid-sentence without<br />
the chance to resolve, ending before it had<br />
even begun.<br />
The imminent arrival at the next patient’s<br />
bedside dragged me back into my sterile<br />
white coat and polished shoes, squeaking on<br />
the laminate flooring. Approaching the man<br />
on the bed I came to a halt alongside the<br />
consultant so that I was just at about chest<br />
level of the patient. I regarded his peaceful,<br />
wrinkled face, his eyes shut and mouth open, I<br />
imagined him to be dreaming of better times.<br />
All the while the registrar systematically read<br />
from the observation chart. “Patient bed<br />
number 16, temperature thirty-seven point<br />
eight, oxygen saturation ninety-five per cent,<br />
heart rate seventy-two, blood pressure onehundred<br />
over sixty, respiration rate thirteen<br />
breaths per minute, currently unresponsive<br />
but patient is reported to have been much<br />
better over the last few days and could be<br />
sent home soon”.<br />
“Excellent, another bed cleared, job well<br />
done” affirmed Doctor Numen.<br />
All the while the prone pensioner had<br />
not moved a muscle. One of the House<br />
Officers’ quipped jokingly “as long as he is<br />
just sleeping”. Numen stopped and looked<br />
quizzically at the junior “check him”. Even<br />
from where I was standing, less than a foot<br />
away, there was no reason I could see to<br />
suggest anything but a deep and restful sleep.<br />
“His hands are warm”.<br />
“Feel for the pulse.”<br />
I watched as the young physician grasped the<br />
wrist for a radial pulse. His fingers lingered<br />
there for a few moments until he proceeded<br />
to probe the neck for the carotid. For a full<br />
minute we stood, waiting expectantly, like the<br />
guests at a surprise birthday party. Finally he<br />
took his stethoscope and placed it firmly at<br />
the left sternal edge in the second intercostal<br />
space as I had become competent doing over<br />
the preceding months. At this point a line of<br />
forgotten poetry tinkered its way from my<br />
hippocampus into my cortex “in a dead man’s<br />
chest, the silence before creation began”.<br />
Another minute passed before the shake of<br />
a head confirmed it. The whole team; from<br />
consultant to uninitiated medical student,<br />
stood stunned for what felt like an hour but<br />
was surely less than six seconds, intrigued by<br />
the pearls forming in the corner of the nurses<br />
eyes.<br />
The brief moment lingered until the<br />
consultant’s bark pulled us out of the daze.<br />
“Right! Next on the list, item number 17”.<br />
Before I knew it I was left alone with the body.<br />
His face had not changed at all but somehow<br />
the wide snoring mouth had stretched into<br />
a silent scream. The loudest scream I had<br />
ever heard! The eyes were shut forever, never<br />
again to lock with his wife’s. They would<br />
not gaze admiringly on grandchildren. The<br />
wrinkled skin, so accommodating a minute<br />
ago was now waxy, pulled tight across his<br />
skull. The nameless, lifeless, vacuum-packed<br />
skeleton lay before me, demanding more<br />
attention than I dared to give. His face had<br />
not changed.<br />
I suddenly had an instant desire to know this<br />
man’s story. I tried to grasp the thick, leather<br />
bound tome from the metaphorical shelf but<br />
it slipped and fell lethargically through the<br />
air. As it crashed to the ground pages spilt<br />
out of the bindings. They were all blank, all<br />
seventy chapters worth. It was too late. He<br />
was gone. I did not even know his name.<br />
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HISTORY<br />
HISTORY<br />
39<br />
<strong>GKT</strong> Greats: Thomas Addison<br />
Photograph courtesy of Charlie Ding<br />
Fi Kirkham MBBS2<br />
Like many <strong>GKT</strong> alumni, Thomas Addison’s father pushed him towards a<br />
Addison had his eccentricities, not career in the Law but his shyness made<br />
least that his exact date of birth is him reluctant. Instead Addison enrolled<br />
unknown. Born sometime in April 1793 he at Edinburgh University and graduated<br />
had an inauspicious start to life as the son just three years later in 1815 as a Doctor of<br />
of a grocer in Newcastle-upon-Tyne. As with Medicine. In December of that year Addison<br />
some of the students of <strong>GKT</strong> today Addison’s came to Guy’s hospital to continue his<br />
parents were determined to see him reach training as a ‘perpetual Physician’s pupil.’<br />
his full academic potential even if this meant<br />
making sacrifices to see him succeed. In In 1827, Thomas Addison became a lecturer<br />
time Thomas Addison gained admission to to the students of Guy’s Hospital. Over the<br />
the Royal Free Grammar school where he next ten years Addison worked tirelessly<br />
learned Latin to the extent that in later life for both his patients and students. He was<br />
his annotations would be in this language noted as viewing the body as more a machine<br />
and so his students required equal fluency. than that of another being. Although not<br />
a favoured viewpoint in our era of holistic<br />
His ability with Latin meant Thomas medicine and patient-centred care, Addison<br />
was able to remain sufficiently detached<br />
to make many revered observations for<br />
which he is still amongst the most revered<br />
physicians.<br />
In 1835, Thomas Addison became joint<br />
Lecturer of Medicine with Richard Bright,<br />
himself an outstanding physician. They<br />
worked together closely for the next three<br />
years before Bright’s retirement. Bright was<br />
an affable man from a wealthy family who<br />
had a charisma he was much admired for.<br />
Addison’s shy nature made him an unlikely<br />
replacement but his brilliance as a scholar<br />
and commitment to his students allowed him<br />
to, in the hospital at least, overcome this.<br />
Thomas Addison is most famous for his<br />
discovery of the disturbance of suprarenal<br />
capsules: a condition characterized<br />
by progressive anaemia, bronze skin<br />
pigmentation, severe weakness and low<br />
blood pressure; now known as Addison’s<br />
disease. Despite this being his most<br />
well-known discovery, his first major<br />
medical breakthrough was almost entirely<br />
overlooked. Had it not been for his devoted<br />
students, Addison’s description of pernicious<br />
anaemia, the first one made, would have<br />
been attributed to another doctor. Perhaps<br />
his taciturn nature meant that he did not<br />
publicise his findings broadly enough, but<br />
the commitment he showed his students<br />
meant they ensured he was not forgotten.<br />
Despite Thomas Addison’s obvious diagnostic<br />
abilities and brilliant lecturing style he had<br />
his insecurities. Samuel Wilks, the student<br />
closest to Addison, would remember: ‘We<br />
know... that, although wearing the outward<br />
garb of resolution, he was beyond most other<br />
men, most liable to sink under trial.’ Prone<br />
to increasingly depressive episodes, Addison<br />
slowly withdrew from university life. Finally,<br />
his depression became too much to bear and<br />
in 1860 he took his own life.<br />
Thomas Addison’s death was announced by<br />
the Medical Times and <strong>Gazette</strong>, but both the<br />
Lancet and BMJ failed to record it. Suicide<br />
remained illegal until 1961 and so his death<br />
was regarded as a crime. In a time when<br />
depression was treated as the mark of a weak<br />
mind Addison could so easily have been<br />
removed from the history of this medical<br />
school. However Addison’s passion for<br />
teaching means that a plaque in his memory<br />
can still be seen in the chapel at Guy’s today,<br />
remembered for what he was: a truly great<br />
man of Guy’s.<br />
Image: KCL Digital Assets<br />
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HISTORY<br />
Guy’s At War: The Home Front<br />
Compiled by Joshua Getty MBBS4<br />
The bombing of Guernica in 1937 by the Luftwaffe left Britain and her allies in no doubt to<br />
the consequences of war with Germany. Once the British Expeditionary Force had escaped<br />
Dunkirk in 1940 during the fall of France, the people of Britain waited with baited breath<br />
for the bombs to fall.<br />
Whilst the RAF’s Spitfires and Hurricanes fought the Battle of Britain, the autumn of 1941<br />
saw war come to the streets of London as Germany sought to bring Britain to her knees.<br />
War had come to Guy’s.<br />
20 th September 1941<br />
a series of fires were started following<br />
an intensive air raid; using these fires as<br />
Guy’s has been subjected to modern<br />
beacons, the raiders returned throughout the<br />
warfare. The enemy has seen fit to<br />
night to attack.<br />
indulge in indiscriminate bombing<br />
raids over London, and we have received<br />
From the start of this offensive, a steady<br />
casualties. On Saturday, September 7th<br />
stream of casualties began to arrive at the<br />
Memorial Gates of Guy’s Hospital. What we<br />
had prepared for in the previous months<br />
had suddenly come to pass. Almost all were<br />
suffering from shock, for not a few of them<br />
had seen their relatives and friends fall<br />
victims to this wretchedness.<br />
The immediate problem was the adequate<br />
administration of resuscitation. This is<br />
not the time for a description of cases<br />
and a weighing of results, but one cannot<br />
help remarking on the recovery of<br />
seemingly lifeless casualties after vigorous<br />
resuscitation. Many had suffered perforating<br />
wounds of chest and abdomen together<br />
with head injuries and burns. To avoid<br />
congestion of the wards, evacuation to base<br />
hospitals was started at once. As soon as<br />
emergency treatment had been applied and<br />
the patient had sufficiently recovered, he was<br />
accommodated in a stretcher bus. In spite<br />
of many of these operations taking place at<br />
night under constant exposure to bombs and<br />
shrapnel, there is not a single report of any<br />
patient having suffered from the journey.<br />
The performance of students and nurses<br />
throughout has been one of merit and a<br />
tribute to themselves and Guy’s Hospital.<br />
There was not the slightest suggestion of<br />
hysteria or fright among any of them, but,<br />
instead, each worked with a cool efficiency,<br />
applying his own intelligence to what had to<br />
be done. Many months ago the student body<br />
was released from the Emergency Medical<br />
Service. At the time there was speculation as<br />
to the reaction of the students, especially with<br />
regard to what might be expected of them<br />
when their services were really required. That<br />
HISTORY<br />
question has now been answered; without<br />
thought to their personal safety, without<br />
bitterness or even a grumble, sleepless and<br />
fatigued as they were, they piled into each<br />
new task with vigour.<br />
From the day he walked into Austria, Herr<br />
Hitler has always scored his successes by a<br />
moral victory. But every bomb that he drops,<br />
every church that he destroys, every home<br />
and person that he shatters only strengthens<br />
our resolve to win.<br />
14 th December 1941<br />
Once again the enemy have descended<br />
upon us in a concentrated attack<br />
more furious than anything yet. This<br />
time different kinds of bombs were used,<br />
since in addition to their incendiary nature,<br />
there was incorporated an explosive feature<br />
which made them much more dangerous.<br />
The whole sky around Guy’s was lighted up<br />
by a brilliant array of colour, serenaded by<br />
the explosions of our guns and their bombs.<br />
In spite of the severity of the attack and its<br />
concentration in our area, Guy’s Hospital<br />
presented an unaltered appearance the next<br />
day. This is a very lucky escape, made all the<br />
more thrilling by the news that a land mine<br />
had fallen within a few hundred yards of us<br />
but that its parachute had been caught on a<br />
structure, preventing the mine from touching<br />
the ground. The mine contained twelve<br />
hundred pounds of explosive, and boasted<br />
seventeen detonators.<br />
The fire and ambulance workers deserve<br />
38<br />
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HISTORY<br />
HISTORY<br />
a great deal of recommendation for the<br />
brilliant way in which they performed their<br />
duties. Without regard for their personal<br />
safety they carried on, knowing that where<br />
they were called to was an enemy target.<br />
Nevertheless, the wounded were carefully<br />
and methodically extricated from the debris<br />
and delivered at the Front Surgery door.<br />
Inside, the surgery was completely altered.<br />
Instead of the usual O.P.O., a large staff of<br />
medical officers, dressers and nurses, waited<br />
in cool readiness for any emergency.<br />
Hardly had we set foot outside when a<br />
shower of incendiary bombs rained down.<br />
Snatching at sandbags, running with buckets<br />
of water, nurses, students and medical staff<br />
alike fought those glowing bombs without<br />
thought of personal risk. While our efforts<br />
were successful, neighbouring buildings were<br />
unattended. It was not long before Guy’s was<br />
ringed by fire on all sides.<br />
In some places electrical switches were<br />
melted by the heat and electric lights began<br />
to shine. Although these had about as much<br />
Down Bros.’ building that it was impossible to<br />
descend into the front quadrangle. Another<br />
famous landmark and standby that is no<br />
more is the old Ship and Shovel, but the timehonoured<br />
initialled table was saved from<br />
the fire and now resides in Guy’s Hospital.<br />
Poor Flossy of the Ship, who in better times<br />
helped Guy’s men out of their depressions,<br />
took refuge with her small retinue in the<br />
underground passage near the kitchen.<br />
All but one wing of the College has been<br />
gutted and even this wing has lost its roof.<br />
Whatever opinions about the adequacy of<br />
the College we might have held, to see the<br />
College so wantonly destroyed was a tragic<br />
sight. With most of the students occupied in<br />
fighting the fire that had started in the roof<br />
of Hunt’s House and others busy evacuating<br />
the patients into waiting ambulances, it was<br />
not possible to save a lot of their personal<br />
belongings. The fire in Hunt’s House has<br />
In these days, when daily stress and anxiety<br />
effect as shining a torch on a bright day, so<br />
tend to colour our views and opinions<br />
automatic had we become that it seemed<br />
about things and people, it is very easy<br />
that the emergency of the moment was to<br />
to become discouraged with oneself and<br />
extinguish these lights.<br />
one’s colleagues. However, it is just such<br />
an occasion as that described above, with<br />
everyone pulling in harmony, that restores<br />
faith in one’s fellows and just as long as that<br />
sense of comradeship exists, democracy can<br />
never die.<br />
Early in the evening, we had the misfortune<br />
to be hit by two high-explosive bombs. The<br />
first scoring a direct hit on the surgical<br />
block, the second involving the bakery and<br />
neighbouring buildings. Parts of Evelyn<br />
and Naaman Wards no longer exist. Dorcas<br />
25 th <strong>Jan</strong>uary 1942<br />
Ward, which was filled with patients and<br />
On the dark dreary and starless night<br />
of December 30th, the population<br />
of the Hospital was scattered in the<br />
different buildings; a gloomy few were dining<br />
in the Spit. Outside, there seemed to be an<br />
excessive commotion which seemed to be<br />
nurses, was very badly shaken. However,<br />
when the fire and fury had cleared, there<br />
was really very little damage to the ward<br />
itself; before many minutes had passed the<br />
students appeared on the scene and began<br />
transporting the patients to safety.<br />
due to a couple of incendiaries in Maze Pond<br />
just outside the Surgery. Somewhat weary of<br />
it all, a few of us wandered towards the scene<br />
of activity more to escape from our present<br />
surroundings than out of curiosity.<br />
By the time all these proceedings had been<br />
carried out, Guy’s was surrounded by a blaze<br />
of fire which rivalled Dante’s inferno. In the<br />
Colonnade alone, one was confronted with<br />
such a blast of smoke and heat coming from<br />
40<br />
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HISTORY<br />
HISTORY<br />
Photographs courtesy of<br />
Imperial War Museum Archives<br />
already been referred to. In fact, by the time<br />
How they arrived is difficult to understand,<br />
enviable daring, removed the neoplasm. An<br />
starts up and the congestion is relieved,<br />
this had got under way, Guy’s was virtually cut<br />
but next morning when the doors were<br />
interesting sidelight on these men is that<br />
and this is accomplished during an aerial<br />
off from the outside world by fire. It became<br />
opened at 8.30 a.m., the Out-Patients’<br />
they receive no extra pay for their dangerous<br />
bombardment. Yes, this is an enviable record,<br />
necessary to evacuate all the patients, a task<br />
Hall was filled with patients; all of them<br />
occupation and they are not voluntary.<br />
with accomplishments enough to satisfy the<br />
which was carried out with commendable<br />
were examined, diagnosed and treated, if<br />
On asking one of the men whether he did<br />
conscience of any man whose sole desire is to<br />
smoothness, again with thanks to the tireless<br />
necessary they were admitted to Hospital. In<br />
not resent being made to serve on such a<br />
serve his country.<br />
energy of the students. It was due to them<br />
that Hunt’s House, in fact Guy’s Hospital,<br />
still stands, a veritable miracle in a district of<br />
burning ruins.<br />
less than three hours from the time we had<br />
sought out a mattress in some underground<br />
corner to rest our aching limbs we had<br />
returned to business as usual.<br />
hazardous job, he proudly replied: “If you<br />
made this job voluntary you’d have the entire<br />
British Army turning out.”<br />
That old criticism concerning the civilian<br />
While everyone is now familiar with the<br />
increasing aid that the United States of<br />
America, is giving, the knowledge that Guy’s<br />
Hospital has been singled out for assistance,<br />
The rest of the history of that eventful evening<br />
concerns the splendid work done by the fire-<br />
22 nd March 1942<br />
medical staffs not taking their part in the<br />
uniformed services, certainly finds its answer<br />
makes us feel its reality all the more. The<br />
American Organization Bundles for Britain,<br />
fighting squads and the Works Department.<br />
Some of the fire parties arrived from some<br />
distance away and everyone was delegated<br />
to save Guy’s Hospital at any cost. On behalf<br />
of Guy’s Hospital we should like to thank the<br />
Fire-Fighting Services for their wonderful<br />
service which was rendered so generously.<br />
Recently two more bombs added<br />
themselves to our already impressive<br />
list of direct hits. The first exploded<br />
in the quadrangle. The second bomb became<br />
buried some thirty feet in the ground. A few<br />
days later the Bomb Disposal Squad, with<br />
in the performance of Guy’s. We have received<br />
a very considerable fraction of all casualties<br />
due to enemy action in Great Britain. When<br />
our wards have been destroyed, we screen<br />
off the wrecked portion and use what is left,<br />
when the stream of casualties threatens to fill<br />
all the available beds, the evacuation service<br />
who have done so much to assist in the work<br />
of alleviating the distress caused by air raids,<br />
has sent this hospital the magnificent sum<br />
of over £2,200 to help. To our American<br />
readers, we offer our gracious thanks.<br />
Next issue: The Liberation of Europe.<br />
42<br />
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RESEARCH<br />
RESEATCH<br />
First in class:<br />
Drug in<br />
development<br />
at King’s shows<br />
promise in asthma<br />
and COPD trials<br />
Dylan Padmakumar BSc Biomedical Sciences 3 rd Year<br />
Ajay Shah BSc Pharmacology Extramural Year<br />
T<br />
he development of the compound<br />
RPL554 holds one of the most exciting<br />
and eagerly anticipated advances in<br />
modern respiratory medicine.<br />
The small molecular entity RPL554 was one<br />
of many compounds co-invented by the extraordinary<br />
late Sir David Jack, whose teams<br />
developed all of the mainstay pharmacological<br />
interventions for treating asthma - salbutamol,<br />
salmeterol, beclometasone and<br />
fluticasone. Verona Pharma, a biotechnology<br />
company co-founded by King’s College London<br />
Professor Clive Page, took on RPL554,<br />
which is now set to become the first novel<br />
class of drug in decades for the treatment of<br />
COPD and asthma 1 .<br />
For years the main treatment for asthma<br />
and COPD has been inhaled corticosteroids<br />
plus bronchodilators (short or long-acting).<br />
However corticosteroids can have profound<br />
adverse effects, while long-acting bronchodilators<br />
have come under scrutiny for possibly<br />
Professor Clive Page<br />
worsening asthma symptoms. Moreover, in<br />
each disease there are populations of patients<br />
who are resistant to current treatments.<br />
There is therefore significant need for novel<br />
therapies to be developed for treating asthma<br />
and COPD. Could RPL554 be the answer<br />
What is so special about this inconspicuously<br />
named compound<br />
RPL554 is a dual action inhibitor – a single<br />
molecule that has the ability to inhibit two enzymes<br />
in the phosphodiesterase (PDE) family,<br />
PDE3 and PDE4 – siblings of the PDE5<br />
enzyme targeted by sildenafil (Viagra) 1 . PDE<br />
enzymes break the phosphodiester bonds of<br />
the secondary messengers cyclic adenosine<br />
monophosphate (cAMP) and cyclic guanosine<br />
monophosphate (cGMP), thus regulating<br />
their cellular effects. PDE3 is involved<br />
in the regulation of contractility of airway<br />
smooth muscle and PDE4 is involved in the<br />
activation of various inflammatory cells. Rationally,<br />
inhibiting PDE3 would therefore be<br />
expected to cause bronchodilation and inhibiting<br />
PDE4 should reduce lung inflammation.<br />
However, previous attempts to inhibit the<br />
enzymes have proved to be therapeutically<br />
problematic. Theophylline, a non-selective<br />
PDE inhibitor and PDE4 specific inhibitors<br />
such as roflumilast highlight the problems<br />
behind the use of PDE inhibitors 2, 3 . Both have<br />
a narrow therapeutic window but more significantly,<br />
come with a catalogue of untoward<br />
side effects with emesis the most problematic.<br />
Increased cAMP in the area postrema (the<br />
vomiting centre) of the brain are thought to<br />
mediate the emesis mechanism. Roflumilast<br />
in one study showed the incidence of adverse<br />
events at 16% against 5% for placebo 3 .<br />
After a series of proof-of-concept studies,<br />
RPL554 however, appears safe.<br />
Between 2009 and 2013, a series of early<br />
clinical studies were undertaken where the<br />
drug’s safety was either the primary or secondary<br />
endpoint1. The compound, unlike its<br />
PDE inhibiting predecessors, was well tolerated-<br />
the frequency of adverse events was<br />
comparable to that presented in the placebo<br />
group 1 .<br />
References:<br />
When given to COPD and asthma patients,<br />
the findings are promising. In COPD patients,<br />
RPL554 led to an increase in forced<br />
expiratory volume in 1 second (FEV1) by 17%<br />
versus placebo and interestingly, a peak effect<br />
comparable to inhaled beta 2-agonists 1 .<br />
COPD is a disease lacking any real effective<br />
treatment, so RPL554 holds potential. In<br />
asthma patients, the increase in FEV1 was<br />
smaller, but still significant, an increase of<br />
14% 1 . Moreover repeat dosing in asthmatics<br />
for 6 days indicated that the bronchodilator<br />
effects were maintained 1 .<br />
Only time (and larger, double-blind, randomised<br />
controlled trials) will tell if RPL554<br />
will live up to the enthusiasm surrounding it<br />
and what impact it will have, if any, on both<br />
current respiratory medicine and on the directions<br />
taken in future drug development.<br />
RPL554 remains in clinical infancy but initial<br />
findings are encouraging.<br />
1. Franciosi, L.G., Diamant, Z., Banner, K.H., Zuiker, R., Morelli, N., Kamerling, I.M.C., et al. (2013). Efficacy<br />
and safety of RPL554, a dual {PDE3} and {PDE4} inhibitor, in healthy volunteers and in patients<br />
with asthma or chronic obstructive pulmonary disease: findings from four clinical trials. Lancet Respir.<br />
Med. 1: 714–727.<br />
2.Barnes, P.J. (2013). Theophyline. American Journal or Respiratory an Critical Care Medicine, Vol.188,<br />
901-906<br />
3.Antoniu, S.A. (2011). New therapeutic options in the management of COPD - focus on roflumilast. Int.<br />
J. Chron. Obstruct. Pulmon. Dis. 6: 147–55.<br />
44<br />
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RESEARCH<br />
RESEARCH<br />
Fighting antibiotic resistance<br />
at King’s College London<br />
Tristan Dennis BSc Biomedical Sciences 3 rd Year<br />
On the 11th of December 1945, Sir Alexander<br />
Fleming delivered his Nobel<br />
Prize lecture on penicillin. In<br />
it, he stated that ‘It is not difficult to make<br />
microbes resistant to penicillin…if you use<br />
penicillin, use enough.’ This is not some<br />
feat of extraordinary prescience by Fleming,<br />
but extrapolation of experimental data.<br />
From the 40s until the 80s, over 17 different<br />
classes of antibiotics were discovered. Since<br />
then, we have developed 3 classes 1 . Following<br />
Fleming’s speech, over 400 infectious<br />
diseases have emerged to maim and kill.<br />
Part of the issue lies with the fact that resistance<br />
is an inevitable consequence of antibiotic<br />
usage. The creation of a selection pressure<br />
(something which causes greater evolutionary<br />
success in a portion of a population) in<br />
a fast breeding species will lead to a rapid<br />
rise in strains that are resistant to the environmental<br />
change. In this case, bacteria have<br />
rapidly adapted to the panoply of antimicrobial<br />
drugs developed in the 20 th century, and<br />
are beginning to become more of a threat.<br />
Despite dire warnings of ‘apocalyptic superbugs,’<br />
by Dame Sally Davies, the fight<br />
against drug-resistant bacteria is gathering<br />
momentum. King’s is playing a part in the<br />
fight against resistant microbes; some of the<br />
work is done at the Institute of Pharmaceutical<br />
Science, a department responsible for<br />
research aiding drug discovery and development.<br />
To help bolster our dwindling arsenal<br />
of antibacterial drugs, novel compounds are<br />
being developed and tested, for example,<br />
antibiotics that specifically and directly target<br />
bacterial DNA – pyrrolobenzodiazepine<br />
dimers (PBDs). PBDs possess a profound<br />
bactericidal effect against gram-positive bacteria,<br />
as well as having potential anti-tumour<br />
effects, as found in other antibiotics 2 . It has<br />
been found that pairs of PBD molecules (dimers)<br />
have a novel and potent mechanism<br />
for bacterial cell killing. They bind to specific<br />
DNA sequences, and cause DNA cross-linking;<br />
this cross-linking renders the DNA inaccessible<br />
by the internal machinery of the bacterial<br />
cell, and the bacteria eventually die 3 .<br />
The Randall Division of Cell and Molecular<br />
Biophysics also participates in research concerning<br />
the characterisation and investigation<br />
of the mechanisms of resistance, specifically<br />
the structure and function of enzymes<br />
involved in resistance, so that novel drug<br />
targets can be identified. As an example beta-lactam<br />
antibiotics, such as amoxicillin, are<br />
a core element of antibacterial therapies. In<br />
response, bacteria have developed enzymes<br />
that disarm many beta lactam antibiotics.<br />
These beta-lactamases have become drug<br />
targets in themselves. Whilst we possess<br />
beta-lactamase inhibitors which are used<br />
in combination with antibiotics (Co-amoxiclav,<br />
for example), the offending bacteria<br />
have inevitably developed further resistance<br />
mechanisms in the form of metallo beta lactamases<br />
(MBLs) – a new breed of anti beta-lactam<br />
enzyme discovered in 2010 4 . The<br />
Randall Division is currently involved in<br />
work determining the precise structure and<br />
mechanics of MBLs 5 . With this research,<br />
we can begin to identify possible drug candidates<br />
that could inhibit this enzyme.<br />
The activity of compounds can be modified<br />
by the addition of different molecules; the addition<br />
of an acetyl group to hydroxyl groups<br />
Penicillin embedded in agar<br />
Lysozyme embedded in agar<br />
Sir Alexander Fleming’s orginal petri dishes<br />
demonstrating antibiotic resistance.<br />
Source: Nobel Lecture Archives<br />
46<br />
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with<br />
extended<br />
material<br />
online'<br />
with<br />
extended<br />
material<br />
online'<br />
with<br />
extended<br />
material<br />
online'<br />
with<br />
extended<br />
material<br />
online'<br />
with<br />
extended<br />
material<br />
online'<br />
RESEARCH<br />
by acetyltransferases on chloramphenicol<br />
molecules will inactivate them. The Randall<br />
Division recently identified the presence and<br />
mechanism of acetyltransferases in Pseudomonas<br />
6 . Developing an inhibitor to chloramphenicol<br />
acetyltransferase, and administering<br />
it alongside chloramphenicol could<br />
overcome this resistance. For now, anyway.<br />
In addition, the Division of Immunology,<br />
Inflammation and Infectious Disease, has research<br />
underway in the prevention of healthcare<br />
associated infections, including classically<br />
resistant pathogens such as MRSA.<br />
Their work involves modelling the dynamics<br />
of resistance and past patterns in order<br />
to develop novel preventative strategies<br />
for resistant hospital acquired infections.<br />
Together, this research represents many of<br />
the facets of combating antibiotic resistance;<br />
the elucidation of mechanisms, identification<br />
of drug targets, development of new drugs,<br />
and the prevention of infection by resistant<br />
organisms. Despite warnings of the post-antibiotic<br />
apocalypse, research is gaining traction<br />
7 , 8 . Work done at King’s does much to<br />
represent the funding, resourcefulness and<br />
innovation involved with tackling the issue<br />
– an encouraging prospect for us all.<br />
CLINICAL ANAESTHESIA CLINICAL BIOCHEMISTRY<br />
Lecture Notes<br />
Lecture Notes<br />
LN LN<br />
Carl Gwinnutt<br />
Simon Walker<br />
Matthew Gwinnutt<br />
Geoffrey Beckett<br />
Peter Rae<br />
4th Edition<br />
Peter Ashby<br />
9th Edition<br />
ELDERLY CARE MEDICINE EMERGENCY MEDICINE<br />
Lecture Notes<br />
Lecture Notes<br />
LN LN<br />
Claire G. Nicholl<br />
Chris Moulton<br />
K. <strong>Jan</strong>e Wilson<br />
David Yates<br />
8th Edition<br />
4th Edition<br />
References:<br />
EPIDEMIOLOGY, EVIDENCE-BASED<br />
MEDICINE AND PUBLIC HEALTH<br />
Lecture Notes<br />
HAEMATOLOGY<br />
Lecture Notes<br />
MEDICAL MICROBIOLOGY<br />
AND INFECTION<br />
Lecture Notes<br />
OPHTHALMOLOGY<br />
Lecture Notes<br />
CLINICAL PHARMACOLOGY<br />
AND THERAPEUTICS<br />
Lecture Notes<br />
1. Powers JH, Antimicrobial drug development - the past, the present, and the future, Clinical<br />
Microbiology and Infection, 2004;10(4):23-31<br />
2. Hu Y, Phelan V, Ntai I, Farnet CM, Zazopoulos E, Bachmann BO, Benzodiazepine biosynthesis<br />
in Streptomyces refuineus, Chemistry & Biology, 2007;14(6):691-701<br />
Yoav Ben-Shlomo<br />
Sara T. Brookes<br />
Matthew Hickman<br />
6th Edition<br />
LN<br />
Chris S. R. Hatton<br />
Nevin C. Hughes-Jones<br />
Deborah Hay<br />
David Keeling<br />
9th Edition<br />
LN<br />
Tom Elliott<br />
Anna Casey<br />
Peter Lambert<br />
Jonathan Sandoe<br />
5th Edition<br />
LN<br />
Bruce James<br />
Anthony Bron<br />
11th Edition<br />
LN<br />
Gerard A. McKay<br />
Matthew R. Walters<br />
9th Edition<br />
LN<br />
3. Rahman K, Rosado H, Moreira JB, Feuerbaum EA, Fox KR, Stecher E, Howard PW,<br />
Gregson SJ, James CH, de la Fuente M, Waldron DE, Thurston DE, Tayor PW, Antistaphylococcal<br />
activity of DNA-interactive pyrrolobenzodiazepine (PBD) dimers and PBD-biaryl<br />
conjugates, Journal of Antimicrobial Chemotherapy, 2012;67(7):1683-1696<br />
4. Kumarasamy KK, Toleman MA, Walsh TR, Bagaria J, Butt F, Balakrishnan R, et al. Emergence<br />
of a new antibiotic resistance mechanism in India, Pakistan, and the UK: A molecular,<br />
biological, and epidemiological study. Lancet Infectious Diseases, 2010;10:597–602<br />
5. Llarrull LI, Fabiane SM, Kowalski JM, Bennett, B, Sutton BJ, Vila AJ, Asp-120 locates Zn2<br />
for optimal metallo-ss-lactamase activity. Journal of Biological Chemistry, 282(25), 18276 –<br />
18285<br />
DISEASES OF THE EAR,<br />
NOSE AND THROAT<br />
Lecture Notes<br />
Ray Clarke<br />
11th Edition<br />
CLINICAL BIOCHEMISTRY<br />
Lecture Notes<br />
LN<br />
Simon Walker<br />
Geoffrey Beckett<br />
Peter Rae<br />
Peter Ashby<br />
9th Edition<br />
LN<br />
Nick Beeching<br />
TROPICAL MEDICINE<br />
Lecture Notes<br />
Geoff Gill<br />
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6. Davies AM, Tata R, Beavil R, Sutton BJ, Brown PR, I-Methionine Sulfoximime, but not<br />
phosphinothricin, is a substrate for an acetyltransferase (gene PA4866) from Pseudomonas<br />
Aeruginosa: structural and functional studies, Biochemistry, 2007;46(7):1829-39<br />
7. http://www.theguardian.com/society/2013/jan/23/antibiotic-resistant-diseases-apocalyptic-threat<br />
(last accessed on 03/01/2013)<br />
8.http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2010PressReleases/100716MRSAandcdiffdownbyathird/(last<br />
accessed on 03/01/2013)<br />
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DENTAL<br />
Dental Foundation Training<br />
The Interview Process<br />
to concentration. I would therefore advise<br />
students not to seek out the most silent<br />
section of the library for their preparation!<br />
The SJT was a rather unknown entity;<br />
although both Portsmouth Dental Academy<br />
and King’s College Hospital coached us to the<br />
best of their ability, the actual test exceeded<br />
both student and teachers’ expectations in<br />
terms of it’s difficulty. It was impossible for<br />
students to leave with any real appreciation<br />
of the quality of their performance. For<br />
example, in the exercise which involved<br />
ordering 5 phrases from the most to least<br />
appropriate there was rarely a clear most and<br />
least appropriate answer as we had practiced.<br />
When picking the 3 most appropriate phrases<br />
there were always 4 or 5 appropriate answers.<br />
Since this was the first year the SJT was used<br />
as an assessment tool, I hope there will be<br />
a greater array of useful examples for the<br />
<strong>2014</strong> cohort to use in their preparations. It is<br />
important to recognise that the SJT is rooted<br />
in ethics as opposed to clinical expertise so<br />
this should be a core consideration during<br />
preparations.<br />
For those receiving offers on the 8th <strong>Jan</strong>uary<br />
<strong>2014</strong> I hope you all get places you are happy<br />
with, and for those in years to come I wish<br />
you the best of luck with the process and<br />
enjoy learning the GDC standards!<br />
Photographs courtesy of Charlie Ding<br />
Lucy Clements BDS5<br />
The 18th and 19th of November 2013<br />
brought the Dental Foundation<br />
Training (DFT) assessments at the<br />
London Deanery Events Centre in Russell<br />
Square to final year dental students hoping<br />
to start their DFT in September <strong>2014</strong>.<br />
Applicants ranked schemes throughout the<br />
UK (minus Scotland) before their interview.<br />
The subsequent assessment and interview<br />
process was to determine which of these<br />
schemes the applicant would then be<br />
assigned to for their first year in practice.<br />
The assessment consisted of three separate<br />
stations. Two lasted 10 minutes with an<br />
allowance of 5 minutes reading time - a<br />
professionalism, management and leadership<br />
(PML) station and a patient communication<br />
station. Following this, applicants either<br />
had no wait or waited between 40 minutes<br />
or 80 minutes for a situational judgement<br />
test (SJT) lasting 100 minutes. We hope that<br />
next year applicants will be told which group<br />
they will fall into in advance so they can plan<br />
accordingly, especially given that bags can be<br />
accessed during the waiting stage.<br />
The communication station was ‘OSCE<br />
like’ for which students can prepare for in<br />
advance, given that they are accustomed to<br />
these stations. The PML station presented<br />
a varied experience for students. Some<br />
found themselves delivering a 10 minute<br />
monologue during which they engaged<br />
with the full portfolio of clinical governance<br />
issues relating to the particular scenario<br />
provided. Others participated in a dialogue<br />
with the examiner involving numerous direct<br />
questions. It is probably sensible to practice<br />
both variations. During the five minutes<br />
‘reading time’ we were positioned in a busy<br />
corridor, an environment far from conducive<br />
54<br />
<strong>GKT</strong> <strong>Gazette</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>GKT</strong> <strong>Gazette</strong> 55
Picture the scene; you’re at a family<br />
wedding without a date, but the champagne<br />
is flowing and everyone’s having<br />
a great time. You find yourself standing<br />
alone with an aunt who you haven’t seen in<br />
years. The small talk dries up and she poses<br />
the dreaded question, “So could your girlfriend<br />
not make it” Clearly the news that<br />
you came out as gay two years ago hasn’t<br />
filtered through to this side of the family.<br />
Sound familiar<br />
I find myself in these challenging situations<br />
regularly when I return home to Dudley. They<br />
are awkward and difficult to navigate but that<br />
is about as bad as it can get. The consequences<br />
of whether or not I choose to disclose my sexual<br />
preferences stop at uncomfortable silences.<br />
As a student nurse the consequences of being<br />
“out” in practice can be far-reaching, as I<br />
Out and Proud<br />
A student nurse’s<br />
reflection on the<br />
implications of<br />
heteronormative<br />
assumptions in<br />
clinical practice<br />
Ryan Passey Mental Health Nursing 3 rd Year<br />
have discovered whilst on clinical placement.<br />
Last year I was working on a great ward<br />
with extremely supportive colleagues. Personally<br />
I was doing well, I had been dating<br />
a guy for a couple of months and felt happy<br />
and secure for the first time since coming<br />
out. One afternoon a nurse asked me<br />
if my girlfriend and I had any Valentine’s<br />
Day plans. I was so taken aback by this that<br />
rather than saying ‘actually my boyfriend<br />
is taking me out for a nice steak dinner,’ I<br />
meekly replied that I didn’t have a girlfriend.<br />
This isn’t the first time that this has happened<br />
to me, and it certainly won’t be the last. What<br />
strikes me about this experience was how<br />
exposed I felt, as though to be honest would<br />
leave me vulnerable in some way. After<br />
speaking with gay and lesbian colleagues I<br />
realised that I wasn’t alone in feeling like this.<br />
“Oh so you’re a lesbian” was the response<br />
when Stephanie* mentioned her girlfriend<br />
to some work colleagues. ‘It was odd because<br />
I’d never say to them “Oh so you’re straight”<br />
It’s just assumed that being straight is the<br />
norm,’ she explained. From experience this<br />
doesn’t seem to be intentionally harmful,<br />
the staff I’ve work with are often unaware<br />
of the impact of their assumptions and as<br />
Stephanie continued, ‘it’s not exactly homophobic’.<br />
Why would you admit to being<br />
abnormal if it makes life easier to pretend<br />
Being in a same-sex relationship (or wanting<br />
to be, for those of us who’ve yet to land<br />
someone) is not abnormal. We are living in<br />
an age where Tom Daley reveals that he’s in<br />
love with a man and the nation rejoices, Ellen<br />
DeGeneres is adored worldwide and is openly<br />
attracted to women and by March <strong>2014</strong><br />
same-sex marriages will be legally performed<br />
across the United Kingdom. Heteronormative<br />
assumptions, the belief that everyone is<br />
‘straight’ until declared otherwise, are rightfully<br />
becoming a thing of the past. Like floppy<br />
disks, or Samantha Mumba’s career, time is<br />
moving too fast for them to survive. There is no<br />
need to hide or feel ashamed by what you feel.<br />
Despite this wonderful progress, a culture of<br />
ignorance and prejudice prevails. Change is<br />
taking time. ‘If I tell people and somebody<br />
doesn’t like it, then I meet them again in a<br />
job interview, you just never know,’ Judy*<br />
explained. Her fears appear less rooted in<br />
shame and more so over the practicalities<br />
of future employment. Anti-discriminatory<br />
practice is mandated in national recruitment<br />
policy, yet would-be applicants are fearful<br />
over how they will be perceived and the effect<br />
this may have on their job prospects.<br />
NURSING & MIDWIFERY<br />
‘I told my mentor I was a lesbian and he<br />
said “it’s a waste”, he was never quite the<br />
same with me after that,’ Judy disclosed.<br />
Our mentors are a close ally in practice; advising<br />
and assessing our practice and shaping<br />
us as nurses. It’s worrying that this kind<br />
personal disclosure can have a damaging<br />
impact on our education and assessments.<br />
Coming out in the first place can be a traumatic<br />
experience. It can be confusing and<br />
isolating, with many people finding that<br />
their family and friends treat them differently.<br />
They say it gets better, and in my experience<br />
it has done. However, it never gets<br />
easier to come out to someone, especially as<br />
the new student on a ward. Judy hit the nail<br />
on the head; ‘it’s hard enough coming out<br />
once, let alone three or four times a year!’<br />
Patients themselves are no more immune<br />
from making assumptions than anyone else,<br />
and having their dignity stripped away whilst<br />
in hospital can leave them desperate for normality.<br />
They may ask us personal questions,<br />
curious about the lives of those caring for<br />
them. How do you respond The key here is<br />
to maintain a balance between developing a<br />
positive therapeutic relationship and keeping<br />
professional boundaries. There’s a fine<br />
line between being honest and oversharing.<br />
So what does all of this mean for us Should<br />
we even bother worrying about the implications<br />
of heteronormative assumptions on our<br />
practice From my understanding it is clear<br />
that having an open and supportive relationship<br />
with colleagues in practice can help us<br />
cope with any difficulties we may encounter.<br />
I would never encourage anyone to come out<br />
at work if they don’t feel comfortable doing<br />
so, but please remember you are not alone,<br />
support is there if you look for it. And for<br />
our straight readers, perhaps think twice<br />
before asking about someone’s relationship<br />
status. Nobody should feel as though<br />
they have to hide to protect themselves.<br />
*All names have been changed<br />
56<br />
<strong>GKT</strong> <strong>Gazette</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>GKT</strong> <strong>Gazette</strong> 57
NURSING & MIDWIFERY<br />
Opening the door to<br />
healthcare for<br />
the homeless<br />
Sarah Cleary Adult Nursing 2 nd Year<br />
Established in 1948, the prevailing<br />
task of the National Health Service<br />
(NHS) is to provide free and accessible<br />
healthcare, to every person living in the<br />
United Kingdom. Wherever you live, you can<br />
register with a GP and gain access to comprehensive<br />
healthcare whenever you need it. To<br />
register you just need to provide your current<br />
address. Simple! Or is it<br />
A survey conducted on one night in 2012 revealed<br />
over 2000 people sleeping rough on<br />
England’s streets. With the reasoning that<br />
you must have an address to access a GP, this<br />
is over 2000 vulnerable individuals who are<br />
potentially excluded from our ‘easy access’<br />
healthcare service. This figure doesn’t account<br />
for the recent prediction of 400,000<br />
people without a permanent address, the<br />
‘hidden-homeless’, who may also be deprived<br />
of vital health services. We have all heard of<br />
the postcode lottery, but if you don’t even<br />
have a postcode, what chance do you have<br />
With expensive secondary care services<br />
stretched beyond capacity, inappropriate<br />
A&E attendance is a hot topic. Homeless<br />
people attend A&E five times more often on<br />
average than non-homeless people. Before<br />
we condemn this behaviour, without access<br />
to the services provided by a GP, where are<br />
these people expected to go to receive treatment<br />
If homeless people are not effectively<br />
linked in with primary care services, A&E<br />
would appear to be their only way of accessing<br />
healthcare, and this is often too late.<br />
I am concerned about just how many homeless<br />
people there are who don’t have access<br />
to the basic healthcare that the UK boasts is<br />
available to everyone. My concern is not unfounded.<br />
The average life expectancy for a<br />
homeless person in the UK is 47. That’s 34<br />
years younger than the general population in<br />
the UK.<br />
The homeless are a population of people<br />
who often have multiple mental and physi-<br />
58<br />
<strong>GKT</strong> <strong>Gazette</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>GKT</strong> <strong>Gazette</strong> 59<br />
Photograph courtesy of Charlie Ding
NURSING & MIDWIDERY<br />
NURSING & MIDWIFERY<br />
cal health problems. Additionally 63% have<br />
a drug problem and 32% are alcohol dependent.<br />
We can point the finger and blame<br />
their ‘lifestyle choices’, we can say their ill<br />
health is ‘self-imposed’, we can turn a blind<br />
eye because these people have little voice in<br />
society… but our health service is meant to<br />
be all inclusive. An alcohol-dependent businessman<br />
can go to his GP and get access to<br />
the help he needs to stop drinking. A 50<br />
year old housewife who has been smoking<br />
for 30 years can go to her GP and get the<br />
help she needs to quit. What about the 24<br />
year old boy who is addicted to heroin, because<br />
it is the only thing that comforts him<br />
when he finds himself cold and lonely on a<br />
park bench for another night<br />
The Health Inclusion Team is a nurse-led<br />
service run by Guy’s and St Thomas’ NHS<br />
Foundation Trust. They aim to ‘reduce<br />
health inequalities, discrimination and social<br />
exclusion in Lambeth, Southwark and<br />
Lewisham’. They care for those who would<br />
otherwise slip through the system; homeless<br />
people, refugees, asylum seekers and those<br />
with blood borne viruses. With regards to<br />
the homeless, the nurses attend day centres<br />
and hostels and meet with them. They<br />
provide for their immediate and ongoing<br />
healthcare needs, however, most importantly<br />
they help homeless people gain access to<br />
the services they are entitled to, primarily a<br />
GP.<br />
Registration with a GP is simply the first<br />
hurdle for a homeless person in terms of<br />
accessing healthcare. Our GP services are<br />
often inflexible with their generic structure:<br />
book an appointment, turn up, register<br />
your arrival, sit in a waiting room, and<br />
then be called in to see the doctor. This is<br />
a well-organised model that allows easy and<br />
fair access to healthcare for the majority.<br />
However, it fails to cater for the needs of<br />
homeless people who may lead chaotic lifestyles,<br />
making it difficult for them to book<br />
and keep appointments. Many GP’s have<br />
a ‘did not attend’ policy that means after a<br />
certain number of missed appointments patients<br />
are no longer allowed to use the GP<br />
service. After difficulties in registering with<br />
a GP, losing registration could be detrimental<br />
to a homeless person’s health. Thus, the<br />
Health Inclusion Team is not only involved<br />
in registering patients with a GP, but also<br />
helping them attend their appointments,<br />
whether this is through linking them in to<br />
a buddy scheme where a volunteer accompanies<br />
them to the appointment, or through<br />
sending them a text to remind them. They<br />
also liaise with GP’s to ensure the patient is<br />
attending appointments and being provided<br />
with appropriate care.<br />
The nurses in the Health Inclusion Team<br />
are non-judgemental and build therapeutic<br />
relationships with their clients. Sitting and<br />
waiting for an appointment can be frustrating<br />
for anyone. Imagine that whilst you<br />
are waiting you become increasingly aware<br />
that the people are slowly edging away from<br />
you, that the receptionist is eyeing you with<br />
suspicion and the man across the room is<br />
frowning at you like you are doing something<br />
wrong by just being there. Imagine if<br />
when you are eventually called through to<br />
see the GP that they also treat you in a demeaning<br />
way, judging you and making you<br />
feel worthless. This may not be intentional<br />
but is often how it seems. One survey found<br />
perceived social stigma to be the reason that<br />
54% of homeless people did not feel able to<br />
attend appointments. Stigma is an issue we<br />
can all help to reduce, but healthcare professionals<br />
should feel a particular responsibility<br />
to prevent. Healthcare professionals<br />
are taught to be non-judgemental and<br />
compassionate. Thus, every member of the<br />
multidisciplinary team should be taking responsibility<br />
for providing the homeless with<br />
non-judgemental healthcare, valuing them in<br />
exactly the same way they would the alcoholic<br />
businessman, the 50 year old housewife, or<br />
any other member of society.<br />
Since 1948 the UK has had a National Health<br />
Service. This means there should be free and<br />
accessible healthcare for all. The Health Inclusion<br />
Team should be a name we can give<br />
to the 1.3 million strong team of people working<br />
for the National Health Service, not just<br />
to the team of about 20 dedicated people in<br />
a section of Guy’s and St Thomas’ Trust. The<br />
first step to achieving this is to reduce the<br />
stigma associated with homeless people, particularly<br />
amongst healthcare professionals.<br />
The <strong>GKT</strong> <strong>Gazette</strong><br />
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BOOK REVIEWS<br />
Big<br />
The<br />
Little Book<br />
of Questions<br />
and Answers<br />
colour photos of slides present in the middle<br />
of the book. The best thing about the book is<br />
that the answers are very detailed and explain<br />
why the answer is correct but also why the<br />
other options are wrong which is very useful<br />
given how ambiguous MCQ’s can be.<br />
It is however unclear exactly who the book<br />
is aimed at as there are perhaps too many<br />
clinically orientated questions for students<br />
in their non-clinical years and yet too few<br />
for those who are in their clinical years. The<br />
questions are all rated according to their<br />
BOOK REVIEWS<br />
difficulty – ranging from what a graduate<br />
should know to what it would be nice for a<br />
foundation doctor to know. So this seems<br />
to be a book designed for use throughout<br />
medical school rather than for any particular<br />
year or exam. As a third year student who<br />
after taking a year out to do a BSc had<br />
forgotten a significant amount of MBBS1 & 2,<br />
I found the book useful for revision and also<br />
for testing some of the clinical information<br />
I’ve learnt so far this year.<br />
Kaushiki Singh MBBS3<br />
Title:<br />
Oxford Assess and Progress: Medical Sciences<br />
Authors: Jade Chow & John Patterson<br />
Price: £19.99<br />
ISBN: 978-0-19-960507-1<br />
This book is part of the Oxford Assess<br />
and Progress series that covers<br />
various specialities. The book contains<br />
approximately 350 multiple-choice questions<br />
(MCQ’s) covering the main medical science<br />
topics and is divided into 3 sections - cell<br />
biology, the biomedical systems and medical<br />
sciences in clinical reasoning. The questions<br />
in each of these sections are further grouped<br />
into topics with the answers present at the<br />
end of each topic. This makes it easy to<br />
navigate the book and find questions on the<br />
desired topic without hassle. The questions<br />
are mostly in single best answer format<br />
however; there are also a fair amount of<br />
extended matching questions. There is also a<br />
scattering of clinically orientated questions.<br />
In particular, the third section which is<br />
devoted to clinical questions. It is this section<br />
that makes this book useful for students in<br />
their clinical years as well as those in the<br />
non-clinical years.<br />
Given the wide range of topics covered, the<br />
mixture of non-clinical and clinical questions<br />
and the number of questions, I would say<br />
the book is good for getting used to MCQ’s<br />
rather than for extensive practice. Some<br />
of the questions are based on very specific<br />
facts and so are also good for learning the<br />
topic as those facts may have been missed<br />
in other study. At the end of each section<br />
there are also suggestions for further study<br />
although these are only for other books in the<br />
Oxford Handbook series. In general though<br />
I think the style of the questions and the<br />
facts covered provide a good representation<br />
of exam questions making the book useful<br />
for exam practice. There are also questions<br />
covering histology that use high definition<br />
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WIN A CLINICAL<br />
PLACEMENT<br />
Slow Man – J.M. Coetzee<br />
Put down by critics as a book all medical<br />
students should read: Paul Rayment<br />
loses his leg in a cycling accident then<br />
falls in love with his carer. The plot itself is<br />
without note but the comments on the limits<br />
of medical care are interesting. His doctor<br />
speaks too factually about amputating his<br />
leg, showing little understanding concerning<br />
the implications it will have to Paul’s life.<br />
His first nurse is patronising. Paul wants to<br />
be treated as a normal, middle aged man<br />
yet she continues to treat him as a small<br />
child, especially when bathing him. Finally,<br />
Marijana becomes his nurse and they reach a<br />
mutual, unspoken understanding concerning<br />
his needs. However, when Paul declares his<br />
Becky Taylor Comparative Literature MA<br />
undying love for her, the boundaries between<br />
medical care and human care are blurred.<br />
This results in Marijana neglecting her duties<br />
in an attempt to distance herself, which puts<br />
Paul’s health in danger.<br />
From personal experience, my medical<br />
friends take it for granted that I will come<br />
to the same conclusions as them concerning<br />
my own medical health. It’s just not true and<br />
I feel Paul’s frustration! The book will help<br />
gain an insight into the patient’s mind so it is<br />
a must read for medical students, although I<br />
would only recommend the first 50 pages as<br />
the plot itself becomes tedious.<br />
Photographs courtesy of Charlie Ding<br />
WITH THE OXFORD<br />
HANDBOOK OF<br />
CLINICAL MEDICINE<br />
NINTH EDITION<br />
You could be practising your clinical skills<br />
in the country of your choice, be it in<br />
Africa, Asia, Latin America or Eastern<br />
Europe by entering our competition to<br />
win an overseas clinical placement.<br />
Visit www.oup.com/uk/medicine/ohcm9 to find out more!<br />
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CAREERS<br />
Struth! Get in the Ambo!<br />
Australian Elective Experience.<br />
Sabina Checketts MBBS5<br />
T<br />
o all current fourth year medics, I have always wanted to go to Australia,<br />
have you decided on your elective partly inspired by watching Neighbors and<br />
placement yet If not, then you Home & Away, while not forgetting Crocodile<br />
better get cracking particularly if you are Dundee (“That’s not a knife”) and my elective<br />
going to a popular destination. A (relatively) seemed the perfect opportunity to obey my<br />
well-planned elective may be the most fun wishful thinking. Particularly as it is unlikely<br />
you have practising medicine in your whole that I will ever be allowed over two months<br />
medical school career - perhaps in your off work to study and travel – that is until I<br />
whole career.<br />
retire at least. When I mentioned my wish<br />
to my family their helpful advice included the<br />
fact that I could emigrate to Australia if my<br />
junior doctor job in the UK falls through .<br />
For those of you who are still struggling with<br />
the mystery of planning an elective then a<br />
great initial source of information was the<br />
Elective Abstract Recording System (EARS)<br />
database on the KCL medical virtual campus.<br />
It is compiled from data submitted by<br />
previous King’s medical students who have<br />
travelled on their electives across the world.<br />
They discuss what they did on their elective,<br />
where they did it, how it went, what could<br />
have been improved and enter various other<br />
useful comments regarding their electives.<br />
As for me, Sydney was my final destination,<br />
specifically in two hospitals under the<br />
Northern Clinical School: The Royal North<br />
Shore Hospital (RNSH) and Manly Hospital.<br />
I chose two hospitals, one large and central,<br />
and the other more like a small district<br />
general hospital as I wanted to experience<br />
the different ways of practicing medicine and<br />
get a good feel for the Australian health care<br />
system.<br />
Meanwhile, the Northern Clinical School<br />
runs weekly socials for it’s elective students<br />
that were well attended and a lot of fun. It is<br />
also a chance to meet a global variety of other<br />
elective students. At RNSH, I did a month<br />
of Renal Medicine, which was interesting<br />
(to me) but a bit heavy on the paperwork,<br />
although it was useful practise for final year<br />
ward rounds. In Manly, I spent a month in<br />
their Emergency Department (ED; a.k.a.<br />
A&E) that I have to say I preferred. I can<br />
highly recommend doing at least half of<br />
your elective in the ED due to the breadth<br />
of patient that you see and the hands-on<br />
experience that you get. A recent study<br />
found that nearly 1 in 4 emergency doctors<br />
in Australia is British so I would be in good<br />
company if I did decide to emigrate.<br />
On the other the hand, one hilarious lecture I<br />
attended at RNSH described the Lord of the<br />
Rings theory of Oncology Frances et al 2005:<br />
the patient is Frodo with his ‘burden’ of the<br />
ring (cancer), the sexy medical oncologist<br />
is represented by Legolas, while the<br />
surgeon is Aragorn wielding his sword. Of<br />
course Gandalf represents the wise general<br />
practitioner who knows all.<br />
Three possibilities of travel for the cash<br />
strapped student in order of preference<br />
include: The Great Barrier Reef (there’s a<br />
reason it is one of Natural Wonders of the<br />
World), Uluru (a.k.a. Ayres Rock) and then<br />
Melbourne. Also visit Manly beach, it’s<br />
quieter and, in my opinion, more beautiful<br />
than Bondi. You can easily travel there on the<br />
renowned Manly Ferry and you should keep<br />
your eyes peeled for pods of dolphins and the<br />
odd humpback whale.<br />
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CAREERS<br />
And last but definitely not least, enjoy it! Your<br />
final year will be a marathon of work and not<br />
much play. Then you will make the largest<br />
leap of your career into your Foundation<br />
programme where you will no longer get<br />
the lovely long holidays you are used to as a<br />
student so make the most of them.<br />
I can definitely recommend Australia and<br />
Sydney in particular. Although I did overhear<br />
one elective student expressing his opinion<br />
that Australia is like Britain in 1930’s but<br />
with sunshine and funny accents.<br />
Summary of my Elective Tips:<br />
• Do take a camera and a smartphone for back up.<br />
• Keep a brief diary of interesting cases.<br />
• Keep your eyes peeled for possible topics for your<br />
elective poster.<br />
• Use it to explore your career options<br />
• I recommend doing an emergency medicine<br />
placement<br />
• Use the chance to travel<br />
Enjoy it!<br />
‘Stalien Slang<br />
Aussie English<br />
Ambos Paramedics<br />
Ankle biter Small Child<br />
Arvo Afternoon<br />
Average Bad<br />
Bogan Chav/Hoodie<br />
Crook<br />
Sick<br />
Sunnies Sun Glasses<br />
A B C D<br />
Ethical judgement:<br />
The Situational Judgement Test<br />
Sabina Checketts MBBS5<br />
Well, it’s finally done. I have no<br />
idea how it went though! What<br />
I’m talking about (along with<br />
every other final year medical student) is<br />
the current bane of our existence – the<br />
Situational Judgement Test (SJT). Every<br />
final year medical student that applies to<br />
FPAS (Foundation Programme Application<br />
System) has to do this exam. It counts as<br />
50% of your FPAS application mark and has<br />
replaced the previous white space questions.<br />
The SJT seems to have a significant weighting<br />
considering it is an exam that technically you<br />
cannot revise for and that counts for more<br />
than your years at medical school, but in<br />
practice the SJT does not actually count for<br />
quite as much as you think it does. They say<br />
that most people achieve an average score of<br />
38-43 out of 50, meaning that your academic<br />
mark does still differentiate between people.<br />
Structure of the exam<br />
The paper takes 140 minutes and is in two<br />
parts with a total of 70 questions. Thus<br />
you only have two minutes per question,<br />
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CAREERS<br />
CAREERS<br />
therefore being time conscious is essential.<br />
In Part One (Q1-47), you have to rank in order<br />
the five responses to the situation. Marks are<br />
available for near-misses and you should not<br />
use the same rank more than once.<br />
Preparing for the SJT<br />
According to the Medical School and the<br />
FPAS website you cannot revise for the SJT.<br />
This is not true; while you may not be able<br />
to revise for it, you can definitely prepare<br />
yourself. A good starting point is to read the<br />
General Medical Council (GMC) guidance for<br />
doctors, such as the Good Medical Practice<br />
and other documents produced by the GMC.<br />
It is probably worth looking at some practice<br />
questions before you do this as then you will<br />
have a better idea of what you are looking for<br />
in each of the documents.<br />
Another source of information is books<br />
about the SJT. I purchased three different<br />
books: Situational Judgement Test (Oxford<br />
Assess and Progress), Get Ahead: The<br />
Situational Judgement Test and finally<br />
250 SJTs (Situational Judgement Test<br />
questions). Of the three I found the Oxford<br />
Assess and Progress to be the most useful<br />
and accurate regarding explanations for<br />
answers to the questions, while the others<br />
were useful for practicing as many questions<br />
as possible. Other useful sources of SJT<br />
questions included: OnExamination (BMJ<br />
question bank) and Passmedicine (N.B. The<br />
KCL medical students’ society (MSA) may<br />
organize discounts to certain question banks<br />
so watch out for their emails).<br />
Personally, the most helpful source of<br />
questions and the rationale for answering<br />
them was the FPAS website itself, where<br />
there is an interactive mock paper. The<br />
rationale for these questions is the closest<br />
you will find to the real exam, so I highly<br />
recommend doing repeated attempts at this<br />
FPAS mock to monitor how your revision is<br />
progressing. It is worth printing out a mock<br />
answer sheet (available on the FPAS website)<br />
and practising filling it in as the layout is<br />
different from previous exams.<br />
Health warning: At times various sources<br />
and answers do not agree.Do not be alarmed<br />
as even the experts who wrote the questions<br />
did not agree on all the answers, but rather<br />
questions were included on the basis of the<br />
majority of the committee agreeing to an<br />
answer.<br />
On the other hand the main pros of the KCL<br />
mock are that it helps you develop your time<br />
management and broaden your knowledge of<br />
topics.<br />
King’s also runs other talks preparing you for<br />
the SJT and I attended a few but they were all<br />
quite similar as there is only a certain number<br />
of potential topics and a certain lecturer kept<br />
popping up to run the sessions. It is worth<br />
attending at least one of the talks though.<br />
Another question I get asked is, “Are SJT<br />
courses worth doing” I tend to think that<br />
people do revision courses out of fear that they<br />
are missing out if they don’t do them, which<br />
is why companies can get away with charging<br />
so much for them. However I succumbed<br />
to the fear and did an ACE Medicine SJT<br />
course. It was expensive but I do think it was<br />
worthwhile to clarify my thinking on the SJT<br />
and to propel my revision further. It also<br />
provided more useful examples of questions.<br />
However, I would suggest that you find a<br />
friend to accompany you as this often means<br />
the courses are cheaper.<br />
Finally, remember to practise as many<br />
questions as you can get your hands on. Good<br />
Luck!<br />
Photograph courtesy of Charlie Ding<br />
SJT Sample Questions:<br />
Remember you must answer what you should do as a Foundation Year One (FY1)<br />
doctor, not what you would do. Also never assume anything and only answer the<br />
question based on the information provided in that question.<br />
Q1. You are just finishing a busy shift on the Acute Assessment Unit (AAU). Your FY1<br />
colleague who is due to replace you for the evening shift leaves a message with the<br />
nurse in charge that she will be 15 to 30 minutes late. There is only a 30 minute overlap<br />
between your timetables to handover to your colleague. You need to leave on time as<br />
you have a social engagement to attend with your partner.<br />
Rank in order the following actions in response to this situation<br />
(1 = Most appropriate; 5 = Least appropriate).<br />
A. Make a list of the patients under your care on the AAU, detailing their<br />
outstanding issues, leaving this on the doctor’s office notice board when your<br />
shift ends and then leave at the end of your shift<br />
B. Quickly go around each of the patients on the AAU, leaving an entry in the<br />
notes highlighting the major outstanding issues relating to each patient and<br />
then leave at the end of your shift<br />
C. Make a list of patients and outstanding investigations to give to your colleague<br />
as soon as she arrives<br />
D. Ask your registrar if you can leave a list of your patients and their outstanding<br />
issues with him to give to your colleague when she arrives and then leave at<br />
the end of your shift<br />
E. Leave a message for your partner explaining that you will be 30 minutes late<br />
Answer: ECDBA<br />
Rationale: This question asks you to demonstrate your commitment to patient care.<br />
Although it is not appropriate for trainees to stay for an extensive period of time<br />
after their shift ends, or do this in a regular basis, staying an extra 30 minutes on this<br />
occasion is important to ensure an effective handover (E). It is more appropriate to<br />
provide information directly to your colleague to ensure they receive it (C) and your<br />
specialty trainee (registrar) could also be able to ensure that your colleague received<br />
the information (D). Leaving lists of information on the end of a bed is less effective<br />
and leaving a list on the notice board is least effective as your colleague is unlikely to<br />
know it is there(B, A).<br />
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CAREERS<br />
OBITUARIES<br />
In Part Two (Q48-70) you choose THREE from eight possible responses, which<br />
address the situation when done together. You must only select three options. An<br />
example of a Multiple Choice Question:<br />
Q2. You review a patient on the surgical ward who has had an appendicectomy done<br />
earlier on the day. You write a prescription for strong painkillers. The staff nurse<br />
challenges your decision and refuses to give the medication to the patient.<br />
Choose the THREE most appropriate actions to take in this situation<br />
A. Instruct the nurse to give the medication to the patient<br />
B. Discuss with the nurse why she disagrees with the prescription<br />
C. Ask a senior colleague for advice<br />
D. Complete a clinical incident form<br />
E. Cancel the prescription on the nurse’s advice<br />
F. Arrange to speak to the nurse later to discuss your working relationship<br />
G. Write in the medical notes that the nurse has declined to give the medication<br />
H. Review the case again<br />
Question 2 : Answer: BCH<br />
Rationale: Ensuring patient safety is key to this scenario. It is important to discuss<br />
the nurse’s decision with her as there may be something that you have missed when<br />
first reviewing the patient (B). Therefore it would also be important to review the<br />
patient again (H). Also relating to this is the importance of respecting the views of<br />
colleagues and maintaining working relationships, even if there is disagreement. As<br />
there has been a disagreement regarding patient care, it is important to seek advice<br />
from a senior colleague (C).<br />
BILL<br />
SHEERAN<br />
1927 - 2013<br />
William Murray Sheeran,<br />
who was on born<br />
10 July 1927, was<br />
trained in dentistry at Guy’s<br />
Hospital in the late 1940s, was a<br />
passionate advocate and notable<br />
administrator of British boxing.<br />
He believed strongly in the social<br />
value of the sport as a channel for<br />
male aggression in a controlled<br />
environment, which instilled<br />
self-discipline, and engendered a<br />
sense of purpose and direction in<br />
young people from disadvantaged<br />
backgrounds. His attitude was<br />
summed up by his car sticker which boldly<br />
declared ‘Pugilism Not Vandalism’.<br />
Born in Maghera, Northern Ireland, Bill grew<br />
up in Bow, in the East End of London, where<br />
his father, James, was a local doctor. He was<br />
bullied at school, so James taught him to box<br />
and took him to boxing tournaments locally,<br />
at The Ring, Blackfriars and at Shoreditch<br />
Town Hall. This triggered a lifelong interest<br />
in the sport. He later boxed for Epsom<br />
College and became Captain of the Guy’s<br />
Hospital Boxing Club, where he was trained<br />
by Matt Wells, a former World Welterweight<br />
champion. Bill joked that the Guy’s Hospital<br />
motto ‘Dare Quam Accipere’ (‘It’s better to<br />
give than to receive’) was an appropriate one<br />
for their boxers. While at Guy’s, Bill boxed<br />
Charlie Kray, elder brother of the gangster<br />
Kray twins, Ronnie and Reggie. Walter<br />
Bartleman, boxing correspondent of The<br />
Star, and later The Evening Standard, told<br />
Bill before the bout, ‘He’ll eat you’, but Bill<br />
won the fight, with his opponent unable to<br />
continue.<br />
After completing his studies, Bill married<br />
a Guy’s nurse, Anne Mulligan, in 1951. He<br />
established a thriving dental practice in<br />
South Norwood, London, and eventually<br />
settled in Chislehurst, Kent, raising eight<br />
children (his three daughters all later training<br />
at Guy’s). Bill’s interest in boxing continued.<br />
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OBITUARIES<br />
After Guy’s, he boxed for the Lynn Athletic<br />
Amateur Boxing Club in London, becoming<br />
the club’s Secretary and later its Patron. He<br />
was trained at the Lynn by Frank Duffett,<br />
who also helped train professional boxers at<br />
the mecca of British boxing - the Thomas à<br />
Beckett gym in the Old Kent Road. Though<br />
he failed to progress as a boxer, Bill soon<br />
became immersed in the London boxing<br />
world and in the early 1960s was appointed<br />
an administrative steward of The British<br />
Boxing Board of Control. He got on well<br />
with promoters, managers, trainers, boxers<br />
and sports journalists alike, and was much<br />
respected for his fairness and integrity.<br />
He was the official in charge of numerous<br />
famous nights of British boxing from the<br />
1960s to the 1980s, and was on good terms<br />
with Muhammad Ali, Henry Cooper, Barry<br />
McGuigan and many other champions. He<br />
was appointed Chairman of the Southern<br />
Area Council of the Board and made an<br />
Honorary Steward on his retirement.<br />
Bill Sheeran’s interest in boxing also<br />
included the history and artistic heritage of<br />
the sport from the late 18th century to the<br />
Second World War. He formed a modest<br />
but important collection, assisted by his<br />
wife Anne, which they sourced from auction<br />
houses, specialist dealers and private<br />
collectors. This included paintings, drawings,<br />
prints, sculpture, ceramics and silver.<br />
Characteristically generous, Bill later gave<br />
much of his collection away to friends. He<br />
returned the 1948 World Light Heavyweight<br />
Championship belt and trophy won by<br />
Freddie Mills to the boxer’s widow, Chrissie.<br />
The National Portrait Gallery borrowed and<br />
later purchased from him a magnificent<br />
Rembrandtesque portrait showing the<br />
British World Light Heavyweight champion,<br />
Len Harvey painted by Thomas Burke circa<br />
1938.<br />
In 1983, Bill Sheeran and his wife Anne<br />
retired to her childhood home – a farmhouse<br />
in the hills of North Wexford, Ireland. Here<br />
Bill’s passion for gardening, and his instinct<br />
for design and colour, found a superb outlet<br />
for more than 30 years. Bill and Anne raised<br />
funds to start a boxing club in their local<br />
town, Gorey. They called upon many friends<br />
in the British and Irish sporting scene to<br />
help out, notably the Olympic gold medallist<br />
Dame Mary Peters, who became a longterm<br />
supporter and visitor. For more than<br />
20 years, Bill helped to train young boxers<br />
and organised tournaments and tours. He<br />
was also elected President of Gorey Boxing<br />
Club, which soon became one of the leading<br />
amateur boxing clubs in Ireland, producing<br />
several national champions. It also became<br />
an important focal point for the community<br />
and a source of much local pride.<br />
In his later years, Bill Sheeran suffered<br />
from Alzheimer’s, sadly missing out on the<br />
progress of his 23 grandchildren and four<br />
great-grandchildren. He would, no doubt,<br />
have been proud that in October 2013 one<br />
of his grandsons, the singer-songwriter Ed<br />
Sheeran, performed three sold out shows<br />
at the world’s most famous boxing venue,<br />
Madison Square Garden, New York.<br />
Bill died on 7 December 2013, aged 86. At his<br />
funeral, Gorey Boxing Club formed a guard<br />
of honour and gave its own tribute: ‘In Bill<br />
Sheeran we have lost a mentor, inspiration<br />
and a role model whose generosity and<br />
kindness have helped thousands of young<br />
men and women in the wider Gorey area.’<br />
Two boxing gloves from the club were placed<br />
in Bill’s coffin.<br />
Obituary by John Sheeran.<br />
KCL - Cambridge<br />
Laurence Clarke Politics 3 rd Year<br />
In the first week of December 2013, KCL<br />
Boxing Club went toe-to-toe with a fit and<br />
talented squad from Cambridge University,<br />
in an 8-bout ‘Fight Night’.<br />
The event took place at one of KCL’s regular<br />
training spots; the Black Prince Community<br />
hub. The hosts came out decidedly on top,<br />
with a final result of six bouts to two. Of the<br />
six wins for KCL, four came by unanimous<br />
decisions, one a majority decision and one by<br />
technical knockout. On the night, both male<br />
and female fighters put on an impressive display<br />
of technique, fitness and aggression.<br />
The KCL squad consisted of Marguerite Gallagher,<br />
Natalie Cass, Nicholas Robin, Inti<br />
Raymi, Nick Higgins, Michael Strawpert,<br />
Izaak Leo and Rob Prince.<br />
Fight Night<br />
The following Tuesday, Club Captain, Rob<br />
Prince, gave his verdict on what he described<br />
as a brilliant night for the club:<br />
“All our boxers have made massive progress<br />
since our last show, and on Friday everyone<br />
boxed at their very best - we’re very proud of<br />
what we’ve achieved. We had a mix of fights<br />
on the night: we had women’s bouts, first<br />
outings, and some more experienced bouts<br />
too – everyone put on a great show.”<br />
“We’ve got a lot of people to thank – our<br />
coaches (especially our head coach, Lee Steggles),<br />
everyone who came down to support<br />
on the night, Cambridge University Boxing<br />
Club, and everyone else who was involved in<br />
putting on the show. Freddie Ellery and Rob<br />
Smith, our social secretaries, deserve a special<br />
mention too.”<br />
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SPORTS<br />
The club hopes to be working closely alongside<br />
Cambridge University in the New Year,<br />
assisting them in preparation for their upcoming<br />
fight against Oxford.<br />
All fighters will be enthusiastic to get back<br />
after the Christmas period and continue<br />
training, and the club is looking to carry the<br />
momentum of this big win in to <strong>2014</strong>. The<br />
more experienced boxers at the club will be<br />
training for the upcoming BUCS tournament<br />
on 8th <strong>Feb</strong>ruary in Coventry, where KCL expect<br />
to be fielding at least 4 boxers. Competing<br />
in BUCS is a big milestone for the club,<br />
which has gone from strength to strength in<br />
recent years.<br />
In addition, <strong>Jan</strong>uary will provide the opportunity<br />
for a fresh intake of new members<br />
of the club, with ‘refreshers’ events being<br />
planned. King’s College London Boxing Club<br />
welcomes and encourages students of all<br />
abilities to come down to the flexible training<br />
sessions, where top-quality coaches offer<br />
a whole range of skills, from ‘the basics’ to<br />
advanced sparring and competitive fighting.<br />
The club trains on Wednesday, Friday and<br />
Sunday afternoons at various locations in<br />
south London. All details can be found on the<br />
KCLABC Facebook page.<br />
Photographs courtesy of Charlie Ding<br />
BDSA Sports Day - Cardiff ‘13<br />
Ushma Patel & Jigar Mehta BDS2<br />
After a long three-month wait, we<br />
were finally heading to Wales for a<br />
weekend of unforgettable merriment<br />
with our fellow ‘Mental Dentals’. Having<br />
never been to a BDSA event before, we didn’t<br />
really know what was in store for us until we<br />
set foot on the coach. The mood was on a high<br />
right from the start, with excitement building<br />
up every mile of the journey. As soon as we hit<br />
Cardiff, geared up in our raunchy red t-shirts,<br />
we made our way to Oceana nightclub to find<br />
ourselves mixing with dental students from<br />
all over the country. Cheap drinks and good<br />
music ensured that everyone had a wild one.<br />
The following morning at 9am, we all awoke<br />
for the sports fixtures with crazy migraines<br />
(the music was far too loud...), but eagerly<br />
made our way to the fields to compete with<br />
twelve other dental schools. Our players<br />
did exceptionally well - most notably the<br />
<strong>GKT</strong> netball team who destroyed all the<br />
competition and easily defeated the Cardiff<br />
team 10-2 in the final! The team was led by<br />
the unbeatable attacking trio of Steve Conteh,<br />
Charlotte Molyneaux and Lucy Clements.<br />
The hockey team, led by Bhavesh Patel, also<br />
played extremely well coming in third place.<br />
That evening, looking stunning dressed as<br />
Vikings, we made our way to Flux, Cardiff’s<br />
infamous SU (which frankly made Guy’s bar<br />
look like a closet). Dental students from all<br />
over the country were dressed to impress in<br />
76 <strong>GKT</strong> <strong>Gazette</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong> <strong>GKT</strong> <strong>Gazette</strong> 77
SPORTS<br />
The <strong>Gazette</strong> Team<br />
their fancy dress costumes and it was another<br />
unforgettable evening of social insanity.<br />
On Sunday morning, after barely any sleep,<br />
we stumbled out of bed to get on the coach<br />
back to London - our weekend had sadly<br />
come to an end. The organisers of the trip,<br />
Olivia Johnson King and Kaly Gengeswaran,<br />
were determined to make this weekend one<br />
to remember, and their efforts were greatly<br />
appreciated.<br />
Lewis Moore<br />
Deputy Editor<br />
News Editor<br />
Kate Anstee<br />
Deputy Editor<br />
Treasurer<br />
Joshua Getty<br />
Deputy Editor<br />
History Editor<br />
Anya Suppermpool<br />
Layout Editor<br />
Katie Allan<br />
News Editor<br />
Zoya Arain<br />
Features Editor<br />
Sabina Checketts<br />
Arts & Culture Editor<br />
Ajay Shah<br />
Research Editor<br />
Previous page: Hockey team<br />
Left: Netball in action<br />
Below: The team<br />
Photographs courtesy of Sadhvik Vijay<br />
Megan Clark<br />
Dental Editor<br />
Matilda Esan<br />
Careers Editor<br />
Sam Evbuomwan<br />
Book Reviews Editor<br />
Georgie Day<br />
Nursing & Midwifery<br />
Editor<br />
Tom Fenner<br />
Sports Editor<br />
Hannah Asante<br />
Advertising Officer<br />
Nayaab Abdul Kader<br />
Merchandise Officer<br />
Charlie Ding<br />
Photography<br />
Lucy <strong>Web</strong>b<br />
Staff Writer<br />
Sarah Cleary<br />
Staff Writer<br />
Fi Kirkham<br />
Staff Writer<br />
Rolake Segun-Ojo<br />
Staff Writer<br />
With Special Thanks To<br />
78<br />
<strong>GKT</strong> <strong>Gazette</strong> <strong>Jan</strong> - <strong>Feb</strong> <strong>2014</strong><br />
Max Coupe-King - Contributing Writer<br />
Katherine Leung - Contributing Writer<br />
Tristan Dennis - Contributing Writer<br />
Dylan Padmakumar - Contributing Writer<br />
Lucy Clements - Contributing Writer<br />
Ryan Passey - Contributing Writer<br />
Becky Taylor - Contributing Writer<br />
Jade Chow - Contributing Writer<br />
John Patterson - Contributing Writer<br />
Laurence Clarke - Contributing Writer<br />
Ushma Patel - Contributing Writer<br />
Jigar Mehta - Contributing Writer<br />
Ellen Wood - Artist<br />
Sam Alsford - Layout<br />
Rebecca Trenear - Layout<br />
Professor Stephen Challacombe - Trustee<br />
Margaret Whatley - Administrative Support<br />
William Edwards - For Assistance and Guidance<br />
King’s College London and our other donors for their<br />
generous support
The Guy’s, King’s<br />
College & St Thomas’<br />
Hospitals <strong>Gazette</strong><br />
Volume: 128<br />
Issue: 1<br />
Number: 2581<br />
ISSN 0017-5870