We're all learning

I'll try a bigger font for this one, I think...

Anyway, time for another clinical session, this time on skin lesions. A familiar clinical tutor appeared, this time he's a resident rather than an intern. He had lined up some excellent, and very helpful, patients for us to see which must have taken considerable time on his behalf. Each patient was well prepared for our visit so rather than the usual shocked / surprised individuals we saw cooperative people.

Interesting to see how he's progressed: his bedside manner was excellent and he seemed to have much more patience with us this time, stressing less about the small things. Perhaps before, he was in the middle of his intern blues, perhaps like us he's developing and improving.

Either way, I was impressed with his approach. Best we've had so far.

Lessons in irony

The most stilted and uncomfortable part of the MBBS are the communications skills classes. Worse even than the ethics classes.

The twenty-odd students sit around for a three hour session, looking unhappy and uncommunicative and annoyed that it's Friday afternoon and they're learning to be empathetic. Of all classes, you need some kind of dialogue or contribution for the session to have any kind of meaning.

Some of the approaches taken by the facilitators doesn't help. Having had a consistently sympathetic discussion around the social situation of a facially disfigured person, he was keen for us to come up with some less kind judgments to make. It was clearly against the nature of everyone in the group to say unpleasant things... I'm not sure that by stimulating this kind of response the guy was raising an awareness of its inappropriateness. From what I saw, no one would have dreamed of being so insensitive... until the facilitator had egged them on.

He then said: "Please don't react like this when you see a patient like this".

Not a chance of that happening.

Great days

A friend of mine (oldest friend when I think about it) sent me a link yesterday to some digitised photos from a holiday we had together a long time ago. I never saw myself as the kind of person who had a photocollage noticeboard in their living room showing me with a bunch of great mates doing great mates things, but blow me down if there isn't a photo of a skinny teenage me jumping into the Mediterranean from a pier accompanied by five or six school friends. Perhaps I wasn't always such as curmudgeon.

Anyway, the photos also showed a very long haired me and my (now) wife looking young. It's quite confronting seeing a photo from ~20 years ago all of a sudden, particularly when you were a few kilos lighter and with hair to your shoulders. Can't say it was such a bad look actually... I thought I'd show my young colleagues a couple of snaps (particularly one guy who is looking to grow some length before the hard core clinical years) and the response was quite reassuring!
Anyway, cue plenty of reflection and introspection, mulling over the person I was then, the person I was now and how the years between have affected and changed me. The young fellow in the picture probably would have been surprised to have seen his older self make a decent fist of I Banking... although whenever I was at my desk my music tastes would have been recognisable. As is not uncommon, tastes tend to ossify around the 17 - 25 years which is the case with me.

One album I was listening to for the first time in a long time, before even the photos appeared, it the Ultra Vivid Scene album Joy: 1967-1990. This was released in 1990 and was very popular amongst the hip young things of the time. Even though I was more of a SubPop fan (probably the more listenable stuff I was into), for some reason Kurt Ralske's poppy- noise(ish) music fitted my mould, and that of my friends too. Probably due to his being a New Yorker (I was very keen on Shimmy Disc at that point), the fuzz on his guitar, the odd lyrics and a song with the same title as a very popular Nick Cave song (Mercy Seat).

I never subscribed to Ralske being 100% derivative of MBV, JAMC and the rest despite him confessing to similar VU roots on a SNUBTV clip I saw. He's pretty original and the mix and the production are so layered you can listen to each track numerous times and spot a different instrument that you've been listening to passively for 20 years suddenly come to the fore.

Back in the jug agane

So - the start of my second year. Finally, some uncharted territory.

Except not. The way this course is structured, save content my second year is a carbon copy of my first year. This isn't the most inspiring thought at the moment. Group projects and assignments have already become routine, formulaic and rather a bore as I think I've mentioned before.

The question is, how can I maintain my own motivation and what will the university be doing to maintain the engagement of the second years? From conversations with and observations of the second years when I was a first year, the answer to the second question is "not a lot". Looks like I'll have to dig deep and find myself some intrinsic motivators from somewhere.

It'll be interesting to look back on this year in 12 months time: ha I been a bit pessimistic, or was it indeed the slog I anticipated?

Private Eye and MMR

Oh, look. My letter to Private Eye on their MMR performance did get published and the mag's response seems to be cause for comment.

Thing is, looks like they still can't see how their credibility is being damaged by not admitting they were in error. My copy arrives a bit late here in Australia so I haven't read the full mea culpa-ish so I can't comment much until it arrives.

Lonely at the top

So... finally had an email exchange with the only other "proper" mature student on the course (ie over 30). He's an overseas student and he went home over the southern summer.

For one reason another it looks like he won't be coming back next year which (from a selfish standpoint) leave me as Mr Outlier. Staying solipsistic just for a moment, he's the guy I sit next to in lectures so I'll be feeling a cold draft all down one side (c. Eric Morecambe).

No time to ruminate now.

MMR & autism - hogwash

Living in the UK in the late 90s (as I did) it was hard to avoid the MMR scandal. I won't go into the details here. This link will tell you what you need to know and concentrates on the part played by the press in the whole palaver. Suffice to say, they did not cover themselves in glory and undoubtedly influenced a large number of parents not to use the triple jab thereby endangering the children of those parents who immunised their kids but for some reason the jab didn't work.

Now that the dust is settling, that the GMC verdict is in and that the Lancet paper retracted, some reflection is appropriate.

Despite the Bad Science link above suggesting that the autism / MMR link is a UK phenomenon, in my young student cohort one person put their hand up in a tutorial to remark on the link when MMR was mentioned. So, the damage has spread globally.

The other entity that comes out of this mess poorly is the magazine Private Eye. Although it is typical for the magazine to take an automatically contrarian view, their lack of understanding of the data disproving the autism link went on for far too long. Even today, there seems to be a reluctance to accept that they were duped by the lobbyists on this one. I sent them a letter post GMC to see if they'd publicise the safety of MMR as thoroughly as they did the imagined dangers, but normally when the letter is accepted you get a "I've passed this on to the editor"... nothing this time. And there's nothing on their website at the moment when you search for 'MMR'.

Oh God, and I forgot about their special report in 2002. 2002! Geez. The BMJ produced an interesting review here.

The problem comes down to the media's lack of understanding of science. Being largely art grads, this is not surprising. Other skills, such as understanding how the biases of sources can bias a piece of work, you would have thought to have been in an experienced journo's tool kit... but in this case the author of the Private Eye report, Heather Mills, even goes so far as to thank these sources on the back cover of the report..!

Following this debacle, a demonstration of little self-awareness of one's limitations amongst the fourth estate is warranted.

Multitasking

See: I'm already making no effort with my pics (the one above is the first that comes up on a Google image search for 'multitasking').

Crap, isn't it?

Anyway, this year, now that I'm a bit settled / stuck in a rut, and what with the economy improving and all, I've started to take on a bit of work based on my previous experience. A bit of cash will be nice and it makes me feel like a grown up again. I've snagged a chunk of research work as a visiting fellow in the local university and am working with a professional services firm (as it were) to help out with a few management consulting projects in the CBD. Not sure whether this work will detract from my strict flash card-based exam technique, but so far I've gone well enough and frankly I quite like having a CV without a four / five year medical school-shaped gap in it.

I've also had conversations regarding going back to the bench for some wet science. I'm in two minds about this. On the one hand, it would be nice to maintain a bit of momentum on the (hard) science side: may help my clinical career although I have published ok over the years so I'm not sure what that would prove. On the other, it was my dislike for bench science (or rather, the crap career structure surrounding bench science) that led me to leave altogether ten or more years ago.

The clincher may be how much time I can spare. There's also a financial consideration of what is the best use of time plus the fact that I would like to use this highly unusual career break to see as much of my family as possible.

We'll see... perhaps the two small roles are fine as they stand.

Deja Ecoute

A Facebook friend was tagged in a photo last week, looking all proud in his A&E gear having spent his NYE rotation there. Thing is, he started med school 18 months after my first go in the UK and he now seems to be racing ahead which triggered a bit of (yay) reflection.

Some of the delay in my training is clearly my fault for messing around changing countries after my first year, deferring my Australian start date due to commitments made prior to receiving the offer etc. However, some of it is due to the structure of this course, which is beginning to get me down a tad.

On this course, the first two years are combined which means that, save for some exams and, of course, the actual content, the second year is largely a carbon copy of the first. Although it's nice to be in a routine, it's taking all of my gumption to maintain a high level of enthusiasm for undertaking ten or so more reflective paragraphs, five more examinations with the same format, working in groups doing largely interchangeable tasks with the same people, etc.

I'm not looking for endless variety, but this next year is going to lack the novelty of the last which probably was last year's saving grace given the other hassles associated. On the other hand, there is a degree of comfort to be gained from not having to go through all the same crap with a new bunch of people, explaining why I'm so old etc.

So perhaps, on balance, yr 2 will be less uncomfortable than yr 1.

Changing views

Worryingly, and from what I can see, typically for a med student, I'm having people asking my opinion on medical matters a task for which I am singly not qualified and tell them so, pointing them in the direction of Wikipedia (joke). Here are some of the complaints I've had to avoid professing an opinion on so far other than go to the doc's ASAP (there are more but I forget):

- Any number of rashes. Nowhere embarrassing yet, though.
- Whether a US based relative should ditch his expensive heart pills and buy some generics. Different formulations, not quite the bioequivalent formulation. Crikey - it's your heart for God's sake, why are you cutting costs there! Buy one fewer watches or go skiing less or something.
- Chest pains (chest pains!).
- Rectal bleeding (proper blood in the water, not the tissue) lasting for a couple of years (years!). I did have a clear recommendation this time: get to the bloody doctor; why are you sat here in a pub quiz night when you could be having this problem looked at?!
- Something that looked like a BCC.

Some if not all of these could well be serious - go to the GP if you have these problems rather than relying on some part qualified idiot like me. Goes to show, perhaps, the importance of trust between the advisor and advisee in a clinical relationship I suppose.

Sad and obsessive behaviour

I must admit to being a bit of a Joy Division tragic. Although I was very young when they turned into New Order, the re-release of their albums in the late 80s found me at an impressionable age and an indie kid to boot. The only JD you would hear typically came at an "alternative" dance night when you'd badgered the DJ for hours to put some on then yo'd be treated to Love Will Tear Us Apart... and a largely empty dance floor.

The sad and frustrating story of the lead singer Ian Curtis' suicide is part of popular culture now having been turned into a film on at least two occasions quite recently (C0ntrol, 24 Hour Party People) but when I started listening to JD it was all very confusing adding to the mystique of the band (give me a break, I was an adolescent...) Living within driving distance of Manchester meant that I could head over to visit the town regularly which cemented a love of the city's music that began with the Smiths and continues to this day. It was an odd experience to walk through Afleck's Palace, loading up with JD posters and a copy of the Komakino flexi disc to take off to college and stick on the walls (the posters, not the disc) . Felt like proximity to the band. Hard to explain but strongly remembered times for me. Probably due to me being 17.

Anyway, this Christmas I received a copy of Who Killed Martin Hannett? , a painfully complete description of the relationship between the man who produced their albums and the band seen by his "best friend" (it says here). The full story of Martin Hannett would take a book to go through (as you can see from the fact that someone has written one) but suffice to say he was credited with the band developing a unique sound, of being a control freak / perfectionist and being increasingly fond of heroin as the albums progressed. Martin H died in 1991 and his story reads like Wired, the John Belushi biography where, even if you didn't know the Belushi story and question the veracity of Woodward's account, you just know the guy has to die soon the way he's going on. I had the same vibe about the author of the Hannett book whilst reading it... imagine my lack of surprise when I found that he had passed away in September last year, poor guy.

Leaving this ghoulish aspect of the Factory story, this brings me to the album of Martin Hannett's Personal Mixes, the cover of which is at the top of this piece. Browsing through a vinyl shop in the CBD, I came this vinyl (mmm... 180g) and having heard about it elsewhere, I laid out the frankly painful $39.98 to buy it. The music here falls into three categories: different mixes, some sound effect recordings (interesting.... having heard them so often as part of a JD song) and a couple of interview snatches (not worth discussing). This album has had mixed reviews, but for a sad man like me it's been an insight.

Basically, it looks like Hannett's reputation for a love of delay and treble is well founded. What is more surprising is the amount of bass that is in the front of the mix. Almost capable of causing nausea. The top end hiss on the recordings of Autosuggestion plays from left to right and causes more disorientation. Two of my favorite tracks on Closer, The Eternal and Decades (which I used to listen to so much as a teenager it still causes my father conniptions) are provided in mixes which only show their differences if you've heard them a thousand times before. The sounds seems comprised of only top and bottom end (bass drum and snare, bass guitar and strange trebly jangling guitar parts) which may have been the idea: to let the singer's voice stand alone in the middle ground with only the sibilants venturng out of this territory.

At the end of side four comes a probably intentional piece of iconoclasm added to provide some contrast: someone telling Ian Curtis to "F*ck off".

Summer is a bummer

Halfway through the summer break here. I have to say, I wasn't looking forward to it a much as my younger colleagues were. I can't help but see these two big breaks in the first two years as being two three month delays in getting through the course. Due to having Christmas away from home, it's tricky to get a chunk of work during this time too so probably the best thing to do is to sort out the odd jobs around the house.

Not sure I have six more weeks of them left in me, though.

Big return

Things that stopped my blogging:

- having to find a relevant image to illustrate a posting
- excessive quality control re referencing my posts
- general busyness

Well, I can rectify the first two and we'll see how the third goes.

Odd goings on in the Guardian

Rather than write the whole thing out again, here's what I posted on the Bad Science forum:

++++++++
First post. Sorry if I appear pedantic but the Guardian's grasp of basic science facts irritates me in the face of their positioning in the market as being the clever clever paper.

Thing is, the Guardian's health correspondent has had a confusing weekend struggling with what E. coli is. Bug, virus or bacteria.

He plumped for virus in the first iteration of the article on which he was the sole author. I posted a link on my blog which now connects to a different article:

http://www.guardian.co.uk/uk/2009/sep/1 ... urrey-farm

This now has two authors, one of whom is, bizarrely, an economics writer. The avoids all mention of viruses or bugs, just "E coli". Confusingly, the article history indicates only a single revision 27 minutes after the first posting which I think is strange given that I had time to read the original article, work myself up into a whirlwind of pedantry, draft my blog bit with a photo (finding one always takes five minutes or so) so it looks like I lucked into a small window there.

Thing is, I think that this was the original piece which has also been edited:

http://www.guardian.co.uk/uk/2009/sep/1 ... urrey-farm

From a different author (Ben Quinn rather than David Batty) but the timing fits with when my blog was updated: http://methuselahmedstudent.blogspot.com/ and it has the requisite "vomiting bug" reference missing from the new piece.

So: either the bylines have been switched, or there has been some unreferenced changes, or I'm a huge idiot missing something (which is always possible). Perhaps I should have archived the original page but I"m not that anal (I didn't even italicise E. coli above, I'm sure you've noticed).

Cheers

Meths
+++++

Science literacy in the media

The Guardian, the paper of the British undergraduate (and me when I lived there), likes consider itself somewhat a cut above other newspapers. It provides a platform to the excellent Bad Science columnist Ben Goldacre (although his recent article on drug patents left a bit to be desired) which is to be applauded.

However, despite all this it still seems to favour the art graduate stepping sideways school of training health correspondents and because of this makes regular, irritating (to me) mistakes in the most basic facts of science stories. There was an article which conflated influence vaccines with therapeutics quite recently etc etc.

Here's a classic. As I clicked on the link, I knew what I would find:

- Story about an E. coli outbreak.
- Covered by David Batty, "Health Correspondent"
- He thinks it's a virus. He's clearly not sure, so starts off with the classic "bug" gambit at the start of the article to avoid committing.
- He even quotes a bacteriologist.

How long does it take to search Wikipedia? I suppose if you don't know what you don't know, you don't know you need to search.

Maybe I could be the Guardian's Australian chess correspondent. After all, I know shag all about that.

Exam time again

It's that time again: exam next week so little time to post.

Share and choose

Working in a small team can be tricky at times. One of the first issues to arise is task allocation. The most intuitive approach understood by most people was codified by Hywell Dda in the laws of Wales and is known to most people as the principle of "one to share, the other to choose".

If you have never come across this approach, it's a treat and is particularly useful if you have children. Here's the deal: the first party allocates the tasks into two groups (or cuts the cake into two bits...); the second party then choses which group of tasks they want to do (or which slice of cake they want: bigger, more smarties on top etc).

This splitting puts a natural fairness control into the process. If the first party splits the work unfairly, they get lumbered with the worst / most work.

If there are more than two parties, then the work is allocated between groups in a iterative process until individuals are choosing.

Bags of fun.

UK universities

I read the most strange statement today regarding the UK GCSE results from the Times'John O'Leary, who apparently writes for their Good University Guide:

"Today’s results are vitally important, especially for those who are aiming for a selective university - whatever those universities might think about GCSE as a measure of academic potential" [my bold]



I'm not going to wade into the dumbing down of A levels / too many people going to university debate, but it's a bit depressing to think there are non-selective universities out there.

Medical literature 3

I actually quite like this book. Although it covers similar ground to the other junior doctor memoirs and is also pre-EWTD, for some reason it doesn't read quite so artificial, probably because it's a collection of short articles written for the Guardian over a period of time, which also makes it a good toilet book.

The author comes over as likeable and self-deprecating in the right measures. He covers the usual topics of sleep deprivation and the rest but offers some personal insights. Unlike other books ("Trust me, I'm a ...") it doesn't read like it could've been set in any workplace.

And, surprise, he chooses to specialise in psych.

A journalist's perspective

Here's grim.

The splash page of the SMH had a nice picture of Marlene Dietrich with the accompanying uplifting by-line letting us know that intersex patients can now be "fixed" by their doctors, which is nice:

"

When the answer to girl or boy is: 'I don't know'

They've been called hermaphrodites and intersex children - but doctors can often fix them. "

Looks like the front page has been changed.

Oh, no: it's back now.

The article itself was unimpressive and looked like an excuse to show glamorous photos with nice titillating hermaphrodite plays on words. Mmm... sexual healing. No sign of the athlete in question, nota bene. Guess she looked a bit, erm, "mannish" for the tone of the article. Nothing as off-putting as an unglamorous intersex person.

Thing is, there's no mention of "fixing" intersex children in the article. Nor should there be, given that many of the generation of intersex children who were surgically "fixed" are a bit (a lot) upset about not being given much choice in the matter what with them being infants at the time. The Intersex Society of North America may not speak for all those born somewhere along the sex continuum, but they represent a large body and have very definite and reasonable opinions on this matter which you would have thought would be taken into account before putting a nice big picture with link on your front page.

Particularly given that the article originated in the right on, intellectual as Guardian newspaper in the UK. Despite being the paper of the discerning, earnest under- and post-grad, it still took their Health Editor, who seems to have been in the job for long enough to pick up a bit of science by osmosis at the least, several goes to get the number of human chromosomes right.

But at least they didn't go for the glam angle, unlike the high brow SMH.

International students: the future

So, looks like after 2010, international students in our state will be at the mercy of the ballot / merit system, if, and it's a big if, the state decides that it needs more interns that can be provided in the shape of local grads.

I think it will take a lot of arm-twisting by the universities to get the state govt to do this: even though our uni in particular brings in A$20m+ pa (my back of an envelope estimate which may be very wrong), I don't that that's enough to sway their current position.

Although I have been wrong before. Not least in hepatology tutorials.

All done

Assignments all done for this term. I have to say I'm beginning to run out of reflections and TurnItIn is starting to get a bit suspicious.

Hope to get back to posting a bit more... just have to worry about this term's exam now.

That time of term again

Posting opportunities will be at a premium over the next couple of weeks whilst I engage in a number of repetitive tasks to complete my in-course assessment activities for this term. IMO, there's far too much of this sort of thing on this course: I'm not sure how much you learn from undertaking more than half a dozen group essays a year with the same group of chaps but I'm sure it's grounded in good educational theory.

Good news!

Here is the first bit of good news on the employment prospect front that I've seen for a long time.

"The number of empty jobs was measured on March 31 this year. Among hospital doctors and dentists, excluding trainees, the vacancy rate was 5.2 per cent, compared with 3.6 per cent in the same month last year. The long-term vacancy rates for this group jumped two thirds from 0.9 per cent to 1.5 per cent. Vacancy rates for GPs increased only slightly from 1.6 per cent to 1.9 per cent. "

Seems that there is a doctor shortage (again) in the UK. Workforce planning has always been a nightmare, particularly with changes to people's preferred working patterns (flexible, part time), the legal landscape (European Working Time Directive, other stuff here in Australia), the sex balance of the workforce (more women, more demand for part time work), etc.

Your big chance to work in a hopsital like the one above.

Despite training a lot more doctors, it looks like the effects of these reductions in productive hours per MBBS plus the attractiveness of the NHS pensions plus the generally admitted "it's not like it used to be" horribleness of the NHS working experience has accelerated the departure of older medics from the profession. Sounds like restriction on non-EU staff are also having an effect.

Given that Australia has a similar set of demographic and work practice changes imminent, it will be interesting to see whether we experience a similar effect here. IMO, given that many medics here retire self-funded, and given the hammering that asset values has taken in the last 12-18 months (esp. sthare and property), I envisage a hiatus in the rush for retirement of senior staff until the economy has picked up a bit.

Overseas students: short term salvation

Well, it looks like the international students who seemed to have missed out are going to be sorted for a training place... this year. Not sure how the state govt is going to find places for them to train given that one idea is to find interstate positions and all of the states are in the same boat. However, this is great news and must be a relief for those students who found themselves in this position.

This situation came as a surprise to most overseas students, but it's been in the wind implicitly for a couple of years and explicitly since the document I showed below entered the public domain months ago. Perhaps this change to scarcity of jobs is such a cultural shift that no one even considered checking to see what the actual situation was.

Whatever the case, I've spoken to some justifiably angry and upset people this week. For some students, by heading to Australia they have given up on their rights to be trained in their home country and so they fall between two stools.

Personally, I think the med student council should take more of an active role: it is at least their respsonsibility as much of that of the university to look after the interests of the student body and to make sure that students are aware of this sort of thing.

The next few years will see this problem get worse and for all students to be affected. This doesn't seem to be appreciated by the student council: I would say that at this time this body has a significant task ahead of it probably for the first time in memory (judging from my experience) and need to get active now.

For the time being, perhaps pub crawls and international student social nights may have to have a lower priority.

Weird looking photo and non-sequitor of the month

The poo continues quite rightly to hit the fan for these buffoons. Good to see that an absolute lack of contrition for acting like a twot doesn't get you very far these days.

In addition to providing a photo where the subject looks very weird around the jaw line (worse in the photo in the link), the article provides a quote from Jackie O's publicist:

"Jackie's a wonderful person so she's having a break [...]"

Not sure of the logic behind that statement. I'm a wonderful person too: where's my break?

News just in

This is interesting: looks like there's a presentation from our university's medical school office regarding the training issue.

I'll head along and see what's the go.

Links to past scientists

The photograph above is of Peter Mitchell, a gentleman scientist who achieved the rare distinction of receiving an unshared Nobel Prize for Chemistry in 1978. His great achievement was the discovery of how the breakdown of glucose and other nutrients in linked to the production of a high-energy intracellular molecule (ATP). It was an elegant theory, elegantly demonstrated. He was, by all accounts, a great bloke too according to my undergraduate tutor who worked with Mitchell in his labs in Cornwall for a number of years. Sitting in tutorials, I was once removed from this work.

When I moved to take a PhD, initially I was similarly once removed or directly involved with a number or biochemitry giants. These included Arthur Kornberg, Lubert Stryer, Hans Krebs and JRS Fincham. Apologies for the nerdy name-dropping

The world of biochemistry seemed to be one where large thoughts were generated and proofs pursued methodically over several years. There were close connections between the big discoveries and current opportunities.

It may be me but these connections are much diluted at the present. The process of developing a scientific lineage of PhD graduates from a supervisor's early work naturally splits a large field into smaller ones as graduates take an element of that work and run with it. After twenty or thirty PhDs have come out of a lab, the field has been split so often it's looking like a bastardised version of Zeno's paradox.

An example of this was a friend of mine who went to work with a scientist looking at a topoisomerase. By the time he'd arrived, two other PhD students had started and the protein's three domains had been allocated to one student each. Unfortunately, the bit he inherited turned out to be a spacer domain which let the other two domains do all the interesting stuff which made his viva interesting.

The sense of excitment I felt as a newbie undergrad scientist undertaking a short research project, the proximity to big leaps that had been made only ten years previously, waned quickly and for others too and by the mid-90s I was also mutating a wee bit of a protein to see what happened... just like four other groups around the world who were working on the same protein.

Watches

Dr Crippin, probably the most read medical blogger in the UK, chose to introduce a discussion on the worried well and prophylactic screening with a discussion on servicing his watch.

This started quite a lively discussion on "watch porn" which provoked a bit of thought with me (hence the solipsistic tag below).

Men's bling in the mainstream is limited to cuff links and watches. I had a psycho boss for a job I was in for short time and the only positive learning I took from this guy was to choose cuff links with a solid spine. Since then, a pair of Tiffany kidney bean links have been all that I've needed to pass myself off as being "smart" in business and formal social occasions. If anyone is looking for a GBP150 present for a god son or whatever, I would recommend a pair of these. They feel nice and solid too.

On the watch front, it's hard to work in finance in Asia without succumbing to bigging it up on a new watch. Working in Singapore, Orchard Road was always a short taxi ride away and the prices were (relative in the odd world in which you existed) reasonable. The "standard" watch was a "Hong Kong Swatch", being a Roles datejust. This was the entry to a world of hurt where you went from Rolex / IWC (depending on how obscure you fancied yourself and how thick your wrist was) to the nightmarish heights of Vacheron Constantin (pictured above, yours for US$80,900).

Seemed like madness to me... but I couldn't resist shelling out for a Bell&Ross Hydromax, water resistant to 11,000 metres. Stupid, but a good conversation starter in the pub and a fraction of the price of a VC.

Them were t'days

This site has a fascinating run through of some old adverts for drugs that were once commonplace but now are... somewhat less so (depending on where you live).

In addition to the usual commentary on the original recipe for Coca Cola, there are plenty of other eye opening ads for an array of exciting drugs.

I've included the standout (for me) above. Reading the copy on the advert, I was wondering where they were going to go with the "it's hard to make nervous kids take a pill" line and which alternate route they were going to suggest. A suppository never entered my mind.

And then you read the last line and realise that you're supposed to stick these up the kid's bottom before they became nervous. Sounds chicken and egg to me.

On this day in history #1: 1996

My lab books from my PhD and post doc are closest thing I have to a diary. Except for the actual diary I kept from 13 - 15, I suppose.

So: what joys lie in these dozen or so books?

Well, on this day 13 years ago, it looks very much like I was setting up another in vitro, cell free virus replication assay using recombinant replicative proteins. And, by the looks of the print outs from the scintillation counter stuck in the book at jaunty angles, it this was another failure. Months spent cloning the damned genes and getting them to express and bugger all to show for it. Not to mention: huge exposure to viruses (even the expression system, vaccinia, isn't very nice), radiation (to check for incorporation of labelled nucelotides) and chemicals (scintillant ain't nice).

This experiment, which I had forgotten until now (hooray), took a couple of weeks to set up and involved a myriad of tubes.

Quote from my lab book: "I don't think this experiment worked very well (at all)".

No change there then.

This experiment, which was repeated many times during my PhD, never worked. The following PhD student had to travel to Europe to see how it was done and did get it to work (finally). The key: lyse the cells in situ and stop the reaction ASAP otherwise all the product is broken down. Shame this wasn't in the methods section of their published papers.

Luckily for me I had a number of other projects on the go so the failure of this one did not scupper my whole doctorate.

This is a flavour of why, if asked, I tend to advise my fellow medical students not to aim for bench research. Otherwise I keep quiet to avoid colouring them with my jaundiced view.

More depressing slouches down memory lane later.

Assisted suicide

UK nurses association (Royal College) has changed its position and is now neutral on assisted suicide (not sure when this became the euphemism du jour over euthanasia).

Have a look at the article:

"The move comes as a poll in today's Times found that 74% of people want doctors to be allowed to help terminally ill people end their lives." My bold.

Given that it would be the doctors who would be killing the patients, unsurprisingly the BMA is less keen on the idea. Hopefully, the RCN will stay neutral: it would be a strange situation to have two very divergent positions on this.

Here's the Times' take on this: unsurprisingly, it's viewed as a wedge in the united front of the healthcare profession.

Internships: it begins

So it begins.

NSW has run out of internships.

And so, in accordance with the letter sent to USyd students a while ago (and shown below), overseas students are being told so long and thanks for all the fees. Although, contrary to the comment from Andrew Pesce from the AMA, med students pay for an MBBS, not for an internship.

BTW applicants from overseas now have buckleys. UK grads be warned.

So, 879 students applied for 670 positions. There were 566 places in 2005 which is an ~18% (~20 pa) increase in five years. According to my rough calcs, to honour the COAG guarantee for Commonwealth funded students, we need to get to ~750 which is another 80 places... 14 more per year until 2015.

Next to lose out will be the full fee and interstate students.

So, perhaps by throwing the full fee payers and the internationals to the wolves, NSW may manage to fulfill their promise.

Medical literature 2

Here's another dated memoir, IMO, although I enjoyed this. Well written, interesting, but a lens to view the world of medicine 20 years ago. I used to work in the hospital where Dr Sparrow trained, and I saw the tail end of what you might call "diversified" medical training (ie lots of drunk rugger buggers).

To be honest, with less of a focus on prior exam performance and the like and more of a broader view of what makes a good doctor, it may be that the older intake of students made for better (that is, more rounded) medics than the current crop.

That being said, I'm surprised that the public still enjoy reading about the young masters' antics at medical school, getting drunk, stealing the toilets / mascots of rival medical schools, being "helped" through exams, chatting up the laydeez and generally behaving like a rampaging Dirk Bogarde. But, buy these books they do so perhaps the medical profession should revert to being a paternalistic profession and make the general public feel like they are being wrapped up in a warm, cosy blanket whenever they are admitted to hospital. Doctor know best.

There's good review of the book here.

Medical literature

Not the most auspicious cover in the world: an Ipcress-era Michael Caine / Julian Clarey lookylikey with too much eyeliner stares out, his mouth somewhat ajar. Above, a glowing reference from Maureen Lipman, possibly impressed by the author's numerous -ologies. A Radio 4 book of the week sticker. Yes, we're well into middle class England territory with this one. Give it to your daughter for her 17th birthday pre-med school interview sort of thing.

It's another "diary of a house officer" book. I picked it up at St Vincent's for $6 (that place has got expensive). Inside, the usual tales of know-nothing first day jnr doctors, advice not to need hospital treatment in the UK in the first week of August, scary consultants etc etc. Nicely written, a likeable, modest author, an hour to read, not a lot to learn. Indeed, no insights as far as I can see albeit from my position as a semi-insider.

Thing is, it reads like it comes from another era. It's pre-MTAS, pre-EWTD; an age when the problem for medical graduates was too much work, too much choice. To be fair to the author, he adds a note at the end of the book to acknowledge this which serves to strip the work of most of it's relvence.

I can't see the point of this book. It may as well as been set in a photocopy shop: genuine anecdotes which connect you with the human side of the job are few and far between. Sure, he screws up an misses a PE. Stripping that out leaves a fairly dull and predictable office romance between an older, married more senior man and the office junior to dominate most of the proceedings.

And, like every other intern / HO who has written a book, he becomes a psychiatrist. What's that all about?

Addendum: he's written a follow up about his SHO year, it seems. At this rate, he's going to have thirty-odd by the time he retires, although "my year marking time as an SpR" might not grip the reader so. If he worked on the counter in Boots he'd meet more people and probably have more of an insight in the human condition. The cover of his new book is worse, btw.

Technorati code

Here it is:

r5embfys2k

Internships: the overseas student's perspective

Which brings us to the overseas students, poor souls who subsidise the locals. NB, I am not an overseas student.

A straw poll of the overseas students on my course found the following:

1. Yes, they would like to finish their intern training here, please.
2. Indeed, to practice in Australia was one of the reasons I am spending ~A$45k pa on tuition.
3. No, I didn't know that there will be a shortage of training places.
4. What's all this about Groups A, B and C.
5. That hardly seems fair.

This is a position that seems wholly reasonable. There is a degree of caveat emptor, but I would be interested to see how overseas applicants' expectations are currently being managed.

From what I can see, the representatives of the student body are doing nothing to help overseas students.

In my opinion, this is not fair.

Internships: the fate of the slowest wildebeest

This all begs the question: should all medical school graduates be guaranteed a job?

Here are some arguments pro and anti off the top of my head:

Pro:

1. Costs a lot of train a medic: wasted if they don't practice.
2. Entry requirements are very stringent and closely matched to likelihood of success in clinical practice (according to ACER anyway.)
3. Poor students are weeded out during a very intense assessment process whilst undergrads which acts like a four / five / six year job interview.
4. The intern year is a required element of training and should be viewed more as an extension of the medical degree.
   

Anti

1. Some medics who make it through are clearly incapable of practice.
2. A bit of competition keeps the students on their toes.
3. Makes for a fairer playing field with other degree courses (accountants aren't guaranteed an accounting job in the government).

Not sure how I see it; perhaps the arguments are balanced. However, from experience there are a small number students who really do not have the motivation, aptitude or competence to practice (in my opinion, obviusly). So, in the absence of any programme of "rank and yank" during the medical degree, a degree of competition post-graduation makes sense.

But that's not to say I think that 40% of students should go begging which is what will happen if something isn't done soon.

Internships: controlling supply

If I find myself again, like the chap above, looking at pretend chemicals in a flask again for a camera (as I did last on a World in Action HepC documentary - fame!) I will be very depressed. But that is what an F1 who taught me in the UK found himself doing for six months of his clinical training. Please, Lord, let the Australians not get so desperate to keep medical graduates off the dole queue that they resort to that.

The good news is that this doesn't seem to be under consideration at first glance. What seems to be being discussed is the following:

1. Expand the number of public hospital training posts (best outcome, really).
2. GP experience.
3. Private hospitals.
4. Other sites: private rooms, community placements.
5. Change the composition of the intern year (please, no, not research placements).Bear in mind that all states (ex-South Australia) require an emergency medicine rotation and that these posts are already scarce, prepare for a change there.

Number 1: best outcome if they provide more resources, but otherwise the only way this is going to work is by decreasing resident hours (sounds like the bloody EWTD), job sharing, subspecialty focuses and non-medical placements. This last suggestion puts the willies up me. One, apparently serious, suggestion is a placement in medical administration. This deserves a discussion of its own later. MEDICAL ADMINISTRATION. By the Lord Harry.

But wait: it gets worse. What's this? Clinical research and teaching? No, not coloured liquids in a flask! How on earth will I learn how to take care of patients from more of that. How would a patient feel when being cared for by someone who spent six months trying to get a PCR to work rather than in the ED?

GP training isn't such a bad suggestion for those that fancy being a GP. Unfortunately, Australia seems to be holding up the UK as a reason for why this is good idea: apparently, 50% of FY2 docs spend a term in a GP's practice. Hmm... isn't that because they are short of proper training places too rather than this being a good idea that was generated due to patient need? Unsurprisingly, starting to use GP's rooms all of a sudden to train medics runs into problems with infrastructure and demands on GP's time. But, don't worry, perhaps nurse practitioners can train med grads. Hooray. Oh, and NSW won't provide indemnity for grad in a GP's practice.

Private hospitals aren't such a bad idea but raise other questions of cost and indemnity. Sounds like a proper training, though.

Other: prisons, drug and alcohol services, crisis call centres? Bloody hell.

Suggestion 5 is a cheat: you will change the quality of the output if you make it acceptable to have medical graduates with much reduced medical experience.

Hmm... so, it looks like although Group A graduates are guaranteed an internship, what that internship looks like is currently in the air.

Have to say: I'll be buggered if I'm going back to bench research.

Internships: controlling demand

The first way to reduce the imbalance is to reduce demand. And the best way to do this is, of course, to change the rules so that fewer people are eligible to apply for a place or so that there is a ranking of eligibity.

Key goals:

1. Ensure that those who have been funded through med school by the tax payer complete their training so that the money isn't wasted
2. Ensure that those educated in that State can complete their training ahead of interstate students to avoid "they're taking our jobs" problems.
   

The lowest ranking slice of the salami is the easiest to identify: the international / overseas students. Sure, if there are a few internships left in unpopular places, then they can have those. This takes ~500 or ~14% of the 2014 oversupply out of the equation; it's a higher percentage at the better med schools.

The next lowest is trickier but will inevitably be full fee paying students. They have not been funded by the local funding state, and if they are unable to complete their training then caveat emptor. If med schools take up the full 25% of Commonwealth student allowance, then that's another ~20% or 700 graduates out of the running. Hmm.... aren't some private med schools all fee paying... what will happen to them?

This leaves ~2300 "core" Commonwealth funded students to train. We'll need ~600 more traning places which is tricky but surely the States should be able to increase by 40% over six years?

The graphic as the top is from a letter from those responsible for NSW medical training to the University of Sydney and shows NSW will be doing it post-2011: Group A are guaranteed. Nota bene the appearance of merit selection for Group C... MTAS here we come.

Given that NSW (plus ACT) provided 566 places in 2005, a 2015 demand of ~750 (944 with the full fee payers stripped out) will be a stretch to meet the demands but probably (has to be) doable. However, I would be worried if I were in Group C... making it into Group B will be a challenge (what is merit exactly... grades, extracurriculars...?) but then will there be any postions for Group B to fill? Depends on "additional workforce demand" and given that NSW Health will already be overstaffed with Group A'ers, I'm sceptical that demand will exist.


Let's look at the supply side next.

Internships: numbers

Hmm... back to front graphic.

Here's the deal*: since 2000, the number of medical schools in Australia has doubled to 20. Further, the Fed Government eased the limit on full-fee paying students for med school. Some will use this latitude, some won't so the actual number of grads is subject to a degree of variation.

The forecast is for the number of Australian Resident medical graduates to rise from 1287 in 2004 to >3000 by the middle of the next decade. The total number of intern places in 2005 was 1622 (great if you graduated then). You need to do this year to be accredited.

So, the situation is going from one extreme where there were plenty of spare internships for overseas grads to fill the gap (many from the UK), to one where there is a 50% shortfall unless training places are increased.

NB: this number excludes overseas / international students at Australian med schools: another ~500 on top of the ~3000.

So: how to solve the problem? As the veteran who has been at the receiving end of a number of expensive management consultants' reports when I was a BSD I Banker, I am well equipped to solve this one. You'll need to understand the BCG supply / demand relationship, though, and it's tricky. Here's the choices:

1) Reduce the demand for internships
2) Increase the supply of internships.

I'll add a third:
3) Discard the weak.

Clever stuff. I'll address each in turn in different posts.

*Much data used here and in later posts is taken from an Medical Journal of Australia briefing paper and from another report found here. Sorry: don't know how to post the article itself.

Internships: elephant in the room

Will I ever get to see a gomer?

Like many countries, Australia has looked to improve the supply of local medics / break the power of the medics (depending on your outlook) by increasing the number of medical students. Massively.

This has been done both by increasing the number of places in existing medical schools and by allowing new med schools to be set up. This has been done by the Federal Government.

Thing is, following your MBBS, you need to spend time as an intern to be accredited. Without the internship, there's not a lot of clinical practice you can do. Thing is, the State Governments look after the provision of internships.

It will not surprise many to hear that the two levels of government have not coordinated their efforts which means that there'll be lots and lots more medical students by 2012 but only a few more internships.

As things stand, it's likely that:

- Overseas students will be told to go home (after dropping A$300k on an education here)
- Inerstate graduates will be told to go home (!)
- "Non-traditional" internships will appear (GP, research, private hospital)
- At some point, there will be an MTAS style system to replace the current ballot (you think your grades don't matter... then they suddenly do)
- You'll be reading about nice middle class children being unable to find a career.
- Overseas applications will not be accepted (goodbye, escape route from the UK).

The depressing thing is, I've seen all this already in the UK. At least then, UK grads could kid themselves they could come to Australia. Not after 2010 they can't according to a letter to Sydney Uni med students (I'll try to upload this letter later).

The worst thing is that my fellow students don't realise this. Most overseas students don't realise this, which is worse for them because their home countries have just the same problem and probably won't let them come home for an internship because they are overseas trained.

I did a lot of research on this issue before taking the plunge and going back to study. I'll try and summarise this info in a few posts rather than all in one go.

Return from a break

Apologies to the 100 people or so who have looked at this site for the gaps in posting. First off it was exams, then a break which meant that I wasn't so busy and was living up to the aphorism of "if you want something doing give it to a busy person". Not that I haven't been busy being Daddy Daycare, but it isn't the same.

Results came out a bit ago and so time to reflect... all for the benefit of my portfolio because I will have forgotten this by next year.

My prep for these exams was much patchier than for those I took in the UK. I managed three or four days proper study between child and partner care (I have to cook a lot, which is tricky due to my immediate family being vegetarians) which wasn't sufficient. I managed to get the flashcards going and a mini whiteboard was handy so I'll keep that approach to the rest of the exams. I think I'll have to annotate as the term progresses from now on: making notes took up too much time and left precious little for proper revision.

The outcome was pretty good. Although the exam was much vaguer than the UK one, which was a bit of a trivial pursuit exam at times (esp. the spotter), I manged to up my % a bit. Some of the questions were tricky indeed: the only way I knew one of the answers was because I'd done it before. It hadn't been taught to us here. That was probably the only prior knowledge that came in handy!

Kids on this course being, I think, brighter (or at least better at exams) than at my old med school, I dropped a couple of centiles from my ranking but still did well enough should grades determine internships (more of that later...) I'd like a Top 10 finish: perhaps with the experience of this format I'll manage to hop up a couple of spots when this differential between 1st and 2nd years become leveled out (we take the same exams). I'd be interested to see how I performed cf my own year rather than year 1 and 2.

Hmm... I'll probably fail the next exam after writing all that. Serve me right.

Student quality

I know I have moaned about the attentive qualities of my fellow undergrads, but on the whole they're a high quality bunch. Particularly my small study / clinical group of six or so.

I spent my year in the UK med school astounded at the poor quality or complete lack of motivation demonstrated by a small minority of my peers. Some of them I could never in a million years imagine in practice. In my year, we had some of the most arrogant people I have ever come across. And bear in mind that I used to work in the City. We had completely incapable idiots who couldn't grasp straightforward concepts. We had Tim NBDs like the chap above who had no idea what they we doing at med school let alone how they found themselves in the north of England parking their mother's 3 series on the street. The worst were those with no apparent interest in care, no empathy and a complete lack of insight into their own character.

Here, on the other hand, despite being much younger than their UK counterparts (some being 17...), there isn't a single student that I have come across so far who I couldn't imagine making a good doctor. Or at least wanting to be a good doctor. It's fun watching them develop... case in point a very introverted young man having to raise his voice to make himself hear by a elderly WWII veteran. He got there in the end...

Lots of fun to come.

Boomshanka

Just to prove that procrastination is the thief of time, I'm going to spend a few minutes posting rather than write my reflective section of the report that is due on Monday.

I remember during the last month of my first degree asking my sister to return the video of the Young Ones that she'd borrowed so that I could watch them one last time as an actual student. How wrong I was...

The Young Ones have a few aspects relevant to them appearing on this blog:

1. they were popular both in the UK and Australia, rather like Are You Being Served, and so are a rare cultural touchstone linking the countries (they're rarer than you'd imaging);
2. erm.. they're students and Vyvyan was a medical student (at a poly.. never!);
3. They were on the telly when I was very young: like Monty Python, it was the pups that formed the first strong fan base and have perpetuated their popularity (reference needed);
   
4. popular opinion is that the series is getting dated and I was interested to see if that's really the case..

So, the main reason for revisiting to see whether they've dated well or poorly. Let's consider different aspects of the programme before delving into specifics. I'm not going to go into details of the programme here. Head over to Google if you're keen.

Politics
Lots of anti-Thatcher commentary, so obviously 25 years out of date. Still resonant for those who grew where the effects of Thatcherism were at their most malevolent so perhaps not as dated as all that. However, from what I've seen, the political activist Rik-like student is dead and buried largely due to the pressure of fattening up the CV.

Fashions
Neil the hippy was always out of date being a character from Nigel Planer's late70s set transported into the format. Nostalgia being what it is, this slight anachronism of the time now seems less obvious and, oddly, Neil now seems to make more sense rather than less. Rik's hair looks like it is, being an early 80's rat tailed nightmare. That's the problem with being up-to-date: you tend to date. Mike looked bizarre at the time and still looks odd. For a man who isn't keen on hippies, he has a predilection for the lapels seldom seen outside 70s school photos. Vyvyan falls into the Neil camp: what kind of punk was he supposed to be? A poorly thought-out hybrid punk / new wave of British heavy metal nightmare. From the neck up, he could pass for a punk with the forehead and nose piercings and a very odd sort of mohican sort of not haircut plus a chain around his neck. His "Very Metal" denim body warmer and Whitesnake T shirt plus wrist bands are pure poodle metal. Waist down, the patchy-bleached jeans and DMs fit either label. Whatever: punk we wasn't. But does he look dated: not really; like Neil, he looked odd then and looks odd now.

Conclusion: doesn't look too bad (except for Rik, particularly when he goes the yellow dungarees).

Music
The live bands selected have stood the test of time... except maybe for Rip, Rig and Panic. Motorhead still look the same as do Madness. Ultra-short term nostalgia being what it is, most of the bands you see are still touring so music isn't problem (ex-Party where a Human League record makes an appearance... but Phil and the girls are still touring too...)

Surrealness
Never the strongest part of the deal, oddball cut-aways to elephant men, Chekov pisstakes and the like look even worse today.

Animation
Poorly animated chips / carrots and SPG looked poor at the time and still do now: no more dated now than then.

Student life
Probably the biggest anachronism. There are no grants here or in the UK. Lectures are attended on pain of unemployment with large debts. Medical students don't dress like that (if they ever did). New Universities don't get to go on University Challenge (often). Trips to the laundrette don't happen. Student houses are fully serviced and have broadband. You work your summers. Can't remember last time I saw a rag mag.

That all being said, there's lots of similarities: student parties, acne, poor hygeine, poor housing, etc. And this is, I think, the main thing. Much of the humour comes from recognition of these things, and many more people attend university now than when the Young Ones first aired which has grown the audience of people who recognise the humour.

Watching the programme today, I still find it enjoyable. But then again, it could just be that it's my own Proust's madeleine (Copyright every single lazy writer trying to seem well read).

Random tasks slow posting rate shock

Been a busy couple of weeks so little time to keep this diary going. There's a much greater emphasis on this course on written reports than there was on my last and these are taking up too much of my time at the moment. This could be due to a number of factors:

1. I still think I'm writing a document that has to be legally correct and suitable for circulating to a paying client / customer;
2. I am over engineering everything because I don't know the level that's required;
3. I'm working inefficiently;
4. I'm incompetent;
5. I'm busy with a whole load of grown up crap in addition to uni that my fellow students don't have to take care of; or
   
6. mix of 1-5.

Whatever the cause, I'm going to have a group assignment every term until clinic takes over so I have to get used to it. It's a challenge working with some of my new colleagues sometimes. On other occasions, the quality of their writing knocks my socks off: beautiful written English at age 18.

Just on that, the quality of the character and intellect of my fellow students is most impressive (attentiveness / inappropriateness of comments in lectures notwithstanding). They're coping well with having a weird old knowitall in the class: I would have been very standoffish at their age. And I would have struggled with the volume and the diversity of the workload, I'm sure.

Right: time to finish my individual assignment. Living the dream!

Motes and eyes

Funny: the new advert for low carb beer from Toohey's can be found here:

www.youtube.com/watch?v=G8PCuh6eZeQ

Lots of jolly underdog racism here: those stupid fat seppos, eh?

Odd thing is, which is the obese more nation? Let's not get facts get in the way of a bit of stereotyping, though, eh?

BTW I'm not as po-faced as these last two postings make out: it's just that some things get my contrarian goat.

Pig Ignorant Students

I've posted before on the phenomena of students playing flash games on their laptops, passing the computers between one another in group of six or so. Irritating, rude and hard to understand. Why not stay at home and play, or go down the pub?

My theory: this minority of students are such a bunch of repressed swots that they would feel guilty if they didn't attend each and every lecture. Most of my fellow students are the product of educational hothousing both at school and at home and would probably feel the need to birch themselves should they not attend (physically, if not mentally). I'm getting tired of listening to fellow students conversations: the background level of hubub is unlike anything I've ever experienced during any of my previous degrees (been to uni too often) either in the UK (which was a med school) or in Australis (which wasn't).

I can normally put up with this, but today I had to say something. The irony of ignoring and carrying on a loud conversation whilst an aboriginal lecturer asks for attention and highlights how people's attitudes to indiginous populations need to change seemed lost on the young Australian students in front of me. The fact that the lecturer was effecting a welcome to aboriginal land to all students from where ever they came and was managing to strike a perfectly balanced tone did not help my mood.

However, I let that ride, and said nothing hoping that the students would engage as the lectuer progressed. Bear in mind here that the vast majority of the audience paid respectful attention. This did not include another student in front of me who was taking the opportunity to complete his individual assignment (why do this in a lecture? why not stay at home, you arse?)

Next up, I heard a sniggered comment from behind me when the lecturer informed the auditorium that many aboriginal people lived in Sydney and in particular in a suburb called Blacktown. I looked around to see what the deal was, but couldn't see what was going on or who was having such fund.

So far, so poor.

However, when, during the lecturer's discussion on the intervention, which contained real insights, the girl in front of me picked up her friend's iPhone and started playing some kind of bar tender game. This being the last straw for me, I leaned over:

"Perhaps you might like to listen to what's being said rather than playing a game on your friend' little phone".

The girl at least had the decency to realise that her behaviour was perhaps inappropriate and at least feigned rapt attention for the remaining five minutes.

It's going to take a while before I regain my faith in my fellow students, and the poor behaviour comes from a particular sub-population. Apologies for the lack of proof reading, but I'm a bit angry at the moment.

More on feedback

Following up from the crap sandwich discussion, I had a vague recollection of being taught something about peer feedback and how to make negative feedback as palatable as possible.

And... after spending far too much time going through old lecture notes and searching using Google, I found this* short document based on published work. This document gives guidance on how the nature of feedback affects motivation and also recommends not beating about the bush when it comes to providing feedback - so no crap sangers, please.

I particularly like the "Recognition Grid" which has stuck in my mind since I first came across it almost ten years ago:

Type of feedback / Effect on motivation (in what seems to be arbitrary units)
Generalised positive +100
Specific positive +50
Specific negative –200
Generalised negative –1,000

The point here being that generalised feedback applies to character traits, behaviours and other impossible to change aspects of an individual whereas specific relates to a particular action taken by that individual.

Thus, "I like working with you" is great to hear: I must be a stand-up guy! Compared with "You are terrible to work with"... what is it, do I have bad breath or something and if I do how do I change that?

Final point: negative feedback is remembered for much longer than positive... the taste of crap kinda lingers, a much more potent flavour than sliced white bread.

Reference: Carlopio, J., Andrewartha, G. & Armstrong, H. 2005. Developing management skills: a comprehensive guide for leaders. 3rd edn. Longmans, Australia. 409–410.


*For some reason Blogger is attaching some extraneous text in front of the ANU link. Remove the clearly wrong text if you want to see the file.

Helpful patients

One final note: I forgot how pleasant and helpul some elderly female patients are. It was a nervous group of med students who stepped onto the wards with their ill-fitting jumpers and slacks to take their first histories, but the patients couldn't have been better at putting them at their ease. And I was proud of my cohort: polite, interested, tactful.

Being a crusty old bugger, I found it reassuring to see that the public still are willing to help out such young trainees. Reminded me of the lady in the Doctor at Large (or at Something) film who told Dirk the answers to his OSCE or whatever it was called then.

Mmm... life affirming!