Jan
04

The start of a new year and the loss of a best friend…

Big Ben

I have always been puzzled by the custom for New Year’s celebration. Christmas I get, but why New Year? New year’s eve does, of course, mark the end of the calendar year and new year’s day the start of the next, but this of course only relates to the Gregorian calendar derived from Roman times; our Medical Students come from over 20 different countries and many of you will be far more aware than I that Chinese, Iranian, Punjabi and Gujarati (to name a few) new year days fall at different times throughout the year.  Interestingly, our own new year’s day has moved throughout the ages; up until 1751 we started the new year on Lady Day – the 25th March – but for some reason thereafter we followed the Scots and moved to 1st January. Equally puzzling is the national diversity in how new year is celebrated from the Hogmanay “first footing” in Scotland, eating grapes to chiming bells in Spain and central America, carrying Spruce trees in Serbia or simply watching Big Ben strike the magic hour. Of course a common theme is traditional foods, alcohol and family and friends, all of which frequently culminates in a somewhat jaded start to the new year on awakening on January 1st.

My own new year was saddened by the loss of our golden retriever “Caffrey”, unashamedly named after the Irish beer. It was George Graham in 1870 who said that “the one absolutely unselfish friend that a man can have in this selfish world, the one that never deserts him and the one that never proves ungrateful or treacherous is his dog.” To lose “man’s best friend” is indeed upsetting – those of you with pets will know how they effectively become a family member and I suspect many of you will have experienced similar losses.

Dog at the VetThe contrast between veterinary and human Medicine however was interesting and caused me to reflect on what we have learnt and perhaps what we might learn from our sick pets.  I remember as a junior doctor in Edinburgh presenting a Christmas Grand Round detailing how a Professor of Medicine diagnosed his dog with Addison’s disease and a Cardiologist his dog with digitalis poisoning caused by foxglove ingestion. As an Endocrinologist my phone occasionally rings with queries from vets all over the UK about weird and wonderful hormonal diagnoses in animals such as Cushing’s syndrome in horses, crazy thyrotoxic cats where carbimazole is needed in huge doses, and acromegalic cats who are extremely insulin resistant. Inter-breeding has in effect made consanguinity the norm and whilst this places most kennel club breeds at risk from autosomal recessive traits such as epilepsy, joint dysplasias and arthritis and cancers, it has yielded immensely useful genetic data that has led to the identification of new pathways in cancer biology, neuronal signalling and joint pathologies. 

But perhaps the greatest thing to learn from our veterinary colleagues is their compassion and their ability to optimally manage of an end of life crisis. Caffrey was 13 years of age and disabled with arthritis; he developed what I suspect was a fairly major acute abdominal event over the new year period with vomiting, abdominal pain, guarding and rigidity. Preventing ongoing suffering was the priority and the ability of the vet to end this immediately with an ultimately lethal injection of sodium pentobarbitone was a huge relief.  In your careers you will be faced with difficult decisions and dilemmas around managing terminally ill patients, ensuring you do what is best for the patient whilst complying with the law, bearing in mind physician assisted euthanasia is outlawed in the UK. Undoubtedly, there will be situations where you and the patient will have a great deal of sympathy with the compassion afforded to managing our domestic pets in similar situations.

Sorry to start 2012 on a somewhat sombre note … but I am sure the year will bring health and happiness to many of you. Whatever your own particular cultural background/ nationality I warmly welcome you back to the Medical School and wish you all a very successful new year!

PM Stewart

Nov
08

7 billion and counting ……. and its impact on your future medical practice

Newborn Danica CamachoIt is two minutes before midnight on Sunday 30th October in the Jose Fabella Memorial hospital in Manila, Philippines. In the maternity unit Danica – a 2.5kg girl – is born prematurely to parents Camille Galura and Florante Camacho. Nothing unusual in itself but hugely symbolic in that the United Nations officially classified Danica as the world’s 7th billion person. For those of us who aren’t Roman Abramovitch or Bernie Ecclestone, 7 billion is a hard number to conceptualise.  Numerically as written it is 7,000,000,000 – twice the number of base pairs in the human genome and 1400 times the number of people living in the West Midlands.

An interesting exercise is to go to the BBC website http://www.bbc.co.uk/news/world-15391515 and discover your “global number” – I was the 2,983,981,641st person to enter the world.  But frightening to think that in the time I have been on the planet the world’s population has more than doubled.  And of course I can claim some personal responsibility, adding to the total with our 2 children! Population growth is not static and will continue to escalate with a projected 8 billion by 2025 and 10 billion by 2080. In the time it will take me to write this blog World Population Increasethe world’s population will have increased by a further 100 people. Population growth is most rapid across Africa and India but it is not just population growth to blame – in virtually every country people are living longer. When I was born life expectancy was 71 years in the UK, now it is 81 years. For India in the same timeframe life expectancy has risen from 42 to 65 years of age.

(http://www.google.co.uk/publicdata/overview?ds=d5bncppjof8f9&ctype=l&strail=false&bcs=d&nselm=h&hl=en&dl=en). 

Scary statistics that will impact on your lives for sure. To feed an additional two billion people food production will need to increase by 70% and it is predicted that we will reach a point where we outgrow global food and water supplies. In recent years more people have died globally from the consequences of over nutrition (obesity) than malnutrition but this is likely to reverse. Poverty is likely to increase and with it the return of major public health issues such as infection.

So what can we do? Although highly effective it is hard to endorse the Chinese “one child only” rule that is strictly enforced, but can we afford to stand by and watch what is happening particularly in Africa and India?

Crowded street in India

I visited Africa last year and was taken aback by the view – often from the well educated – that having many children often from different partners was a crucial “human right” of the African person.  In India too, cultural and religious beliefs are strong as they are in Central and South America – the Vatican’s response to the birth of Danica was to conclude that “the challenge posed to the world by the birth of its 7 billionth inhabitant isn’t how to stop population growth, but to find ways to ensure the continued growth can benefit all humanity.” Medicine of course provides us with the technology to halt population growth. Whatever one’s beliefs, the facts are that contraception works and an estimated 215 million women worldwide who desire contraception have no access to it (Babatunde Osotimehin, head of the U.N. Population Fund).

AgeingSome things might be just too difficult to change, but research based in Birmingham might improve the outcome for our ageing population. As outlined above, life expectancy is rising – 20% of our population in the UK is over 60 years of age. The important issue however is not living longer per se (which few of us relish) but ensuring a healthy life expectancy. It is addressing healthy lifespan that forms the focus of the new Arthritis Research UK and Medical Research Council Musculoskeletal Ageing Centre lead by Professor Janet Lord in Birmingham. This was awarded to Birmingham last month in the face of stiff competition and will help to improve our understanding of changes in body composition with age (obesity, sarcopenia, osteoporosis), cognitive decline and an ageing immune system and DNA make-up, that collectively contribute to the “ageing phenotype”. 

 http://www.birmingham.ac.uk/research/heroes/staff/janet-lord.aspx.

 Janet’s team comprises clinical and non clinical staff from the College of Medical and Dental Sciences, Psychology and Sports Exercise Science in Birmingham in collaboration with a group based at the University of Nottingham. The hub of the centre will be in the laboratories based in the first floor of the new Queen Elizabeth Hospital.

So the “7 billion milestone” is an opportune time to reflect on how this might impact on your own careers in whatever discipline of Medicine you chose to follow.

PM Stewart

November 2011

Oct
19

Plagiarism … more than just being a “copy cat”. Take this seriously!

I have been meaning to blog about this topic for sometime but it came to a head a few months ago when an associate of mine Professor Philip Baker resigned as Dean of Medicine at the University of Alberta in Canada. Professor Baker was a recent appointment having moved to Canada from the University of Manchester in the UK.

So why did he resign? Quite simple … plagiarism. In giving one of his first graduation speeches Professor Baker delivered a truly motivational piece giving personal examples of how medical science had helped some of his immediate family members. Inspiring stuff but the complicating factor was that parts of the speech were lifted from a talk delivered by a surgeon, Professor Atul Gawande, from Stanford University in 2010. Professor Gawande is a regular contributor to the New Yorker (http://www.newyorker.com/magazine/bios/atul_gawande/search?contributorName=atul%20gawande). The discovery appears to have been made by the students themselves and the ensuing uproar  culminated in Professor Baker resigning on the grounds that it would be “difficult for him to maintain his moral integrity” http://www.cbc.ca/news/canada/edmonton/story/2011/06/17/edmonton-dean-medicine-resigns.html.  (You can read the blogs themselves to appreciate some of the strength of feeling on the issue). It is important to reiterate that there is no suggestion whatsoever than Professor Baker plagiarised any of his 200 or so research publications.

So what is plagiarism and why the fuss? After all if the speech inspired students in Canada as well as Stanford is that a bad thing? Well of course it is …  plagiarism is far more than just “copying” or “borrowing” someone else’s piece of work but goes to the very heart of academic principle, that is the ownership of original ideas/ thoughts through one’s own innovation. Wind the clock back a few years and imagine yourself being Steve Jobs inventing the iPad. He was able to protect his innovation through filing intellectual property rights on his invention, to effectively prevent a third party from stealing his idea. Why should a novel piece of written text, or an inspiring communication be any different? Without knowing all the details in this particular case, to steal ideas from another source and fail to recognise the source itself is an act of fraud termed plagiarism. Other specific examples detailed in websites such as http://www.plagiarism.org include:

  • turning in someone else’s work as your own
  • copying words or ideas from someone else without giving credit
  • failing to put a quotation in quotation marks
  • giving incorrect information about the source of a quotation
  • changing words but copying the sentence structure of a source without giving credit
  • copying so many words or ideas from a source that it makes up the majority of your work, whether you give credit or not

You can easily see how this is a common occurrence, particularly with the diverse array of learning material available over the internet. At times of pressure it is all too easy to “cut and paste”, often without considering the consequences. Indeed even in resourcing this blog I have had to make sure I am not a guilty party. The crucial issue is often citing the source – recognising that the words/ sentences you have used are not your own (as I have done above), but readily volunteering the source, in this case http://www.plagiarism.org, thereby giving due credit to others.

Quite rightly you will find that many organisations including this University take the issue of plagiarism very seriously. In another role serving on editorial boards of Endocrinology journals, papers are routinely screened using plagiarism software (just as we do with all your written work) to worm out investigators who have merely copied other studies. Of course there needs to be leeway – there are only a few possible ways, for example, of describing a RT-PCR reaction – the real issue here being whether so called “original material” is indeed truly original or someone else’s discovery.

The University of Birmingham has recently issued a new Code of Practice on plagiarism: http://www.birmingham.ac.uk/Documents/university/legal/plagiarism.pdf   (interestingly directed only at the student population and not its staff – an omission that, with Professor Baker in mind, I am trying to correct!).  This Code of Practice recognises that sometimes it is hard to understand how to cite sources when you start out, but is not so lenient to repeat offenders or those who fabricate data.  The General Medical Council also highlights this as an important aspect of your code of conduct both as an undergraduate (http://www.gmc-uk.org/education/undergraduate/professional_behaviour.asp) and as a practising doctor. It is clearly prepared to enforce its statutory remit, notably suspending a high profile psychiatrist and media expert, Dr Raj Persaud in 2008 for “passing off other researcher’s work as his own”.

Copying material from another source without crediting it amounts to stealing in the eyes of many. Please read the guidance documents above – they are very useful for new and mature learners alike. The lesson is simple – don’t do it! Be aware of your own learning strategies and avoid plagiarism at all costs, however easy it may be to fall into the same trap as Professor Baker…

PM Stewart

Sep
19

A new intake, a new foyer ….. welcome back to the Medical School

A warm welcome to the 408 of you who form the 2011 intake to the Medical School at The University of Birmingham, and congratulations to the rest of you for passing your exams and returning to the pack! I hope the 2011-2012 year is another successful one for you all.

For the Freshers amongst you this will probably be your first Dean’s blog, but all the earlier blogs are posted on WebCT and others will appear during the year. It is just one important mode of communication between my office and the Medical School and the Students and I hope you continue find the content useful and of interest. 

With new fee structures looming, the University is committed to enhancing the Student experience by improving its infrastructure. In accessing the Medical School building via the main entrance you will have noticed the rather spectacular transformation of the Medical School Foyer. Overseen by Steve Johnson (Operations Manager for Estates and Infrastructure) and his team, this was achieved in 10 weeks and hit the target date for completion in time for the University Open Day last week and the start of Welcome Week. This impressive refurbishment is phase one of a two phase programme of works to modernise the Foyer and Ground Floor of the Barnes Library at a cost of £2M. In addition to the new reception area there is a dedicated student services information desk that will serve a single point of access for all your queries.  The Information Officer, Teresa Lynch, will not know the answer to every question off the top of her head, but she is committed to answering where she can and finding out or directing you to someone who knows the answer when she doesn’t. 

Phase two is scheduled to open in January 2012. The Barnes library entrance will relocate back to the ground floor with a new Library services desk and short loan facility. In addition there will be dedicated office accommodation  for our outstanding Student Welfare support team led by Professor Kate Thomas, with 5 interview rooms to be used by welfare tutors, careers advisers, the International Student Advisory Service and a range of other staff when meeting with students one to one. In collaboration with Learning Spaces there will also be circa 90 seats in a combination of open shared desk space and study booths with WiFi connectivity, a limited number of static PCs and numerous TV/PC monitors advertising Medical School lectures and activities. Personally I think the new Foyer is terrific and set alongside the Wolfson Education Centre provides an unrivalled environment for your Medical Student experience.

Our principal remit is to train you to be an outstanding doctor whilst encouraging you to participate in the many activities that University life brings. There are however a few new changes for 2011. Building on your outstanding Science achievements at School/ College, I am particularly keen that you continue to hear about scientific breakthroughs in Medicine from our own staff – many of whom have International reputations in their own disciplines from Cancer to Immunology to Endocrinology to Cardiovascular disease and Community based/ Public Health Medicine. The new “Birmingham Does …” series of interactive lectures/ discussions will expose you the latest advances in Medical research from Birmingham and highlight how these impact upon disease pathogenesis and patient treatment/ outcome. Diabetes/ Obesity, Infection, Liver disease and Cancer genetics will be the first areas to be presented.

Another change relates to Anatomy. Acting on a thorough review Chaired by my predecessor Professor Ian Booth, a series of changes have been made to Anatomy teaching across all years of the curriculum that will increase the exposure time and quality of this crucially important specialty.

Finally, we continue to evolve and improve based on your feedback. In my view, bearing in mind the numbers and complexities involved, the School office does a brilliant job in co-ordinating your timetables, clinical placements, exams, results and of course oversight of support and wellbeing. However, with tweaking of some of the administrative structures we feel we can do even better to meet the demands of you all as our “customers”.

So I hope you like the new look to the Medical School and benefit from some of the new changes we have made for 2011-2012.

Paul M Stewart

Dean of Medicine

Sep
09

Professionalism, privacy and your social networks

Welcome to the latest edition of the Dean’s blog. I am the Dean of Medicine in Birmingham and I’ve decided in this edition to share with you some of my most embarrassing moments and let you view some of my most humiliating photographs ……  OK, I’d better come clean, I’m not the Dean and it’s more than my job is worth to impersonate him in a public forum, but for this edition Prof. Stewart has kindly handed his blog to me to consider some of the issues involved with online professionalism.   

Twitter, Facebook and other social networks or discussion forums give us an unprecedented opportunity to share our views, behaviour and images with the world and we can all think of occasions where this is really useful.  Large agencies, including the UK government are now using such forums to gather information on public opinion and there are lots of examples of positive change or charitable work coming from such initiatives.  However, I think we can all think of personal examples where social networks have caused harm or embarrassment.  It has recently been reported that an estimated 8% of US companies have fired a member of staff in relation to something posted on a social network.  Now I can fully understand the need after a bad day in the office to get home, pop your lasagne in the microwave and have a moan to your partner, best mate or in my case the cat.  In fact, we know that not being able to do this can be detrimental to our psychological well-being.  The problem arises when we feel the need to share our anger or upset with the world.  In 2009 a paper published in the Journal of the American Medical Association reported that 60% of medical schools who responded to a survey had dealt with issues of students posting unprofessional behaviour online[i].  These related to a range of issues including violations of patient confidentiality, posting of sexually suggestive material and images depicting severe intoxication.   Issues like this typically occur via social networking sites but have also been linked to discussion forums and chat rooms – so if your local football / hockey / book group has a discussion board, use it, benefit from it and enjoy it but consider how your posts may appear to others.

These issues are even more important for those of us in roles where public trust in us is critical.  Imagine the situation where after a rather frustrating day in General Practice a doctor or student posts ‘If I have to see another middle-aged woman convinced that it is my job to sort out her awful life I think I’ll scream’ – hardly something which is going to persuade patients of your compassion, or encourage them to seek you out for care. It may sound far-fetched but such posts happen with frightening frequency.  We all have bad days or indeed frustrations with our employers (or the medical school!) but sharing these in a public domain is a really high risk strategy.   When we think of it in real world terms our online behaviours do seem strange – we would never stand at the bar in the pub talking about named patients, we wouldn’t tell our patients that we got so drunk last night we fell over getting into a taxi …..so why are we so much more lax about our behaviour online?

Some of you may have seen the Daily Mail story in January of this year about the drunken antics of medical students at Imperial – a story which came to light through images and online postings.  The headline ‘Pass the sick bag: The antics of these Imperial College medical students should worry us all’ will not have increased public confidence in the future generation of doctors and I suspect it is highly unlikely the students were praised by their institution!

One of the problems is the sheer numbers of people we seem prepared to invest with ‘friend’ status in the virtual world.  I’m not ashamed to say that I think I can count my real friends on my fingers, but when I recently looked at my 18 year old niece’s facebook page I noted she had over 600 ‘friends’, many of whom I suspect also had 600 friends. So without tight privacy settings we rapidly share our stories with hundreds of people, many of whom we don’t know at all.  Last year one of the intercalating students was somewhat surprised (and I suspect secretly horrified) when I complimented them on their recent fancy dress costume – unbeknown to us both we shared a mutual friend who had posted the images, which thankfully were all perfectly decent.  So next time you allow someone to take photos of you on a night out – beware – what might be a funny picture now may well come back to haunt you when you become the Chief Medical Officer or medical advisor to our 2020 Olympic team!  Privacy settings also do protect you from social network ‘stalking’ and we have already experienced cases of students being ‘stalked’ online by patients they have met in clinical placements – so consider your current ‘friendbase’, new friends and all of your privacy settings to protect yourself now and in the future.

The other issue which I think seems to be increasing is that of impersonation online.  Again I think most of us who can think of examples of posts which were placed by someone other than the account holder.  Mostly these are harmless – my sister’s boyfriend regularly uses her account to post stories of what a wonderful and good-looking guy he is – but it is all too easy for your reputation to be harmed by someone else using your account.  I suspect the reason this is happening more and more is because so many of us now have social networks streamed continuously to our mobile phones and these are not always protected with the same care as our laptops and other devices.  Leaving your mobile on the table while you nip to the toilet on a night out may be asking for trouble, in the same way as leaving your email open in your room when friends come to visit.  An email sent from a friends account after a few drinks may seem like the funniest prank, but is often less humorous in the cold light of day!

Social media therefore presents two main risks. Firstly it blurs the boundary between public and professional engagement  – to never have frustration with your job or studies would make you less than human, but sharing this publically is unprofessional.  Secondly your reputation and image may be compromised by posts you place or those placed when your identity is stolen, and this does have an impact on the way the public trust and engage with members of your profession. This has to be balanced with the real benefits social media bring to the profession. This year I attended a couple of academic conferences which had their own facebook sites and one even offered a prize for the best ‘tweet’ during the conference sessions – lots of interesting observations were generated which would not have come to light in the time restricted question session after each presentation.    I think it is important for doctors to live ‘normal lives’ (if such a thing exists) and there are definite personal and professional benefits from online engagement.   I also understand the concerns of medical students that they are constantly being judged[ii] and it is inevitable that to some extent professional policing, which is essential, gives this impression.  I don’t think we need to be alarmed and I don’t think we all need to abandon social media but I do think we need to reflect on whether we operate the same levels of professional behaviour in the virtual world as we have been doing for centuries in the real one.

The BMA are aware of the many practical and ethical issues social media present to doctors and have this year produced their own guidance for doctors and students and I do encourage you all to review it http://www.bma.org.uk/images/socialmediaguidancemay2011_tcm41-206859.pdf. In the meantime I thank you for reading this and I’m now going to go and have a good old moan to the cat about the fact that the Dean was on holiday whilst I was stuck writing his blog ……..

Best wishes to you all

Dr Lesley Roberts (Year 1 Welfare Tutor and BMedSc Population Sciences and Humanities Intercalation Lead)


[i] Chretien KC, Greyson SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students. JAMA 2009, 23:302(12):1309-15

[ii] Finn G, Garner J, Sawdon M. ‘You’re judged all the time!’ Students’ views on professionalism: a multicentre study. Medical Education 2010, 44:814-825

Post-script from the Dean …..

I do hope you all take notice of these words of wisdom from Lesley. Like so many facets of being a Medical Student it is really a question of pausing to think about the consequences of your actions.

Sadly this Dean has no Facebook friends, no cat to moan to and is so sad he spends his evenings on vacation reading Lesley’s words of wisdom!

Thanks Lesley!

Jun
07

Fitness to Practise

 When talking to students I get one of three reactions: sheer terror that we (”The Medical School” spoken as if with capital letters) are lying in wait to catch people out and get rid of them from the course; “it’s not fair” we should be able to lead our lives like any other students or laughter – “I don’t think I’ve breathed in and out right – that’ll be fitness to practise then”.

I don’t think that many students have a problem with understanding why Fitness to Practise (FTP) is required.  If you look at the GMC’s very helpful document: Medical Students: professional values and fitness to practise (http://www.gmc-uk.org/static/documents/content/GMC_Medical_Students.pdf), it is easy to see that someone who is involved with child pornography or who is dishonest is not suitable to be entrusted with the responsibility of being a doctor.  Or that someone who has a health problem that an independent Occupational Health Physician says prevents him/her working safely in a clinical environment cannot therefore complete their training.  However, I think that sometimes what students do struggle with is the feeling that their every move is watched and that from the age of 18 they aren’t able to be like other students.  To a certain extent this is true and we have a lot of sympathy for the fact that you have to ‘grow up’ fast.  You certainly aren’t the only students to feel like this – research shows that many others do too 1.

Students in the later years of the programme tend to say that FTP isn’t actually something they need to think about very often – they manage to have a lot of fun without getting into fights, they turn up to their placements as expected, or keep the Medical School informed if they can’t (repeated, unexplained, very poor attendance is one of the most common reasons for getting to an FTP hearing – what the University calls lack of Reasonable Diligence) and they are honest.  Perhaps the trickiest area for some is avoiding getting so drunk that their judgement becomes impaired and without realising it they take risks or get into situations that when sober they would know to avoid.

In the last nine months The Dean, Sue Grant and I have done a lot of work at revising our FTP procedures, working with the GMC, the University and its legal services department.  Our intention is to make the procedures clearer and quicker.  At the start of the next academic year for each cohort we will be talking to you about the process and answering questions, but in this blog will introduce you to the ideas behind the changes.

The first thing to say is that up to now the University has required that any disciplinary matter involving a student on an full time professional course (Dentistry, Education, Medicine, Nursing, Physiotherapy, Social Work) has been dealt with as FTP.  In future if a student gets to a hearing it will be the job of the panel to decide whether the issue is either misconduct or FTP.  A way of thinking about this is to consider some possible incidents in the Guild.  If a student gets drunk and boisterous and pulls a door off its hinges that’s misconduct as this doesn’t bring into question the student’s fitness to practise.  If, for example, a student assaults another student by shoving a glass in his face following a perceived insult, that does bring into question the student’s fitness to practise as his response when angry is disproportionate and violent.

Secondly, in order to be sure that cases are not delayed when key staff are on leave a second Investigating Officer (IO) has been appointed.  The IO is the person who sees a student after it has been determined that the matter is disciplinary (see below).  Professor Janesh Gupta, who is Senior Tutor for Professional Behaviour, and Dr John Winer, who is Head of NHS Liaison, are the Investigating  Officers.

The third major change is that we have established a Professional Support Unit (PSU) for students.  This makes more formal a resource that the Year Tutors have used for a long time.  It builds on work that the Interactive Studies Unit (ISU), who are responsible for teaching you clinical communication skills, does with the West Midlands Postgraduate Deanery Doctors in Difficulty scheme.  The Unit is led by Professor John Skelton, and he and his team see doctors who run into problems during their career: ones who cannot pass exams (although their knowledge and skills are such that they should pass); or who get a lot of complaints; or who have difficulty working with colleagues.  The idea of the PSU is that we will be able to get help for students who seem to be running into trouble so that we can help with things like being terrified of taking OSCEs, or being so shy they cannot talk to patients, or where there seems to be a pattern of unprofessional behaviour developing.  Any of us can make a mistake, but what we are looking for are people who don’t seem to learn from that mistake and keep repeating the behaviour.  Our aim, through the PSU, is to help people understand why their behaviour gives cause for concern and learn to change it.  This, we hope, will prevent the issue ending up at FTP and, equally importantly, will mean that these people don’t end up in trouble at work.  The Unit is genuinely supportive and we estimate that 50 medical students will be referred each year – so if you ever do get referred don’t assume it’s because you are heading to FTP – it rarely will be, and take up the offer as people almost always benefit from it.

So, when we talk about FTP what do we mean?  Really we are talking about when a student gets to a hearing – this is very rare (in reality affecting 0.02% of the cohort in the last 5 years).  We know that teaching and administrative staff in the Medical School and the NHS sometimes misuse the term FTP for any minor indiscretion e.g. being late.  It is an unprofessional behaviour to be late for teaching, but alone it is certainly not an FTP matter.  We also know that a small number of staff use FTP as a threat and we will now work with staff to explain to them how unhelpful this is.  Educating everyone from staff to students, to understand exactly what we mean by FTP – and what we don’t will be a priority.  To get as far as a hearing a problem has to be very serious and there are a lot of steps before a student gets that far.  Unless it concerns a very serious matter, e.g. dealing drugs, no one can say whether something is a Fitness to Practise matter or not until they have investigated it.

Most problems come to the Medical Schools’ attention through a Concern Form or a report of an issue.  Plagiarism, for example, is dealt with by staff involved with the relevant module and is only referred on if it is clear that the student intended to be dishonest.  Once the Student Development and Support Office receives notification of a concern the student is asked to see their Year Tutor to explain what happened from their side of the story.  Some things are clearly not serious and the matter rests there.  Sometimes it is not clear whether a matter should be pursued or not – often this is when a student has had several concerns reported and a pattern of unprofessional behaviour seems to be forming.  Some things are so serious that a referral to the Investigating Officer is needed, e.g. forging a Consultant’s signature on a logbook or cheating in an exam.  Whichever of these it is the Year Tutor who will discuss the case at a meeting of the Student Welfare and Development Advisory Group (SWADAG), which consists of the Year Tutors, myself, the Investigating Officers, Professor Skelton and relevant administrative staff.  This means that no one person makes a decision without a discussion with senior colleagues.  This group of people, by virtue of their interest in student welfare, can be thought of as “pro-student”, and generally we will look to find a way to help students improve their behaviour.  However, there are times that the student’s behaviour is such that a referral to the Investigating Officer is needed.

If a concern about a student is serious or of a nature to be investigated further this is what happens:

  • The student will be informed in writing of the detail of the concern and invited to attend a meeting with the Investigating Officer.  This letter is very formal and marks the fact that it is not something to be taken lightly.
  • S/he will be invited to provide a written response to the detail of the concern.  The student will also be invited to bring a friend to the meeting.  [In University “speak” a “friend” must either be a student or member of staff of the University].
  •  The student (and his/her friend) will meet with the Investigating Officer to discuss and agree the facts.
  • S/he will receive a summary report of the meeting and be given the opportunity to review it and agree its accuracy.
  • The Investigating Officer will decide on further action based on the balance of probabilities that the student’s fitness to practise is impaired – options are:
    • no case to answer / case not proven – dismissed
    • refer back through the welfare system if further support is appropriate
    • refer to the Professional Support Unit for further assistance – e.g. behaviour / attitude
    • request that the student accepts an undertaking (e.g. remedial teaching)
    • award a summary penalty – e.g. warning or reprimand (to be declared to   the GMC)
    • referral to a College Misconduct and Fitness to Practise Committee to decide whether the student’s  fitness to practise is impaired
    • referral to a College Misconduct and Fitness to Practise Committee to decide whether the concern raises a disciplinary issue but there are no concerns about the student’s  fitness to practise
  • The student will be advised in writing of the Investigating Officer’s decision. 
  • If the student does not accept the decision of the Investigating Officer the issue will be referred to a College Misconduct and Fitness to Practise Committee for further consideration.
  • If the Investigating Officer’s decision is to refer to a College Misconduct and Fitness to Practise Committee, the student will receive a comprehensive report detailing the concern or allegation and will have 10 working days in which to provide a response.  S/he will also be invited to object to any of the committee members on reasonable grounds.
  • The student will be invited to bring a friend to the College Misconduct and Fitness to Practise Committee.  S/he may also bring witnesses but s/he must inform the Committee Secretary of his/her intention to do so before the hearing.
  • After the hearing, the student will be informed of the Committee’s decision within 2 working days.  Support will be made available to him/her as s/he receives the decision.
  •  The student will be provided with information on how to appeal against the Committee’s decision as s/he has the right to do so.

 

We strongly advise students who have to see the IO or go to a hearing to contact the Advice and Representation Centre (ARC) in the Guild for help and support in preparing documentation, as they are expert in understanding the workings of the process.  They can also arrange for one of the Guild Sabbatical Officers to attend as the student’s friend, which is something that students who have been to a hearing have found very helpful.  Sue Grant, who is the College of Medical and Dental Sciences’ Student Services Manager, is responsible for the process of FTP and she is incredibly helpful and supportive of students who are involved at any stage.  I also offer to support students through the process, which, as you can imagine, they find highly stressful.

Students have to inform the GMC of any disciplinary or Fitness to Practise matters – so anything that is a summary penalty or more serious (in the list above it’s summary penalty or below).  The GMC deals with all the UK Medical Schools, so is used to reading about problems from all over the UK.  The key thing in any dealings with the GMC is to be absolutely honest and transparent – never tell a partial truth and never try to conceal anything.  If you follow that advice there should be no problems.  It is a myth that you cannot register if you have been to an FTP hearing.  At a GMC meeting in May they compared the number of FTP cases each Medical School deals with in a year and the way in which Medical Schools deal with them.  Reassuringly the numbers and outcomes were very similar across the all Schools, with Birmingham being very average.

I hope that this has been helpful in enabling you to understand what Fitness to Practise really is and that it seems less scary.  Getting to a hearing is rare and being required to leave because of Fitness to Practise is even rarer.  For the vast majority of students their Fitness to Practise will never be questioned.

1.  Finn G, Garner J, Sawdon M.  ‘You’re judged all the time!’ Students’ views on professionalism: a multicentre study.  Medical Education 2010;44:814-825.

Professor Kate Thomas. 

With thanks to Mrs Sue Grant for her invaluable contribution.

May
17

Birmingham University Medical Society, the best in the UK and it’s official!

If you cast your minds back to entering Birmingham Medical School you will recall that you needed to be more than simply academically gifted. 7A* at GCSE (or whatever it was in your day) wasn’t enough – you were required to demonstrate your activities and life outside Medicine. Our reasons for this are very simple; firstly all of us need a life outside Medicine (how many times a week does my wife remind me of this fact?), but secondly,  we believe that your interaction with extra-curricular activities does make you a better doctor by improving communication skills, team working and a greater appreciation of society at large.

As you will be aware much of this activity at medical school is conducted through the Medical Society at Birmingham – a body run by Students themselves, separate from our Academic structures and the University Guild  (http://medsoc.bham.ac.uk/medsoc/).  Comprising some 3000 members, it encompasses no less than 22 individual Societies, 8 charities raising approximately £7000/ annum, 16 sports teams and has hosted no less than 15 social events this year.  It provides the Dean’s team with much welcomed academic student representation through CAWC (and congratulations to Laura Kelly the new Chair) and with it an improved course and welfare system.

The Medical School’s Council is the forum through which all the Deans of the UK’s 31 Medical Schools come together to collectively discuss issues such as curricula, student numbers, fees, quality assessment and welfare. How appropriate therefore that whilst attending our annual residential meeting last week, I heard the terrific news that our MedSoc had won the 2011 Student Medical Society of the Year Prize.  Of course I am biased – I can see you have an outstanding website, governance structures and see first-hand the emerging talent on a daily basis – be it the work of CAWC in establishing the Feel Bright campaign and Mindfulness relaxation sessions, at “MedSoc’s Got Talent” to my treasured “Tutti” compact disc, the 2011 calendar hanging in my office or hearing about successes such as Surg Soc, Emergency Medicine and excelling at many different Sports – but to have all of this recognised externally is indeed a superb achievement.  

The Award itself was conferred at the inaugural conference of the newly founded UK Medical Students Association (UKMSA) held in Bournemouth on 11th May 2011. Several of our Students attended, many presenting research posters, and heard presentations from esteemed speakers such as Andrew Lansley MP, Professor Christopher Bulstrode, ex-dean of Oxford and Prof Jim McKillop, chair of the GMC undergraduate board.

The “MDU Student Medical Society of the year prize 2011”, for the best MedSoc in the UK was presented to Sophie Lumley by Prof Michael Baum, Director of UCL clinical trials group and a former Birmingham graduate himself.  As Sophie readily admits however, this award was a culmination of activity from 3 generations of MedSoc Presidents: herself, Majd Protty (president 2010-11), Jake Mann (2009-10), and the 2010-11 Vice President (Academic), Aruna Ekanayaka.

I speak for many of my colleagues in warmly congratulating you on this prestigious award. The School remains committed to supporting the raft of MedSoc activities and in helping you organise the next MedSoc conference here in Birmingham. We are very proud of your achievements – well done!

May
03

An Easter Feast: Betjeman’s Cornwall

Chairing the 3rd and 4th year exam boards 2 days before Good Friday left me with a warm feeling. You really are a smart bunch – very few failures so I was able to escape for my family vacation with a pat on the back, reassured by the fact that we are doing a good job! (Although as I think about it post holiday maybe our exams are too easy? I must look at this!).

The Prime Minister on holiday in Polzeath

And so to the North Cornish coast and a delightful village called Trebetherick opposite Padstow on the Camel estuary. And what a week it was – not a cloud did we see, the surf at nearby Polzeath was reasonable, and all elderly parents and dogs survived to tell the tale without incident.

So why bore you with all this? Earlier blogs have I think lacked a certain cultural flavour so I thought you might be interested to hear about some of our “neighbours” on vacation. Nothing like name-dropping but one was David Cameron and family – down for the Easter weekend for surfing lessons for the kids. Seeing him walk into my favourite coffee bar clutching daughter Endellion (named after the nearby village St Endellion) was an unusual experience to say the least.  Perhaps of greater importance however, was that the house next door to us was “Treen” – former home to the Poet Laureate Sir John Betjeman.  Poor Sir John was afflicted with Parkinson’s Disease for the last 10 years of his life and died in this very abode in 1984 aged 77 years.

John Betjeman's grave

He is buried just 800 yards away at St Enodoc Church which itself is steeped in history having been buried in sand dunes between the 16th and 19th centuries, before excavation in the 1860’s. Betjeman was clearly an interesting character who unlike most of you, sadly did not fair so well with University exams. He scraped into Magdalen College at Oxford as a so-called “commoner” having failed the maths entrance exam. At College he failed to see eye to eye with his tutor – one C.S.Lewis no less – who he felt was “unfriendly, demanding and uninspiring” whilst Lewis himself refers to Betjeman as an “idle prig”. (No such student-tutor conflicts in Birmingham eh?).

Eventually having taken a series of re-sits, one involving a somewhat rebellious submission of a paper in Welsh, he was evicted in year 3 without a qualification. (Ironically he was subsequently given an honorary degree from Oxford in 1974).

Memorial to Betjeman at St Pancreas Station

He is famous principally for his poetry through which he achieved immense public popularity. However, the quirky, humorous side of many of his pieces I understand still divides literary experts. He became Poet Laureate in 1972 interestingly after the death of CS Lewis. His poetry and writings also focus on buildings and the redevelopment of towns and cities (notably “Slough” http://www-cdr.stanford.edu/intuition/Slough.html and Leeds where he appears to have prevented many Victorian buildings being totally destroyed in the 1960-1970’s). (http://www.bbc.co.uk/insideout/content/articles/2009/02/12/yorks_lincs_betjeman_s15_w6_video_feature.shtml). This love of Victorian architecture also saved the façade of St Pancras station on Euston Road, London where a commemorative statue now sits.  In an amazing foresight of public engagement he made several albums recording his poetry onto vinyl and I was interested to see one of these – “The Licorice Fields of Pontefract” (http://www.youtube.com/watch?v=XmtF8LH2J34) since my MD thesis many eons ago had explained how licorice caused hypertension and hypokalaemia.

Nearer to home I leave you with this rather sad poem by John Betjeman entitled “Death in Leamington”.  An interesting man and a story I would not have uncovered without a week away in Cornwall …..

She died in the upstairs bedroom
By the light of the ev’ning star
That shone through the plate glass windows
From over Leamington Spa.
Beside her the lonely crochet
Lay patiently and unstirred,
But the fingers that would have work’d it
Were dead as the spoken word.

And Nurse came in with the tea-things
Breast high ‘mid the stands and chairs—
But Nurse was alone with her own little soul,
And the things were alone with theirs….

And ‘Tea !’ she said in a tiny voice
‘Wake up ! It’s nearly five.’
Oh ! Chintzy, chintzy cheeriness,
Half dead and half alive !

Mar
28

At the cutting edge…

Surgery is the red flower that blooms among the leaves and thorns that are the rest of medicine.  

 I am not entirely sure of the source of this lovely quote – I came across it yesterday, but it was a timely reminder that I needed to update you all on the recent activities of your own SurgSoc here at the Medical School. Perhaps my greatest insight as Dean has been to witness all the amazing things our students participate in, and SurgSoc is yet another example.  Founded in 2002 with the aim of promoting surgery and inspiring students to undertake a surgical career, it boasts its own impressive website (www.surgsoc.co.uk) and has a vibrant membership of more than 350 students drawn from all years and courses in the College. Piyush Sarmah (Year 5) is the current student President and Professor Derek Alderson – our very own Barling Professor of Surgery – is the Honorary President.   

Mr John Black

Mr John Black

 Surgery of course is a crucial underpinning discipline of Medicine and one which is embedded in the undergraduate curriculum – so much so that when you graduate you actually receive two degrees rolled up into one; from the Latin Medicinae Baccalaureus (Bachelor of Medicine – MB), and Baccalaureus Chirurgiae (Bachelor of Surgery – ChB).  Surgical training is endorsed through the Foundation years programme and for those of you who wish to undertake a surgical career there are 184 core surgical trainee posts across the West Midlands alone.   

 SurgSoc runs many events throughout the year catering to all its members, and it has invited an impressive array of surgical guest speakers to speak on various topics over the last few years, all I would emphasise organised by the students themselves – Professor Nadey Hakim (ex-President of the International College of Surgeons) has come to speak on transplantation surgery, and Professor Harold Ellis CBE, the world-renowned anatomist and author of anatomy and surgical textbooks, has visited Birmingham for each of the last three years to speak on Anatomy and the History of Surgery. But perhaps its greatest coup so far has been to invite the current President of the Royal College of Surgeons, Mr John Black, accompanied by Mr Richard Collins, the Vice President, and Martyn Coomer, the Head of the College’s Research Department, to Birmingham a few weeks ago.   

 Mr Black trained at Cambridge and St Thomas’, but spent the majority of his professional life specialising in vascular surgery and then pioneering laparoscopic surgery at Worcester where subsequently he became Medical Director. Here he played a key role with one of my predecessors in establishing Worcester as a linked teaching trust for our students. Mr Black is also an alumnus of the University having obtained his MD from Birmingham in 1978. His lecture entitled My life in surgery was a delightful historical interlude into famous surgeons up and down the land, but with a very strong influence on how Birmingham based surgeons have contributed to and enhanced the discipline over many years. This was preceded by the awarding of the prizes and certificates by the guests from the Royal College to those students who’d participated in two of SurgSoc’s programmes running throughout this year: the Anatomy Course & Lecture Series, now into its second year, and the National Academic Prizes Competition.   

Anwari (L), winner of the SurgSoc Anatomy Cup for the Clinical Years, receives her trophy from Mr Black (R)

From L-R: Ravinder Banwait (SurgSoc VP), Martyn Coomer (RCS Head of Research), Piyush Sarmah (SurgSoc President), Mr Black (RCS President), Avril Krempic (SurgSoc VP) and Mr Rochard Collins (RCS VP)

Mr Black and his team from the College were immensely impressed with the great work of SurgSoc. Their only demand before returning home was to be treated to another Birmingham based success story – the Birmingham Balti!! This was a meal very much enjoyed by our guests, myself, and the SurgSoc committee who took what was surely a once-in-a-lifetime opportunity to have a curry in the presence of such distinguished people!   

Harvey Cushing

Harvey Cushing

Of course as a “Physician”, to be surrounded by all these successful and yet more budding surgeons was a little disconcerting to say the least. Although I thoroughly enjoyed my own surgical training and gruelling house jobs as they then were, surgery just somehow wasn’t for me. But for those of you enthused within SurgSoc, my advice is stick with it – we need as many of you as possible to step up to the plate and be tomorrow’s surgeons. Perhaps however I can endorse one message from one of my own heroes Harvey Cushing – of Cushing’s Syndrome fame. Cushing was actually an outstanding neurosurgeon, not a physician – I leave you with his words of wisdom ….   

 I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work.    

Even surgeons also need to be Physicians!

Mar
11

Stand Tall ….. you might be better off

 Monday this week began with a treat. Kate Thomas arrived for our weekly Dean-Vice Dean’s meeting clutching my personal copy (though not signed I hasten to add!) of the MDU calendar, which, for those of you who haven’t seen a copy is in effect Birmingham’s answer to the Calendar Girls featuring our very own Medical Students. Impressive indeed and it has already found its way to prominence on my office wall! Congratulations to all of you who took part – a brave thing to do to bare all in front of your peers – it has raised much excitement in the Dean’s Office (can someone drop off a copy to Karen and Keeley – my secretaries? Thanks).

It also provides me with a tenuous and rather pathetic opening gambit to the recurring issue of whether size matters? Last night I couldn’t help marvel at the sheer elegance of Lionel Messi – (the Barcelona midfield football player for those of you whose brains are scrambled through revision) – as he negotiated the Arsenal defence like a hot knife through butter, teasing the opposition with such sublime and unique skill. At 5 foot 6 ½ inches tall (and at this height every ½ inch matters) he somewhat bucks the “heightism” trend – the suggestion that in many facets of life taller people fair better than short ones.  Easy for a Dean who measures in at 6 foot 3 inches, or more appropriately as Europhile 1.90m, but is there any truth in this nonsense? Well yes there probably is.  The classic 1960’s BBC comedy sketch involving Ronnie Corbett, Ronnie Barker and John Cleese ridiculed the British Social class structure, but in fact the different outcomes of these scenarios were more closely aligned to height rather than social class.  Mangers are taller than non management staff within corporate institutions (1). Height also predicts success in US presidential elections – since 1900 the shortest US President has been 5 foot 10 inches, but importantly the tallest candidate has won in 19 of 28 elections.  Furthermore tallness predicts salary; in the UK a well rehearsed figure is that an extra inch of height conveys an additional £235/annum. In the USA similar studies predict that a 6 foot employee earns $166,000 more over a 30-year period than a 5 feet 5 inches employee (2).  So Lionel Messi at 33 million euros/ year is indeed the exception to the rule! But one area where he may be compromised is life expectancy – tall people also live longer. The classic studies of David Barker in Southampton, endorsed through large Scandanavian series provide considerable insight into the role of height predicting mortality. Counties in England and Wales (we won’t worry too much about the Scots!) with the tallest populations had the lowest mortality from bronchitis and cardiovascular disease (3). David Barker has gone on to suggest that this may be explained intra-utero programming of disease probably through nutritional signals across pregnancy. Total mortality was inversely correlated with height in over 31,000 subjects from Finland with adjusted risk ratios of 0.89 and 0.86 for every 5 cm increase in height for males and females respectively (4).

One area where height is potentially bad news is cancer risk. Taller subjects do appear to be at increased risk of developing breast and prostate cancer, and here our friend Lionel Messi may provide a key clue. Lionel Andres Messi was born in Sante Fe in Argentina, and played as a Junior for River Plate – a famous footie team in Argentina. However, at the age of 11 he developed growth hormone deficiency. Growth hormone (GH) of course, is the key hormone controlling longitudinal growth – pulses of GH particularly at night are crucial in ensuring linear growth throughout childhood and adolescence, so that by the time puberty has kicked in and the ensuing growth spurt with epiphyseal fusion, final height is achieved (5). Arguably, I have had a little more GH pulsing through my childhood bones that someone who is vertically challenged, but endogenous GH deficiency is a cause of severe short stature. Recombinant growth hormone is the treatment of choice but is expensive at about £500/month. Sadly Messi’s family, nor River Plate could afford the treatment and this is when Barcelona took charge signing him up as a very short, but clearly talented junior with the promise that they would fund his GH therapy. Money well spent for sure – without growth hormone Messi would be just over 4 feet tall. Messi’s story also provides a link between Cancer risk and height. Additional research demonstrates a positive relationship between leg length and cancer risk; GH excess is associated with colon, prostate and breast cancer and it is possible that the same GH secretion driving longitudinal growth may also drive IGF-1 and other tissue growth factors to cause development of cancer (6). 

There may well be prejudism based on height within our society, but there are also real links between height and patterns of disease and mortality. For now however, let’s just enjoy the magic of Messi … after all life is too short!

  1. Egolf D, Corder L. Height differences of low and high job status, female and male corporate employees. Behavioural Science, 2001; 24:365-373
  2. Judge TA, Cable DM. The effect of height on workplace success and income: preliminary test of a theoretical model. J Applied Psychology, 2004; 89:428-441
  3. Barker DJ, Osmond C, Golding J. Height and mortality in the counties of England and Wales. Ann Hum Biol, 1990; 17:1-6
  4. Jousilahti P, Tuomilehto J, Eriksson J, Pushka P. Relation of adult height to cause-specific and total mortality: A prospective follow-up study of 31,199 middle aged men and women in Finland. Am J Epidemiol 2000; 151:1112-1120.
  5. Phillips JA, Cogan JD. Molecular basis of familial human growth hormone deficiency. J. Clin Endo Metab, 1994; 78:11-16.
  6. Gunnell D, Okasha M, Davey-Smith G, Oliver SE, Sandhu J, Holly JMP. Height, leg length and cancer risk: A systematic review. Epidemiologic reviews 2001:23:313-342.

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