Where would you rather be?

PHYSICIANS NURSES ALLIED HEALTH

healthmatchbc.orgHealth Match BC is a free health professional recruitment service funded by the Government of British Columbia, Canada

FIND A JOB IN BC

TEL EMAIL: welcome@healthmatchbc.org

Please note: Specialists with postgraduate training from the UK or Ireland must hold the CCT/CCST or equivalent. UK and Irish trained Family Physicians must have a minimum

of two years approved and accredited postgraduate training and may be eligible for certifi cation without examination with the College of Family Physicians of Canada.

Photo: Picture BC

ENRICH YOUR CAREER. ENHANCE YOUR QUALITY OF LIFE. Hundreds of physicians have moved to British Columbia, Canada to enjoy a quality

of life that is envied around the world. Meet our physician services team in March

and fi nd out how we can assist you in matching your lifestyle interests with exciting

career opportunities. Register for an information session today!

Health Match BC

Information Sessions

Cardiff, March 24

14:00 and 19:00

Cardiff Marriott Hotel

Leeds, March 26

19:00

Leeds Marriott Hotel

Dublin, March 28

14:00 and 19:00

Westbury Hotel

London, March 30

19:00

Melia White House Hotel

Visit our website for more information and to register.

Dr. Entwistle & wifeBritish Columbia, Canada

TRIAGE 3

THE MAGAZINE FOR JUNIOR DOCTORS

Presenting History

JuniorDr is a free lifestyle magazine aimed

at trainee doctors from their first day at

medical school, through their sleepless

foundation years and tough specialist

training until they become a consultant. It’s

proudly produced entirely by junior doctors

- right down to every last spelling mistake.

Find us quarterly in hospitals throughout

the UK and updated daily at JuniorDr.com.

Team Leader

Matt Peterson, team@juniordr.com

Editorial Team

Yvette Martyn, Ivor Vanhegan, Anna Mead-

Robson, Michelle Connolly, Muhunthan

Thillai, Anjali Balasanthiran

JuniorDr

PO Box 36434, London, EC1M 6WA

Tel - +44 (0) 20 7 193 6750

Fax - +44 (0) 87 0 130 6985

team@juniordr.com

Health warning

JuniorDr is not a publication of the NHS,

David Cameron, his wife, the medical

unions or any other official (or unofficial)

body. The views expressed are not neces-

sarily the views of JuniorDr or its editors,

and if they are they are likely to be wrong.

It is the policy of JuniorDr not to engage

in discrimination or harassment against

any person on the basis of race, colour,

religion, intelligence, sex, lack thereof,

national origin, ancestry, incestry, age,

marital status, disability, sexual orientation,

or unfavourable discharges. JuniorDr does

not necessarily endorse or recommend the

products and services mentioned in this

magazine, especially if they bring you out

in a rash.

© JuniorDr 2012. All rights reserved.

Get involved

We’re always looking for keen junior doc-

tors to join the team. Benefits include

getting your name in print (handy if you

ever forget how to spell it) and free sweets

(extra special fizzy ones). Check out

JuniorDr.com.

What’s inside

04

08

09

20

28

22

30

LATEST NEWS

PHOTO FEATURE

BEGINNERS GUIDE TO

RESEARCH

ORAL AND MAXILOFACIAL

SURGERY

WEEKEND WARD ESCAPE

DR. FAIRYTALE: JAMES BOND

COURSES AND

CONFERENCES

I n the 1940s it was estimated that 81% of men and 39% of women in the UK smoked. Adverts adorned the sides of

buses proclaiming the health benefits and attractiveness of this glamorous habit - even Eton College made smoking compul-sory at one point.

Few people believed that smoking had any serious impact on health - and those that did understood it to be a minor incon-venience to the stress-relieving benefits tobacco brought.

�en in 1951 Richard Doll and Austin Bradford Hill published their pioneering paper in the BMJ. �ey studied patients across 20 London hospitals and their research finally demonstrated that smok-ing was a causal link in the development of lung cancer.

�eir work continued over the next three years as they enrolled 40,000 doctors in a study which looked at whether smok-ers went on to develop lung cancer. �ey found a direct correlation, and following two further papers the government final-ly embarked on a tobacco control policy which dramatically helped to reduce use.

Today the number of smokers is under 20% of the adult population - across both men and women. Without the ground-breaking work of researchers, such as Doll, the link between smoking and cancer may never have been discovered.

Clinical research is critical to the ongo-ing improvement of health, and many would say should be a key component of the training and activity of doctors. Sadly it is not an integral part of the curriculum for most doctors and often the first formal exposure is applying for a PhD.

In this issue, with the help of the team from NIHR CLAHRC Northwest Lon-don, we’ve produced a Beginner’s Guide to Research. We’ll take you through the routes into research, practical advice for getting research off the ground as well as tips on sources of funding.

We hope you’ll find our guide use-ful no matter what career stage you’re at. Read our guide then search out answers to your questions from our experienced team online at JuniorDr.com.

THE IMPORTANCE OF RESEARCH

NEWS PULSE4

Tell us your news.

Email team@juniordr.com or

call 020 7193 6750.

P atients admitted to hospital at the weekend have a significantly increased risk of death within the fol-

lowing 30 days compared to those admit-ted on a week day, according to research published in the Journal of the Royal Soci-ety of Medicine.

�e analysis of 14.2 million NHS admissions between April 2009 and March 2010 showed that elective and emergency admissions on a Sunday had a 16 percent increased risk of death within 30 days com-pared to those admitted on a Wednesday.

“�is study is further evidence that patients admitted at weekends are more likely to die following admission than patients admitted to hospital during the week,” said Dr Andrew Goddard, director of medical workforce at the Royal College of Physicians.

“�ere are many reasons for this, but the two most important are that the patients are more ill and there are fewer doctors available.”

�ese results, from the Quality and Out-comes Research Unit at University Hospital Birmingham Foundation Trust, are consis-tent with a similar study of 254 not-for-profit hospitals in the United States.

�e Royal College of Physicians says the outcome of this study strengthens the evi-dence behind their call that any hospital admitting acutely ill patients should have a consultant physician on-site for at least 12 hours per day, seven days a week.

SEVEN DAYS A WEEK WORKING

Despite a higher death rate in patients admitted at weekends the overall death rate on Saturdays and Sundays was found to be lower than during the week. For every 100 deaths among patients in hospital on a Wednesday, 92 deaths would occur among similar patients in hospital on a Sunday.

“�is phenomenon must be due to the way services are organised since, all things being equal, we would expect a similar num-ber of deaths on each day of the week,” said Professor Domenico Pagano, lead researcher in the study.

“It may be that reorganised services pro-viding seven day access to all aspects of care could improve outcomes for higher risk patients currently admitted at the weekend. However, the economies for such a change need further evaluation to ensure that such reorganisation represents an efficient use of scarce resources.”

jrsm.rsmjournals.com

INCREASED RISK OF DEATH FOR PATIENTS ADMITTED AT WEEKENDS

PATIENT SAFETY

GMC

N ew guidance from the General Med-ical Council which prevents doc-tors entering into contracts or agree-

ments which stop them raising concerns about poor quality care has come into effect this month.

�e guidance document, which has been sent to all 240,000 doctors, explains that doctors have a duty to act when they believe patient safety is at risk, or when a patient’s

care or dignity is being compromised.Raising and acting on concerns about

patient safety (2012) has been implement-ed as a result of so-called ‘gag’ clauses which have prevented employees criticising care provided by their employer.

“Our guidance makes clear that doctors have a duty to act when they believe patient safety is at risk, or when a patient’s care or dignity is being compromised,” said Niall

Dickson, the Chief Executive of the Gen-eral Medical Council.

“Our new guidance also makes clear that doctors must not sign contracts that attempt to prevent them from raising con-cerns with professional regulators such as the GMC and systems regulators, such as the CQC.”

www.gmc-uk.org

Dr Andrew GoddardDIRECTOR OF MEDICAL

WORKFORCE, RCP

“This study is further evidence that

patients admitted at weekends are

more likely to die following admission

than patients admitted to hospital

during the week.”

GUIDANCE PREVENTING DOCTORS BEING ‘GAGGED’ COMES INTO EFFECT

S urgeons aged between 35 and 50 years pro-vide safer care compared to their younger or older colleagues, according to a study

published on bmj.com.Existing research has found that surgeons reach

their peak performance between the ages of 30 and 50 years or after about 10 years’ experience in their specialty but few studies have measured the association between clinicians’ experience and performance.

�is new study by the University of Lyon reviewed 3,574 thyroidectomies by 28 surgeons and found that patients were at higher risk of per-manent complications following thyroid surgery when operated on by both inexperienced surgeons and those in practice for 20 years or more.

When thyroid surgery was performed by

surgeons in practice for 20 years or more, the probability of permanent complications increased considerably. Surgeons between 35 and 50 years old had better outcomes than their younger or older colleagues.

�e authors say their findings suggest that sur-geons’ performance varies over the course of their career and that a surgeon cannot achieve or main-tain top performance passively by accumulating experience which raises concerns about ongoing training and motivation throughout a career that spans several decades.

www.bmj.com

SURGEONS AGED BETWEEN 35 AND 50 PROVIDE SAFER CARE

SURGERY

W ide variations in MRCOG pass rates appear to be linked to the particular med-ical school where the student graduated,

according to research published online in the Postgraduate Medical Journal.

�e research looked at first time pass rate for doctors who had graduated from UK medi-cal schools for both parts of the Royal College of Obstetricians and Gynaecologists (MRCOG) membership exam between 1998 and 2008.

Among the 1335 doctors who took Part 1 and 822 took Part 2 MRCOG during the study peri-od, analysis revealed considerable variations in the pass rate, depending on the medical school the candidate had attended.

Doctors who had studied medicine at Oxford had the highest pass rate (82.5%+), followed by graduates from Cambridge (75%), Bristol (just under 60%), and Edinburgh (57.5%) for the Part 1 exam. At the other end of the spectrum, grad-uates from Southampton (just under 22%), and Wales (18%) had the lowest pass rates.

For Part 2, graduates from Newcastle upon Tyne had the highest pass rate at just under 89%, followed by those from Oxford (82%+), Cam-bridge (81%), and Edinburgh (78%+). Con-versely, only around half of those from Glasgow

(49%+) and just over a third of those from Leices-ter (36%+) passed the written exam.

Overall academic performance of the univer-sity’s students was associated with the pass rate in Part 1, but not in Part 2, the findings showed.

“Undergraduate and postgraduate medical education are now considered as a continuum in the training of a specialist in all fields of medicine,” say the authors, but “little consideration is given to the effect that changes in style of learning, the curriculum and objectives of undergraduate edu-cation might have on postgraduate performance.”

pmj.bmj.com

MEDICAL SCHOOL LINK TO WIDE VARIATIONS IN PASS RATE FOR MRCOG

TRAINING

www.garlandscience.com

978-0-415-68003-5

978-0-415-69314-1

978-0-415-68416-3

978-1-85996-264-0

NEW IN 2012

Immunology, Third Edition

Neuroscience, Third Edition

Microbiology, Fourth Edition

Biochemistry, Fourth Edition

Kindle versions

also available

Recently published

NEWS PULSE6

W omen who apply for surgical training are proportionately more likely to be appointed than men, according to a

paper published in the Bulletin of the Royal College of Surgeons.

�e study looked at all applicants to surgi-cal training in England and Wales over a two year period. It found that, while 29 per cent of applicants to basic surgical training were wom-en, 31 per cent of appointees were female, sug-gesting women performed better in the appli-cation process than men.

Women’s success rate was even greater in higher surgical training: in one year (2008) only 16 per cent of applicants were women, making up 22 per cent of appointees.

“Surgery needs the very best doc-tors and this means ensuring everything is being done to encourage the widest pool of applicants,” said Scarlett McNally, Con-sultant Orthopaedic Surgeon at East-bourne District General Hospital and Chair of Opportunities In Surgery.

“Given that the majority of those qualifying from medical school are women, to ensure the best possible surgeons in the future it is essen-tial that a surgical career is seen as an attractive choice to both sexes.”

�e paper also reported an attrition rate, with the 25 per cent of the female applicants for basic surgical training dropping to 15 per

cent for higher training suggesting that the years of postgraduate training coinciding with the years of child-rearing may be a factor in dis-suading female doctors from remaining in sur-gical training.

Surgery remains a profession significantly populated by men. Women account for 55 per cent at medical school but only 7 per cent of consultant surgeons. All surgical specialties are very competitive, with only 9 per cent of appli-cants securing a training post.

www.rcseng.ac.uk/publications/bulletin/

N ew appointees to the Foundation Pro-gramme will undertake a minimum of four days shadowing immediate-

ly before starting F1, the Department of Health in England has announced.

�e new shadowing scheme has been intro-duced following pilots across England and oth-er parts of the UK. �e aim is to reduce the lev-el of stress which many newly qualified doctors experience whilst also improving patient safety.

All foundation doctors appointed in Eng-land will spend a minimum of four work-ing days shadowing the F1 job that they will be taking up and completing a trust-based induction.

Foundation doc-tors will be paid for this shadowing period on a pro-rata basic F1 salary and all new F1s have been told they must ensure they are avail-able for at least the last week of July 2012.

New F1 doctors in Wales have been required to participate in a paid four day shadowing period for the last few years. Dif-ferent arrangements exist in Scotland and Northern Ireland and further information will be provided to new F1s in these coun-tries in the near future.

www.foundationprogramme.nhs.uk

FOUR DAYS SHADOWING FOR FY DOCS

TRAINING

WOMEN MORE LIKELY TO BE APPOINTED TO SURGICAL TRAINING

SURGERY Doctors for export

Fifteen percent of US doctors were

trained in low income countries, ac-

cording to research published in PloS

ONE. The study by the Stanley Medical

Research Institute found the practice

was clinically and economically benefi-

cial to the US but may have a negative

impact on the countries of origin. They

found that the Philippines had the big-

gest loss of doctors to the US.

www.plosone.org

Healthy advice from healthy docs

Doctors who have more healthy

habits are more likely to recommend

five important lifestyle modifications

to patients, including eating healthy,

limiting sodium intake, maintaining a

healthy weight, limiting alcohol and be-

ing more physically active. The study

by the Emery School of Medicine also

found that doctors who exercised at

least once a week or didn’t smoke were

about twice as likely to recommend the

five interventions.

www.heart.org

Blockbuster binge drinking

Teenagers who watch a lot of mov-

ies featuring alcohol are three times as

likely to start binge drinking compared

to their peers, according to a study pub-

lished in BMJ Open. After watching on

average 4.5 hours of on-screen alcohol

use in the two year study the proportion

of teens who started drinking alcohol

more than doubled from 11% to 25%,

while the proportion who began binge

drinking - defined as five or more drinks

in a row - tripled from 4% to 13%.

bmjopen.bmj.com

Collision injuries from iPods

The number of cases of serious in-

jury sustained while walking along the

street wearing headphones for a hand-

held device, such as an iPod or MP3

player, has tripled in six years, accord-

ing to research published in Injury Pre-

vention. During the study period, there

were a total of 116 collisions - 81 (70%)

of which were fatal. In three out of four

cases, eyewitnesses said the victim was

wearing headphones at the time.

injuryprevention.bmj.com

H eavy alcohol use one year prior to an operation is associated with lon-ger stays, more days in intensive care

and increased return to theatre, according to new research published in the Journal of the American College of Surgeons.

�e study of 5,171 male patients found patients who score highest on the Alcohol Use Disorders Identification Test-Consump-tion (AUDIT-C) experience longer post-operative hospital stays and more days in the intensive care unit (ICU); they are also more likely to return to the operating theatre within 30 days of a surgical procedure than patients with low AUDIT-C scores.

Men with high-risk drinking spent nearly a day longer in the hospital and 1.5 more days in the ICU, and they were twice

as likely to return to the operating theatre compared with low-risk drinkers (10 per-cent versus 5 percent, respectively).

“�e findings from this study indicate that preoperative alcohol screening might serve as an effective tool to identify patients at risk for increased postoperative care,” said Anna Rubinsky, lead author of the study.

A previous randomised, controlled tri-al among patients scheduled for elective colorectal surgery who reported drink-ing more than four drinks daily found that patients who stopped drinking for one month prior to the procedure reduced their risk for postoperative complications by as much as 50 percent.

www.facs.org

M ore than one in ten (13%) UK based scientists or doctors are aware of colleagues intentionally altering or fabricating data during their research or for the purposes of publica-

tion, according to a survey by the BMJ.A further 6% of the 2,700 responses say they were also aware of

possible research misconduct at their organisation which has not been properly investigated.

“While our survey can’t provide a true estimate of how much research misconduct there is in the UK, it does show that there is a substantial number of cases and that UK institutions are failing to investigate adequately, if at all,” said Dr Fiona Godlee, BMJ Edi-tor in Chief.

�e study reflects previous research among newly appointed con-sultants in seven UK hospitals. One in ten said they had first-hand knowledge of scientists or doctors intentionally altering or fabricat-ing data, and 6% admitted to past personal research misconduct.

“�e BMJ has been told of junior academ-ics being advised to keep concerns to themselves to protect their careers, being bullied into not publish-ing their findings, or hav-ing their contracts termi-nated when they spoke out,” said Dr Godlee.

www.bmj.com

HEAVY ALCOHOL USE ASSOCIATED WITH POORER SURGICAL OUTCOMES

HIGH RATE OF RESEARCH FABRICATION IN UK

SURGERY

ETHICS

Dr Fiona GodleeBMJ EDITOR IN CHIEF

“The BMJ has been told of junior

academics being advised to

keep concerns to themselves to

protect their careers.”

Night sweats?It’s four a.m.

You’ve been bleeped.

You know what to do.

But it would be good to get a second opinion – just for peace of mind.

That’s exactly what Best Practice provides. A trusted second opinion on the assessment, treatment and management of patients.

On call. All day. All night.

Just when you need it.

DIAGNOSE • TREAT • MANAGE • LEARN

For the best in clinical decision support tools, visit bestpractice.bmj.com

BRAINS AT THE WELLCOME COLLECTION

A “BRAINBOW”

A ‘brainbow’ forms from the process of highlighting individual neurons in the brain by using fluorescent proteins. It produces colourful images by randomly expressing different ratios of red,

green, and blue derivatives of green fluorescent protein in individual neurons. "is process has been a major contribution to the field of connectomics, or the study of neural connections in the brain.

Brainbows form part of ‘Brains’ - a major new free exhibition at the Wellcome Collection until 17 June. It seeks to explore what humans have done to brains in the name of medical intervention, scientific enquiry, cultural meaning and technological change.

Wellcome Collection, 183 Euston Road, London NW1 2BE

www.wellcomecollection.org

Used with permission. Livet and Lichtmann

Harvard University.

RESEARCH 9

A BEGINNERSGUIDE TO

Conducting research as a clinician can be an exciting and

rewarding opportunity. Even if you don’t make the next ‘big

discovery’, with the right approach, preparation and support

you can make new connections and learn new skills which

can enhance your clinical practice - and provide significant

benefits for patients.

This guide to research is produced by selected authors with

research experience and covers important considerations

from the earliest stage of a research idea to undertaking a

career in research.

Read the advice from our experts then join the discussions

and ask your questions online at JuniorDr.com.

RESEA

Research: Your First Thoughts

Research Methods

Engaging with Statistics in Research

Patient & Public Involvement in Planning and Executing

Research

The Practical Aspects of Getting Research ‘Off the

Ground’

The Importance of PR & Communications in Conducting

Research

Patient and Public Views of Electronic Health Records

Routes into Research

Government Sources of Research Funding

Non-Government Sources of Research Funding

Transferable Skills from Research

Applying the Findings from Research to Benefit Patients

Experiences of a Researcher

IN THIS GUIDE

Dr Anjali Balasanthiran

CLINICAL RESEARCH FELLOW NIHR CLAHRC

FOR NORTHWEST LONDON

Professor Derek Bell

CHAIR OF ACUTE MEDICINE, RESEARCH AND

DEVELOPMENT DIRECTOR AT CHELSEA AND

WESTMINSTER HOSPITAL, DIRECTOR OF NIHR

CLAHRC FOR NORTHWEST LONDON

SECTION EDITORS

RESEARCH10

GETTING STARTED

�e first step on the research career lad-der is to identify a research topic that inter-ests you - which can often be a difficult task. Strategies to help you with this include keep-ing an interest log or diary, brainstorming ideas (looking for patterns and recurring top-ics) and approaching local researchers to find out what is already going on in your area. Regular reading of the medical literature may also reveal startling gaps in current knowl-edge that you may be the first to recognise!

You may then, for example, express an interest in cancer research but which aspects in particular? Do you want to work on a specific cancer? Do you want to perform molecular or epidemiological studies or do you want to work on cells in culture, animal models or clinical studies?

Whilst it is beneficial to be flexible in the topic you wish to study you should aim to define a topic which is manageable with a small scale focus, with options available for the investigation of your hypotheses.

Once you have considered various top-ics you may wish to approach potential research supervisors whose interests cover the topic you wish to study. �eir role will be to assist you in formulating appropriate research questions, guiding you through the design, planning, funding and management of your project.

Most large academic institutions run ‘graduate schools’ that can assist you in find-ing an appropriate supervisor for your stud-ies. Your supervisor need not be a clinician and many advances in medicine have come about through collaboration with chemists, engineers and others.

Remember that the goal of medi-cal research is not only to generate new knowledge but also to become a competent researcher, capable of undertaking indepen-dent study in your chosen field. Involvement in existing projects may allow you to devel-op these skills in a supportive environment before progressing to lead your own work.

Dr Caroline Patterson, Clinical Research Fellow, Imperial College, London

DISCLAIMER: THIS ARTICLE PRESENTS INDEPENDENT

RESEARCH PARTIALLY COMMISSIONED BY THE NATIONAL

INSTITUTE FOR HEALTH RESEARCH (NIHR) UNDER THE

COLLABORATIONS FOR LEADERSHIP IN APPLIED HEALTH

RESEARCH AND CARE (CLAHRC) PROGRAMME FOR

NORTH WEST LONDON. THE VIEWS EXPRESSED IN THIS

PUBLICATION ARE THOSE OF THE AUTHOR(S) AND NOT

NECESSARILY THOSE OF THE NHS, THE NIHR OR THE

DEPARTMENT OF HEALTH.

RESEARCH 11

A BEGINNERS GUIDE TO RESEARCH

Research methodology, or design, describes how a researcher goes about answering a research question. Broadly speaking, research design in health scienc-es is either descriptive or empirical (see Fig 1). �ese differ in philosophy, approach, measurement and purpose. Other consider-ations include prospective and retrospective data collection. �e appropriate choice of study design depends on the research prob-lem you are trying to answer.

For example, if a researcher wishes to discover whether intervention with Drug B will improve mortality rates in elder-ly patients who have been admitted with an acute stroke, a randomised control tri-al is entirely appropriate. If, however, the researcher wishes to discover how carers of elderly patients who have suffered an acute stroke cope in the community, a question-naire survey investigating carers’ percep-tions is the most appropriate choice1.

Dr John Soong, RCP Clinical Quality Improvement Research & Training Fellow

Further information about qualitative research: Mays N, Pope C, Journal BM. Qualitative research in health care: Wiley Online Library, 1996.

Key messages:

Seek advice from a statistician early and oftenDon’t underestimate the extent to which a statistician will need to understand the detail of your proposed research in order to advise you effectively; or the time this will take.“Wisest is he who knows he does not know” - be prepared for the statistical ad-vice you receive to shape the design and implementation of your studyInvolve your statistician at all stages of your study

Consider your statistician in funding ap-plications and publications Be open minded about the statistical ap-proach required - but also bear in mind the needs of your stakeholders: patients, staff, funders, journals, etc.

Talk to a statistician

If you are embarking on a career in health research, you are very likely to hear these words sooner or later, maybe from a colleague, maybe in a lecture, maybe even from a statistician. �is is really good advice - but what exactly do these wise words mean

for you? Which statistician should you talk to? What should you say? When should you approach this statistician? �e way in which you interpret this superficially simple piece of advice could be a key factor in the success of your research project.

The Science of Statistics

Statistics - the science of collection, anal-ysis and presentation of data - is the means by which the hard work of your study will be transformed into meaningful knowledge. You could say that without statistics, your results will be meaningless!

RESEARCH METHODS

ENGAGING WITH STATISTICS IN RESEARCH

FIGURE 1: TRADITIONAL HEALTHCARE RESEARCH METHODS

In addition to the traditional medical research model above, new methodology has been recently developed to better

cope with the complexities of evaluating the success of interventions in real healthcare systems. These methods are

broadly described as improvement science, and come in various flavours including quality improvement, statistical

process control, lean, six-sigma and evidence based implementation.

RESEARCH12

Statistics is a science in its own right, dis-tinct from, but symbiotic with, the other sciences. It is not surprising therefore that navigating through the forest of disciplines, theories and techniques available for the sta-tistical elements of your study will require the skills and experience of a trained stat-istician. �e choice of statistical methods for your study is intimately woven together with the other aspects of your study design.

�e statistical considerations involved in a study of the implementation of a new diagnostic test will be completely differ-ent from those involved in a retrospective cohort study, or a double-blind randomised controlled trial … and within each of these broad classes of design there will be myriad factors that may be unique to your study, each impacting on the statistical design … you get the idea. �is certainly doesn’t mean that you shouldn’t aspire to having a good understanding of the methods used in your study - just that it is unrealistic to aspire to do it all yourself.

Talking to Your Statistician

In discussions with a statistician it is important to keep an open mind with regard to the methodological approach - whilst a ‘hypothesis test’ may be the appro-priate analysis when you are using a random sample to make inferences about a large population, this approach is likely to break down when studying the implementation of an intervention for real in a specific setting. In that latter case, statistical process control may be a more appropriate methodology to adopt. It is also crucial to bear in mind the needs of your stakeholders: patients, oth-er healthcare professionals, managers, col-leagues, funders, journals, etc.

Keep Talking

But it isn’t enough to talk to a statistician once at the start of a study and then wave goodbye until it’s time to analyse the data. In fact your first conversation will inevitably come up with questions that need answer-ing before the work can progress. Once you’ve established the high level plan, it’s time to talk details - will you be sampling or is all the relevant data available? If you are sampling, how will you choose your sample? How big will it need to be? What data will you need to collect? How should you go about collecting it? What is the best approach to storing your data? Answering these questions is as important as deciding

which analysis to use - a t-test is merely a wild stab in the dark if due consideration has not been given to these crucial ques-tions. Also note that some of these ques-tions are far from trivial to answer, even for the most seasoned statistician.

You may need to review existing litera-ture, collect baseline data or perform a small pilot study in order to plan your main study well.

A good research study will require statis-tical input throughout the work - from con-ception to publication and from publication to implementation. �is can amount to a substantial amount of work, and this should be reflected in any project planning, fund-ing applications, and publication author-ship. But do not despair, help is at hand! To mention but a few: your research insti-tution may have a statistics advisory service, your department or group may have dedi-cated statistical support, there is the NIHR research design service, the list goes on.

I hope that the above convinces you first-ly that it is important to “talk to a statisti-cian” about any piece of research you intend to carry out, and secondly that it is impor-tant to do this early on (right at the start), in detail (the statistician needs to understand enough about your study to locate and suc-cessfully navigate through the right area of the forest), and frequently throughout your work.

Further reading and resources:

http://www.nihr.ac.uk/infrastructure/Pages/infrastructure_research_design_ser-vices.aspx

D.G. Altman Practical Statistics for Med-ical Research, Chapman and Hall

J.M. Bland An Introduction to Medical Statistics OxfordB.R. Kirkwood and J.A. Sterne Essential Medical Statistics BlackwellD.J. Wheeler Making Sense of Data : SPC for the Service SectorGrafen, A; Hails R. Modern Statistics for the Life Sciences. Oxford.

Dr Tom Woodcock, Principal Information Analyst/Statistician, NIHR CLAHRC for Northwest London

RESEARCH 13

Explore and contribute to the world’s largest repository of case reports

Become a BMJ Case Reports Fellow today and you can submit

an unlimited number of cases and access all published content.

casereports.bmj.com

For an Institutional Fellowship and free trial, email

consortiasales@bmjgroup.com. Personal Fellowships

available for £115 + VAT. For more information visit

casereports.bmj.com/site/about/becomeafellow.xhtml

it

Over 3,000 cases

to view

Now

accepted for

indexing by Medline

(PubMed)

PATIENT AND PUBLIC

INVOLVEMENT IN PLANNING AND

EXECUTING RESEARCH

“�e more you engage with customers the clearer things become and the easier it is to determine what you should be doing” - John Russell, former Vice President of Harley Davidson Motor Company

Industry has long accepted that it is cru-cial to think about and engage with custom-ers when designing or creating products. It is easier to think this way when company profits relate directly to customers purchas-es, but perhaps more difficult to think this way in the NHS, where care is free at the point of access. But in the NHS it has long been accepted that for care to be effective it must be delivered in a more patient-cen-tred way.

And it is this ideal that should be the centre of your research. Engaging the end

user, be they staff, patients, members of the public, carers or families is crucial to ensure your research leads to useful improvements and change for healthcare. �is goes beyond involving people in a randomised controlled trial, to engaging the right people in the whole research process.

A CLAHRC-funded project, evaluat-ing a quality improvement framework to improve antibiotic prescribing in hospitals (AQIP), found value in engaging the right type of people in the right way. Local and national patient advisors were crucial mem-bers of the project team and continued to raise awareness of the project in other set-tings, thereby reaching a wider audience than the project initially intended.

Similarly, OMERACT, an internation-al network aimed at improving outcome measurement in rheumatology, gained new insights as a result of patient involvement. Novel outcomes such as fatigue were iden-tified by patient groups and incorporated

into the research agenda. �is was followed by substantial qualitative work demonstrat-ing the importance of fatigue in rheumatoid arthritis and the development of powerful instruments for measuring fatigue.

It is apparent that engagement of the right people at the right time in both these case studies added value which would oth-erwise not have been realised, or would have taken much longer to achieve.

For practical information about patient and public involvement in research, visit the INVOLVE website (http://www.invo.org.uk/) or Research Design Service, Lon-don (http://www.rdslondon.co.uk/Patient---Public-Involvement.aspx)

Meerat Kaur, Associate Programme Lead for Patient and Public Involvement, NIHR CLAHRC for Northwest London

A BEGINNERS GUIDE TO RESEARCH

RESEARCH14

THE PRACTICAL ASPECTS OF

GETTING RESEARCH ‘OFF THE

GROUND’

�e early stages of the research pro-cess will vary according to factors such as the type of research and the research unit. Despite this, there are some broad tasks for most new researchers.

Start communicating eg: supervisors, re-search colleagues, potential collaborators clinical staff, university, local research net-works, PPI experts, statisticians, hospital/

medical school’s research financial advisorConsider logistics eg: working space, storage facilities, lab/equipment/software training, stationary, data storage, good clinical practice training Get reading eg: research papers, local guidance, requirements for ethics, R&D and higher degree registration Get writing eg; initial assessments, re-search protocol, participant leaflet, GP information sheet, informed consent form, grant applications, project plan, Integrated Research Application System [IRAS] - an online application form in-corporating ethics, MHRA and Research

and Development (R&D) and other ap-plications (figure 2). Remember to leave plenty of time.

�is is not an exhaustive list and some examples may not apply to you. Your supervisor(s), local R&D department and research colleagues should be able to pro-vide local guidance. Ask if you are not sure!

Dr Anjali Balasanthiran, Clinical Research Fellow, NIHR CLAHRC for Northwest London and Imperial College and Dr John Dixon, Clinical Research Fellow, St George’s Hospital, London

FIG 2: SUMMARY OF GAINING NHS PERMISSION FOR RESEARCH (AN EXAMPLE FROM CHELSEA & WESTMINSTER)

Aligned to the recommended NIHR processes and reproduced with kind permission from the Research & Development

Support Office at Chelsea & Westminster Hospital NHS Foundation Trust.

RESEARCH 15

Meetings, emails, phone calls, texts; these are things we do every day to com-municate with each other, yet may be the first to be forgotten when starting a research project.

Conducting a piece of research requires help via the most unexpect-ed sources. In our experience, convinc-ing people to fill out a questionnaire was the most taxing aspect, making it neces-sary to obtain help from as many differ-ent people as possible. For example, get-ting to know the receptionists at the GP practices led to the questionnaire being integrated into the checking-in system at the desk. �is proved to be quite effec-tive and demonstrates the benefits of

networking - it even doubled our recruit-ment numbers on consecutive days!

Although sometimes time consum-ing and occasionally expensive (with the amount of chocolates given out!) we couldn’t have reached the number of questionnaires filled out without being friendly and using a bit of charm. You never know who might be willing to help and you will never find out without put-ting in the effort.

Sarah Hancox & Joshua Wolrich, Medical Students and Investigators on ‘Patient & Public Views of Electronic Health Records’ (study supported by the Wellcome Trust)

A study was conducted to obtain patient’s views on the use of electronic health records for healthcare and research. Recruitment exceeded expectations and 5336 patients filled in the study questionnaire across Northwest London. Below, the researchers highlight some factors they feel contributed to their suc-cess and made working on the study a rewarding experience:

Prior to launch, the questionnaire was piloted with patient and public involvement networks. Revisions were made until all participants found the questionnaire clear and concise.Ample time was left for communication with frontline staff in order to raise the profile of the study. �e message was spread using formal cor-respondence, informal visits, departmental meetings, posters and trust bulletins.A one week induction period was invested in ensuring all researchers were clear about the aims of the study and the importance of research in the field.During recruitment, researchers always ensured they introduced them-selves to staff in the clinical areas and observed the way patients moved through the department.Close monitoring of recruitment statistics (electronic spreadsheet and whiteboard) provided a clear idea of progress as well as areas for improve-ment. Regular meetings were held to discuss problems and share success stories and tips. Networks were developed.A Gantt chart was used for project management, clearly demonstrating deadlines.Motivational charts were used and goals were set. Researchers scheduled time for socialising in order to keep fresh and motivated!

Study supported by the Wellcome Trust. Dr Anjali Balasanthiran, Clinical Research Fellow, NIHR CLAHRC for Northwest London and Imperial College

CASE EXAMPLE : PATIENT & PUBLIC VIEWS OF

ELECTRONIC HEALTH RECORDS

THE IMPORTANCE OF PR, COMMUNICATIONS AND NETWORKING IN

CONDUCTING RESEARCH

A BEGINNERS GUIDE TO RESEARCH

RESEARCH16

ROUTES INTO RESEARCH

�e route into research has traditionally been convoluted and unclear. More definite routes are now being established. For exam-ple, if you decide early on that you wish to be a clinical scientist, you can now under-take an intercalated MB PhD at under-graduate level. For more information visit - www.academicmedicine.ac.uk/careersaca-demicmed/medstudents/mbphd.aspx

For those medically qualified and at the early stages of their specialty training, NIHR Academic Clinical Fellowships are specialty training posts that incorporate

academic training into the rotation, with 75% of the rotation devoted to specialty training and 25% devoted to research (fig-ure 3). It is a structured platform to allow for the development of academic skills and experience that will support a candidate’s future application for a Research Training Fellowship (eg PhD). For more informa-tion: www.nihrtcc.nhs.uk/intetacatrain/acfs

Another option is to undertake a post-graduate degree in translational medicine or clinical research. �ese courses benefit from being fairly flexible in nature: part-time whilst in specialty training or full-time out-of-programme; at postgraduate certificate

level or up to a full masters. �ey expose trainees to both theoretical and practical aspects of research and increase the attrac-tiveness of a candidate when applying for research training fellowships.

If you intend to continue clinical work during your time in research consider care-fully how this will impact on your research time. Also note that if you would like your time in research to count towards your total training time this should be agreed prospec-tively by the deanery.

Dr John Soong, RCP Clinical Quality Improvement Research & Training Fellow

FIGURE 3: ACADEMIC TRAINING PATHWAY (THE NATIONAL STUDENT ASSOCIATION OF MEDICAL RESEARCH, NSAMR)

RESEARCH 17

GOVERNMENT SOURCES OF RESEARCH FUNDING

�e Government currently funds health related research through two main routes, the Medical Research Council (MRC) and the National Institute for Health Research (NIHR).

In 2010-2011 the Medical Research Council received £682 mil-lion from the Department of Innovation, Universities and Skills and the National Institute for Health Research (NIHR) received £992 million from the Department of Health.

�e MRC supports research across the biomedical spectrum, from fundamental lab-based science to clinical trials, and in all major disease areas.

�e NIHR supports NHS, social care and public health research. �e role of the NIHR is to develop the research evidence to support decision-making by professionals, policy makers and patients, make this evidence available, and encourage its uptake and use. NIHR research covers the full range of interventions, including pharma-ceuticals, biologicals, biotechnologies, procedures, therapies and practices, for the full range of health and healthcare delivery such as prevention, detection, diagnosis, prognosis, treatment and care.

Both the MRC and NIHR provide opportunities for young doc-tors to get involved with research and have established career paths to support development of clinical academics.

MRC Career Path and Funding Options

Clinical research training fellowship: Up to three years support for clinically qualified, active professionals to under-take specialised or further research training.

Doctoral Studentships: �e MRC funds postgraduate research training through studentships. �ey do not provide funding to students directly; prospective students should con-tact the institution at which they wish to study

Clinician scientist fellowship: To enable outstanding clini-cal researchers to consolidate their research skills and make the transition from postdoctoral research and training to indepen-dent investigation.

Jointly funded clinical research training fellowship: Opportunities for additional clinical research training fellowships through collaborations with Royal Colleges and Charity funders.

Senior clinical fellowship: Prestigious award for clinical researchers of exceptional ability.

For further information see www.mrc.ac.uk/Fundingoppor-tunities/index.htm

NIHR Career Path and Funding Options

NIHR Integrated Academic Training Programme: An inte-grated academic training scheme for junior doctors to enable them to combine academic and professional training.

Two main schemes make up this NIHR-funded pathway: Aca-demic Clinical Fellows (ACFs) and Clinical Lectureships (CLs). Funding is provided for some 250 ACFs and 100 CLs for doctors:

An Academic Clinical Fellow provides a protected period of pre-doctoral research training (25% WTE) with the remaining time spent undertaking specialty training. Fellows prepare themselves for a subsequent period of PhD training that may be funded by NIHR or other major research funders (see routes into research). A Clinical Lectureship is an early postdoctoral award that splits time equally between research and clinical training.In-Practice Academic Fellowships for fully qualified general

practitioners (GPs) and dental GPs with only limited research experi-ence, but who can demonstrate potential as future clinical academics.

NIHR Trainees - PhD studentship opportunities

NIHR-funded PhD students based mainly in NIHR Biomedi-cal Research Centres (BRCs), Biomedical Research Units (BRUs) and Collaborations for Leadership in Applied Health Research and Care (CLAHRCs).Trainees are supported through approved training programmes offered by NIHR Schools.

NIHR Fellowship Programme

Four levels of fellowship are offered covering four career stages from PhD training through to establishment as an independent researcher:

NIHR Doctoral Research FellowshipsNIHR Post Doctoral FellowshipsNIHR Career Development FellowshipsNIHR Senior FellowshipsFor further information see http://www.nihr.ac.uk/faculty/ or

http://www.nihr.ac.uk/Lists/Research%20Training%20Awards/awards_current.aspx

Dr Julie Reed, Health Foundation Improvement Science Fellow and Head of Research Strategy for NIHR CLAHRC for Northwest London

Learn more about the BMA atwww.bma.org.uk

Worriedabout yourpension?

Concernedabout NHSreforms?

The British Medical Association – providing doctorswith peace of mind in the workplace.

Join your trade union today to have your say!

A BEGINNERS GUIDE TO RESEARCH

RESEARCH18

Your local R+D financial advisor will be able to advise you on any potential study costs involved and suggest sources of funding. Some are listed below:

1. Commercial/Pharmaceutical compa-nies - often sponsor early phases of drug trials and will pay full economic costing (i.e. staff salaries and building overheads). Usually several centres will be involved in the same trial. Amount: often >£100K.

2. Professional bodies (e.g. Medical Roy-al Colleges) - will often fund small proj-ects to small-scale fellowships lasting 12 months. Don’t forget to apply to interna-tional bodies (e.g. European and US Soci-eties). Amount: £1-100K.

3. Disease-or-specialty-specific charities (e.g. Diabetes UK, Kidney Research UK) -provide a range of fellowships and other smaller grants. Amount: £5K-150K.

4. Local (hospital) charities - usually fund small studies or top-up more substantial grants. Amount: usually £5K maximum.

5. Non-medical research charities - rarely

fund medical research, although there are some exceptions (e.g. Bill and Melinda Gates Foundation).

6. !e Grants register - is a reference book available in most libraries that is a comprehensive guide to worldwide profes-sional and postgraduate funding.

It is important to check the relevant funding body’s website regularly because most will hold finding applications only once or twice per year.

Further information

Your Local R&D office will often be able to provide an up-to-date list of lo-cal, national and international funding opportunities.Medical Research Council. www.mrc.ac.uk/fundingopportunitesNIHR www.nihrtcc.nhs.ukWellcome trust www.wellcome.ac.ukBMA Research grants web page www.bma.org.uk/about_bma/awards_grants/ResearchGrantsOther.jsp�e Grants Register

Dr John Dixon, Clinical Research Fellow, St George’s Hospital, London

TRANSFERABLE SKILLS FROM RESEARCH

Aside from clinical and technical skills, here are just a few of the other skills you may develop/hone during your time in research. �ese skills are likely to boost your confidence, enhance your practice and make you more appealing to potential employers.

For tips on incorporating your research experiences into your CV as well as general med-ical CV writing skills see: http://careers.bmj.com/careers/advice/view-article.html?id=3043

Dr Anjali Bala, Dr Caroline Patterson, Dr John Soong

Problem-solvingIndependent thinkingSelf-directed learningProject managementTime ManagementNegotiationAssertivenessResource Management

Adaptability PresentationStatisticsEthicsCritical AnalysisSystematic reviewInformed consentSelf awareness

NetworkingCommunication Team workingCreativityStress managementIT

APPLYING THE FINDINGS FROM

RESEARCH TO BENEFIT PATIENTS

Research plays an extremely important part in the development of new treatments and technologies for use in healthcare and also provides a greater understanding of patients’ needs and experience. However, the transfer of research knowledge into care is slow at best and absent at worst. For every £100 spent on research only £1 is spent on implementing the findings of the research to improve patient care.

Cooksey2 identified two gaps in the translation of research in to healthcare. �e first gap is between the translation of biomedical knowledge to innovations, the second gap lies between the generation of innovations and their inclusion in the stan-dard delivery of care.

�e National Institute of Health Research, directly funds research within the NHS and aims to create a world class infra-structure in the UK for the comprehen-sive development, testing and implemen-tation of innovations that benefit patients. �e NIHR funds a range of programmes including Biomedical Research Centres and

What is your role within the NIHR CLAHRC for

Northwest London?

I am a clinical research fellow but whilst my main role is working on my postgradu-ate research project (see below), I have also been fortunate enough to get involved with several parallel projects.

CLAHRC has also offered me the opportunity to gain experience in quali-ty improvement through research strategy meetings and learning events. Collabora-tions with non-clinical and clinical experts have made me challenge some of my views and helped me gain an appreciation for dif-ferent perspectives.

What area of research are you working on,

and how did you get interested in it?

Knowing myself, I appreciated early on that I would be happiest working on a practical, patient-facing project. I chose to work on stress hyperglycaemia, a com-mon and under-diagnosed condition, often

REFERENCES

1. Crowe M, Sheppard L. Qualitative and quantitative research designs are more similar than different. Internet

Journal of Allied Health Sciences and Practice. 2010;8:1-6.

2. Cooksey D. A review of UK health research funding. 2006 [http://www.hm-treasury.gov.uk/d/pbr06_cooksey_final_

report_636.pdf]

NON-GOVERNMENT SOURCES OF RESEARCH FUNDING

RESEARCH 19

Units, which aim to bridge the first trans-lational gap through new innovations and advances in medical care from basic clini-cal and biomedical research. A recent addi-tion to the NIHR family of research pro-grammes includes the Collaboration for Leadership in Applied Health Research and Care (CLAHRC). �e aim of the CLAH-RCs is to close the second translational gap in delivering research evidence into every-day practice. Nine CLAHRCs have been established across England receiving over £88 million of government funding.

�e CLAHRC for Northwest London was established in October 2008. �e CLAHRC for Northwest London’s vision is that patients experience a seamless journey with consistent delivery of the highest quality evidence based care achieving this by developing a systemat-ic and scientific approach to the implementa-tion of evidence based care that is generalis-able and transferable across health economies. Key components of the CLAHRC for North-west London approach are:

Understanding care from the perspective of patients and carers through engaging patients and public with the design and development of care

Bringing research more rapidly into ev-eryday practice, utilising rapid-cycle re-search, improvement methodologies and rigorous evaluation of clinical and cost effectivenessAdopting industrial standards of quality in the NHS through utilising informa-tion to drive evidence based implementa-tion and support evidence based practiceIncreasing staff capacity for research and implementing change and improvements across professional and organisational boundaries.

�e CLAHRC for Northwest London is conducting improvement driven research in 18 different clinical areas ranging from managing Sickle Cell in primary care to increasing referrals to mental health servic-es and improving compliance with NICE standards from COPD in acute care.

Stuart Green, Public Health Information Officer/Research Fellow, NIHR CLAHRC for Northwest London & Dr Julie Reed, Health Foundation Improvement Science Fellow and Head of Research Strategy for NIHR CLAHRC for Northwest London.

associated with poor outcomes. �e study design is prospective and observational and patients are recruited from the acute assess-ment unit (AAU).

�is area of research fits in very well with my training as it covers aspects of Diabe-tes, Endocrinology and General Medicine. I became interested in it after lots of read-ing and chatting with colleagues and super-visors. �e office whiteboard was useful for brainstorming ideas!

I am also an investigator on a multicen-tre randomised, double-blind trial. I got involved in this after making contact with various experts in the field of stress hyper-glycaemia and expressing an interest.

What does a typical day entail for you?

A typical day for me would start with checking AAU for patients who may be suit-able for my study. Often I will do this with our research nurse. If recruitment is success-ful, then study procedures typically take up most of the day. If I do not recruit, then

there is plenty of work to keep me going! I try to keep it varied and interesting as sit-ting at a desk can sometimes be tricky when you are used to pacing the wards all day!

Desk-work may include literature review, data analysis and entry, telephone follow-up of recruited patients, grant applications, affiliated projects supporting CLAHRC, or work on the outcomes of research (post-ers, presentations, papers etc). I also attend courses which complement my research and training eg: statistics, academic writing, spe-ciality training days and have regular meet-ings with supervisors and collaborators. �ere are also plenty of opportunities to get involved in undergraduate teaching.

What do you enjoy most about your work?

It is great to feel as if you are becoming an ‘expert’ in your field and are contribut-ing, even in a very small way, to knowledge which may benefit patients.

What keeps you awake at night?

Deadlines and missed opportunities!

What has surprised you most about doing

research?

How willing patients are (when approached nicely) to take part in research, even when they know it will not necessarily benefit them directly.

What advice would you give to junior doctors

thinking about getting involved in research?

Whilst there are many positives to research, it may initially be a challenge to adapt to a non-clinical environment and work in a self-directed manner. If possible, try to vary your days to keep refreshed and motivated and allow plenty of time for everything. Keep good people around to talk to and inspire you.

INTERVIEW: EXPERIENCES OF A RESEARCHER

A BEGINNERS GUIDE TO RESEARCH

Dr Anjali Balasanthiran

CLINICAL RESEARCH FELLOW NIHR CLAHRC FOR NORTHWEST LONDON

CAREERS20

What do maxillofacial surgeons actually do?

It may sound like a cliché, but think of the face and ask what a maxillofacial sur-geon can’t do! It isn’t only teeth and max-illofacial surgeons aren’t all just dentists (although yes, you do need a medical and dental degree to start speciality training).

As a junior trainee you will spend your on-call shift seeing facial trauma. �at includes suspected fractures, soft tissue inju-ries and dento-facial infection. Maxillofacial surgery is one of the few specialities where you are able to undertake a wide array of

soft tissue work in A&E - and given the number of soft tissue injuries that present via A&E, a significant number of these will be referred to maxillofacial surgery. Being on-call is not just about admitting and clerking patients, you actually get to treat them too unlike many specialties.

For a specialist trainee the scope of sur-gery is broad and diverse (see table 1) and operations can range from a 12-hour head and neck cancer free flap to advancing a patients mandible and maxilla - both are complex and engaging and you acquire a unique surgical skillset.

Is maxillofacial surgery right for me?

�e face is a ‘high stakes’ surgery and anatomically complex. �ese technical and aesthetic concerns make oral and maxillofa-cial surgery (OMFS) both a challenging and rewarding speciality.

You may be a Medical Student, Founda-tion Doctor, or a Core Surgical Trainee con-sidering ST applications - but all the usual tactics still apply. Speak to trainees and reg-istrars already committed to the speciality.

�e Junior Trainees Group of the Brit-ish Association of Oral and Maxillofacial Surgeons is an invaluable resource1; email a committee member, join the group, or attend their annual conference. If you are a medical student reading this then speak to your local hospital OMFS team and get some exposure.

As a Foundation or Core Trainee you should ‘try before you buy’. Within your

hospital introduce yourself to the lead Con-sultant and arrange to spend some time in the department. Medical school special study modules or trainee taster days/weeks are also great for this. An up-to-date article (Tahim et al.) lists all the above and more, describing the various avenues of learning more about OMFS as a career2, and the online OMFS trainee journal Face Mouth & Jaw Surgery is an excellent source of information3.

How do I get into Maxillofacial Surgery?

If you like what you see then the Trent, Northern and Oxford deaneries all offer Foundation jobs in OMFS, and the Lon-don and Northern deaneries offer Core Training posts. As most Senior House Offi-cer positions in OMFS are filled by dental graduates, departments are always willing to employ enthusiastic medical graduates.

You may choose to take a year out after Foundation or Core training and get real OMFS job experience as this will always be helpful in future dental school or ST appli-cation interviews.

If your decide to pursue OMFS then options for dental school will soon begin to occupy your thoughts. Currently there are several four-year postgraduate courses avail-able, with only one 3-year course offered by King’s College London. However, please note that the length of Dentistry degrees is under review by the EU and may be subject to change (always check the UCAS website).

Although a considerable time commit-ment, returning to university is a unique opportunity to step off the surgical career escalator and spend time gaining OMFS experience, beefing up you CV and pursu-ing other extra-curricular activities. Touch-ing base with a local OMFS unit during this time is crucial; they can offer you on-call shifts, projects and help you keep a foot in the door.

Unfortunately, all the pros listed above are overshadowed by the recent rise in uni-versity tuition fees. A second degree is now a major financial burden. Previously students were able to obtain NHS bursaries to pay one or two years tuition, however this com-mitment has not yet been confirmed for the raised fees. Either way get ready to do plenty of locum shifts and be a poor student again!

It’s fair to say that the training pathway for OMFS is complex, changing and very confusing (figure 1). If you have completed

CAREERS IN ORAL AND MAXILLOFACIAL

TABLE 1

Head and Neck Cancer

Surgery

Removal of tumours and subsequent tissue flap

reconstruction

Craniofacial Deformity Surgery

Correction of congenital or acquired facial deformity

e.g. Cleft Lip/Palate, to improve function and quality

of life

Craniofacial TraumaManagement of soft and hard tissue injuries/tumours

of craniofacial structures

Maxillofacial SurgerySurgery of the teeth, jaw, temporomandibular joints,

and related facial soft tissues

Oral MedicineDiagnosis and treatment of medical conditions of the

oral cavity

Cosmetic SurgerySurgery to enhance facial aesthetics and improve

quality of life

(adapted from the British Association of Oral and Maxillofacial Surgery website1)

CAREERS 21

Foundation Training only, but have been able to pass your MRCS and gain OMFS experience, then you are eligible to com-plete Core Training competencies in one year and proceed to Specialist training4. ST applications are now centralised and run out of the Severn Deanery, with two annual recruitment rounds. Compared to its com-petitive surgical counterparts of Plastic or Neurosurgery, the odds in OMFS are cur-rently very favourable. Be sure to read the person specification well in advance to help tailor you CV5.

Opportunities within Maxillofacial Surgery

As a young expanding speciality there are great opportunities for academic and career fulfilment. Oral cancer is one of the most prevalent cancer types with evidence of an increasing incidence in the UK6. �e sur-vival rate has not improved in the last 20 years, as largely patients still present late because of poor awareness on their part and delayed diagnosis by other clinicians7. �ese statistics are finally getting the attention and research dedication they deserve there is great scope to undertake practice chang-ing clinical research.

Perhaps more than other surgical spe-cialities there is the opportunity to prac-tice OMFS abroad in developing countries. Charities such as Facing Africa or Mercy Ships treat facial conditions from clefts to noma and are always willing to recruit keen trainees to assist in projects abroad.

OMFS is exciting, expanding and engag-ing; and those willing to take a leap of faith and invest in a degree in dentistry will find the job opportunities and satisfaction a just

reward. If this article has sparked your inter-est then take the time to read and discov-er more about OMFS as a career, and the training pathway.

KARL PAYNE, RORY O’CONNOR,

NABEELA AHMED

D MAXILLOFACIAL SURGERY?

FIGURE 1

REFERENCES

http://www.baoms.org.uk/page.asp?id=84

Tahim A, Awal D. What resources are available for under-

graduates considering a career in Oral and Maxillofacial

Surgery: A review. Face Mouth Jaw Surg 2011; 1(2):

71-175

Face Mouth & Jaw Surgery. www.fmjs.co.uk

http://www.mmc.nhs.uk/pdf/PS%202012%20ST3%20

OMFS1.pdf

http://info.cancerresearchuk.org/cancerstats/mortality/

cancerdeaths

Doobaree IU, Landis SH, Linklater KM, El-Hariry I,

Moller H, Tyczynski J. Head and neck cancer in South

East England between 1995-1999 and 2000-2004: An

estimation of incidence and distribution by site, stage

and histological type. Oral Oncol 2009; 45(9): 809-14

Rogers SN, Vedpathak SV, Lowe D. Reasons for delayed

presentation in oral and oropharyngeal cancer: the

patients perspective. Br J Oral Maxillofac Surg. 2011

Jul;49(5):349-53.

Medical School - 5-6 years

Foundation Year 1

Foundation Year 2

SHO post in OMFS - 1 year

Dental School - 3-4 yearsSpecialist Training (OMFS)

ST3-ST7 +/- Fellowship

Core Surgical Training year 1

Core Surgical Training year 2

(CT3 OMFS themed)

Wesleyan Medical Sickness is a trading name of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Ltd is wholly owned by

Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham, B4 6AR. Telephone calls may be recorded for monitoring and training purposes.HD-AD-15 (02/11)

WIN an iPad

Your chance to WIN a new 32GB Apple iPad 3G*.

*Terms and Conditions apply. See entry form for details. Model shown for illustration purposes only and may differ from actual prize.

Wesleyan Medical Sickness specialise

in providing tailored financial advice

to medical professionals.

Our iPad competition is exclusive

for medics. To enter visit

www.wesleyan.co.uk/ipadcompetition

FINANCE 23

S hiv Chopra is a member of Wesleyan Medical Sickness’ Advisory Board. He is currently in his first year as a Core Surgi-

cal Trainee in London, working at the National hospital of Neurology and Neurosurgery.

As if that wasn’t enough, Shiv is also the owner and creator of ‘�e Quack Guide’, the UK’s first and only independent guide to foundation hospitals for students and junior doctors.

In this interview, he talks about the challenges of building a successful medical career while still finding time to run a suc-cessful not-for-profit business.

WHAT IS QUACK?

In 2007 the way junior doctors were re-cruited changed from a local recruitment scheme to a national one. �is meant final year students had to rank all regions of the country in order of preference without any knowledge of the hospitals and surrounding areas.

�e fear in the back of every medic’s mind was that they could end up working in a hos-pital they had never been to before and with no family and friends nearby. Recognising these concerns, I tabled a motion to the na-tional BMA conference to hold an expo or provide more information on all hospital sites, but this was not possible. So, together with a few friends from other medical schools, we created our own guide - �e Quack Guide - a free magazine sent to all medical schools in the UK. Two years later we went online and have just launched our new site.

It is officially endorsed and supported by the medical school heads and foundation schools, and is written by junior doctors with first-hand experience of the areas they are liv-ing in, providing testimonials and advice about living and working in the area and much more.

It is a non-profit website and is free for all students and junior doctors to use.

WHAT HAS MADE IT SO SUCCESSFUL?

Having great relationships with every foun-dation school manager, the UKFPO (United Kingdom Foundation Programme Office) and doctors across the UK, has been vital, as has making sure our information is up to date.

It allows Quack to provide a hassle-free way to find out about a foundation hospital and its surroundings, meaning students don’t have to spend hours researching, which is not ideal when you have finals looming.

And, of course, we wouldn’t be so successful without the dedicated team of Quack-a-holics!

WHAT ARE THE CHALLENGES OF RUNNING A NOT-FOR-

PROFIT BUSINESS?

�e biggest challenge is finding the right balance to keep my sanity. I’m currently a core surgical trainee and I have to complete DOPs, CEXs, TABs and many other three letter ab-breviated assessments throughout the year to stay above water. Alongside all of this is my family, extra-curricular activities and Quack. �ere aren’t enough hours in the day!

Last year I recruited people to help with Quack and was inundated with CVs from keen photographers to doctors who just wanted to express their views. �e finance of the company is a real challenge too, especially as I want to keep the company free for people to use. �is has been at a cost and I have had to invest a lot of my personal junior doctor wage into updating and promoting the site. I hope that through sponsorship and partner-ships with interested companies I can main-tain a free Quack guide in the future.

WHAT ADVICE WOULD YOU GIVE OTHER DOCTORS

WHO WOULD LIKE TO PURSUE THEIR OWN BUSINESS

INITIATIVES?

1. Do your homework2. Speak to people who have set up their own business

3. Form a team of people who can help in all areas of the business from the website to marketing4. Be committed to the project for the long term. Businesses need to be constantly refreshed and updated so you need to be will-ing to commit the hours needed for a suc-cessful venture.

WHAT NON-MEDICAL SKILLS DO YOU NEED TO RUN

YOUR OWN BUSINESS AND WHAT HAS HELPED YOU

FINE TUNE YOURS?

1. Haggle for the best process2. Some basic accounting skills and being good with spreadsheets is vital3. Go on a web design course or teach your-self so you are not always paying someone for the basic things you can do4. Network with everyone to know your market, potential sponsors and competitors5. Be prepared to fine tune your knowledge the hard way - through trial and error and learning from mistakes. �ere is no book on this.

WHAT HAS THE WHOLE EXPERIENCE TAUGHT YOU?

�ere is no ‘I’ in team and no success without ‘U’.

WHAT ARE YOUR FUTURE PLANS FOR ‘QUACK’?

To have coverage of all hospitals, not just foundations training Trusts, and even infor-mation on working at sites around the world and advice on speciality training. I’d also like to create a mobile ‘app’ and produce some Quack merchandise.

WHAT ARE YOUR GREATEST AMBITIONS?

I’d like Quack to be the ‘Lonely Planet’ of guides for medical staff and to keep help-ing my fellow peers through initiatives such as Quack. I’d also like to see Arsenal win the Champions’ League in my lifetime!

Visit Quack at www.thequackguide.com

Specialist financial services for doctors

0800 107 5352 or visit www.wesleyanmedicalsickness.co.uk

• Savings and Investments

• Retirement Planning

• Life and Income Protection

• Mortgages

• Motor, home and

travel insurance

Wesleyan Medical Sickness and Wesleyan for Professionals are trading names of Wesleyan Financial Services Ltd, which is authorised and regulated by the Financial Services Authority. Wesleyan Financial Services Limited is wholly owned by

Wesleyan Assurance Society. Registered No. 1651212. Head Office: Colmore Circus, Birmingham B4 6AR. Telephone calls may be recorded for monitoring and training purposes.

Motor, home and travel insurance is arranged by Wesleyan for Professionals.

Focus on Finance - in association with Wesleyan Medical Sickness

THE QUACK GUIDE

For more information or for specialist financial advice contact Wesleyan Medical Sickness on 0808 100 1884 or visit the website at www.wesleyan.co.uk/doctors.

24

P lagiarism is a serious academ-ic offence, and one that has been around for centuries. Shakespeare allegedly stole most of his histori-

cal plots from Holinshed, and Oscar Wilde too, was repeatedly accused of plagiarism.

Educational institutions are clamping down on the act of plagiarism - passing off someone else’s work as your own. Academ-ic staff are more commonly using a variety of online resources, such as anti-plagiarism software, to check the content of all submit-ted work.

GMC ADVICE

�e GMC has specific advice on this issue in Medical Students: Professional Val-ues and Fitness to Practise. It states that in order to demonstrate that they are fit to practise, students must:

Be honest, genuine and original in their

academic work, including when conduct-ing research, and take effective action if they have concerns about the honesty of othersBe honest and trustworthy when writing reports and logbooks, and when complet-ing and signing formsBe honest in CVs and all applications and not misrepresent their qualifications, po-sition or abilitiesNot plagiarise others’ work or use their own work repeatedly in a way that could mislead.

EPORTFOLIOS, ESSAYS AND CVS

It is not just essays that medical stu-dents/junior doctors need to worry about; CVs and job applications are also checked for plagiarism. On the internet an array of websites now exist offering students cus-tom-made personal statements and essays,

A ‘COPY AND PASTE’for quite a hefty fee. �ese sites promise that they are 100% plagiarism-free, but last year nearly 30,000 university applicants sent in personal statements that Ucas’ “similar-ity-detection service” flagged up as copied (source:TES Newspaper).

Even the personalised essays, which are guaranteed to be unique, come with a num-ber of risks. By presenting someone else’s work as your own it is likely that you would be in breach of any plagiarism policy at any university. And there is also the chance that your tutor, who is probably clued up on your writing style, will spot the signs that your essay hasn’t been written by you. Other areas where foundation doctors may find themselves in difficulty with plagiarism include ePortfolios, CVs and postgraduate academic work.

An article on Medscape News Today says that the reason students are asked to write essays is because this is most likely

Medicolegal Advice - in association with the Medical Protection Society

The temptation to lift someone else’s work from the internet can be overwhelming when

struggling to meet a deadline, but the risk is simply not worth it, says Charlotte Hudson

to demonstrate their ability to analyse and communicate complex material: “All of these are essential skills for the budding cli-nician or medical academic. �erefore, you need to show you can perform these tasks, and a gift for navigating the net and a facil-ity for copying and pasting, is not the solu-tion even if it a useful means to that end.” i

PROBITY

Furthermore, the GMC takes the global issue of probity very seriously, and an allega-tion of plagiarism would undoubtedly raise

questions about your probity.Probity means being honest and trust-

worthy, and acting with integrity. Your actions as a medical professional should be ethical and should uphold the reputation of the profession, helping to maintain public confidence in it.

Never pass off anyone else’s work as your own. If you do use other people’s work, for reference purposes ensure that it is proper-ly attributed and identify any direct quotes appropriately using quotation marks. Ensure that you are familiar with local poli-cies and guidelines in relation to referencing

- in association with the Medical Protection Society

MPS is the leading provider of comprehensive professional

indemnity and expert advice to doctors, dentists and health

professionals around the world.

We actively protect and promote the interests of members

and believe that education is an integral part of every health

professional’s development. As well as providing legal advice

and representation for members, we also offer workshops,

conferences and a range of publications designed to aid good

practice.

MPS is not an insurance company. All the benefits of

membership of MPS are discretionary as set out in the

Memorandum and Articles of Association.

About MPS

MPS Members who

would like more advice

on the issues raised in

this article can contact

the medicolegal advice

line on 0845 605 4000.

www.mps.org.uk

The Medical Protection Society Limited.

A company limited by guarantee.

Registered in England No. 36142

at 33 Cavendish Square,

London W1G 0PS.

academic work. If in doubt, don’t be afraid to ask for help - it could be your future career that you are jeopardising.

�e message in this article is: do not risk your professional reputation and career by “copy and pasting” your way to the top. �ere are a lot of pressures and temptations in modern life that may tempt you to cheat and take the easy route - but in truth, the only person you are cheating is yourself.

Mary was in her F2 year and the dead-line was looming for her application for a specialty post.

She began to panic, but then remem-bered that her house mate Dave had applied the previous year, and he had given her a copy of his form at the time. By coincidence Mary wanted to apply for the same special-ty, and Dave got his first choice last year.

Worried about running out of time

and not contemplating the consequences, Mary used Dave’s application form and got it in before the submission deadline.

While waiting to hear whether or not she had been shortlisted, she was contacted by her educational supervisor who present-ed her with a copy of her application, and Dave’s from the previous year - Mary was accused of plagiarism.

Most colleges and deaneries use anti-pla-giarism software to catch out doctors who try to pass off others’ work as their own.

OUTCOME

Realising the seriousness of the situ-ation, she withdrew her application and successfully reapplied the following year.

Mary put her career on the line just to save a little time - was it worth it?

Read more about plagiarism in an article by Dr Jayne Molodynski, Whose work is it anyway? - www.medicalpro-tection.org/uk/new-doctor/june-2011/whose-work-is-it-anyway.

CULTURE

CASE STUDY

i Marcovitch H, Plagiarism and Medical Students.

Where the boundaries lie, Medscape News Today,

accessed 16 February 2012

HOSPITAL MESS26

BATMAN

I t is a dark winter’s night at my surgery and the last appoint-ment of the evening. �e clinic is deserted and cost-saving measures have meant that only a single flickering light remains

on. Suddenly, creeping from the shadows of the waiting room, a dark figure emerges. Dressed almost totally in a form-fitting rein-forced suit with his head covered in a frightening mask I can make out the outline of a man - or possibly something more supernat-ural. At first he says nothing, then quietly, somewhere between a whisper and a threat, his voice rasps “Doctor, I have an itch...”

Laryngitis - No-one should have to live with a voice that hoarse without seeking medical help. Although there are many causes for this dysphonia, inflammation of the larynx would be the most obvi-ous - most likely due to a simple viral infection or overuse of the vocal cords. I would recommend a combination of gargling, men-thol inhalation, air humidifiers and simple rest. If the problem per-sists I will make a referral to our local voice therapist Dr Joe Kerr.

Erythropoietic porphyria - Perhaps the main reason for “Bat-man” only appearing at dusk is photosensitivity to sunlight. In all cutaneous porphyrias, photosensitivity presents as bul-lous eruptions occurring on sun-exposed areas. �e recommended treatment is actually prevention by avoidance of sunlight and use of sun-protective clothing. A firm diagnosis could be made by testing for porphyrins in plasma, urine, and stool; which would be elevated to levels higher than those in other porphyrias. �is would however necessitate Batman removing his uniform which in itself would be a difficult task.

Histoplasmosis - Quite why this “Batman” chooses to spend the majority of his time in a cave teeming with bats is beyond the limits of this consultation. However, it is common knowl-edge that bats carry various diseases including rabies, the Hen-dra virus and Ebola. What is less well known is that their excrement, called guano, has the fungus histoplasmosis capsulation present in a high enough quantity to cause histoplasmosis - an infectious disease caught by inhaling the spores. Around 10 days after expo-sure many sufferers complain of flu-like symptoms including dry cough, headache, impaired vision and muscle pains. Some cases, however, are more serious often resembling tuberculosis and can be fatal without treatment. My recommendation would be to have the whole cave fumigated and install better ventilation.

Attachment Disorder - While obtaining a family history I uncovered that during his early childhood both Mr and Mrs “Batman” were murdered. It is well known that failure to form normal attachments to primary care giving figures in early child-hood can lead to problematic social expectations and behaviours - particularly emotional dysregulation, self-endangering behaviour and hyper-vigilance. Although treatment is difficult in these cas-es, a narrative-therapeutic approach may allow “Batman” to open and explore other aspects to his personality rather than sticking to this Dark Knight persona.

Assessed by Gil Myers

MEDICAL REPORT

1 Name associated with paradoxical rise in JVP with inspiration (8)

3 Purified cardiac glycoside extracted from foxglove (7) 5 Fourth cranial

nerve (9) 6 Proton pump inhibitor; ‘Losec’ (10) 7 Paediatrician’s name

associated with testing a drop of blood to exclude phenylketonuria (7)

8 FK506, immunosupressant discovered by the Japanese (10) 9 His syndrome

is rheumatoid arthritis with pneumoconiosis; treated with steroids (6)

12 Inflammation of the wall of a vein (9) 13 This ligament forms the floor of

the inguinal canal (8) 16 Cell type of carcinoma of the bronchus with darkly

staining nuclei and scanty indistinct cytoplasm; in porridge (3) 19 Satellite of

Saturn; first cervical vertebra; collection of maps (5) 20 A rare and relatively

benign form of muscular dystrophy of pelvis-girdle type with better prognosis

than Duchenne’s dystrophy; Wimbledon’s youngest men’s singles winner (6)

23 Disease associated with spirochaete Borrelia burghdorferi; sounds like a

citrus fruit (4)

2 Kidnap; moving a limb or other body part away from the midline (6)

4 Terminal organ of the lower limb; 12 inches (4) 10 High potassium (13)

11 Lobe of the brain behind the frontal; contains sensory cortex and

association areas (8) 14 Whitish crescent shaped area at the nail base

(6) 15 Group of mammals considered by some as vermin; ulcer associated

with basal cell carcinoma (6) 17 Itching (8) 18 What you aim for; red blood

cells with central staining, a ring of pallor, an outer rim of staining e.g. in liver

disease, thalassaemia and sickle cell disease (6) 21 Coldplay classic; this fever

is an infectious disease of tropical Africa and Southern America transmitted by

Aedes mosquito (6) 22 Rod shaped bacterium (8) 24 Name associated with

the plantar reflex (8) 25 Flat circumscribed area of skin or an area of altered

skin colour (6)

You can find the crossword solution by searching for

‘crossword answers’ at www.juniordr.com

Compiled by Farhana Mann

ACR

OSS

DO

WN

HOSPITAL MESS 27

Don’t let your batteries go flat at -

£5.99 Royal Hampshire Hospital,

Winchester

Time to recharge at -

£3.45 Kingston Hospital, Kingston

Burns your wallet as well as your mouth at-

£1.80 Royal Free Hospital, London

Lucky chocolate is good for you at -

95p Luton and Dunstable Hospital

Expensive enough to you weep at -

79p Whipps Cross Hospital, Leytonstone

Prices not to be sneezed at -

25p Frenchay Hospital, Bristol

Next issue we’re checking the cost of an apple, chicken and chips and a tube of toothpaste. Email prices to hospitalconfidential@juniordr.com

W hen your hospital food tastes like the remnants of a liposuction

procedure and the price bears more resemblance to the cost of a

PICU incubator things start to take the biscuit. Here’s our regular

column of the best and worse hospital essentials you’ve reported:

Sky HD on 42in High Def plasma, wireless 16Mb broadband, leather sofas, lava lamps. 3 computers in separate computer room: 2 for all

access broadband. Kitchen with dishwasher, microwave, basic food bread, tea, coffee, biccies etc usually topped up. Separate chill out/quiet room (with a few old sofas!). £10/month.

JuniorDr Score: !

4 x AA Batteries

Packet of tissues

‘Writing in the notes’ is our regular letters section. Email us at letters@juniordr.com.

Writing in the Notes

Compliant on paper only

Dear Editor,

I read with disbelief your article on English

hospitals complying with the EWTD ‘Most

training rotas now EWTD compliant’ (Iss 23,

p7). On paper they might do but I think you

will be hard pressed to find any junior doctor

who does work under 48 hours per week and

gets all their statutory breaks as required. If

the BMA vote to strike goes ahead and we end

up ‘working to rule’ there will be a lot of jobs

which will go uncompleted.

NAME WITHHELD

LONDON

Good news from the GMCDear Editor,

Finally some good news! It seems the nev-er ending tide of increasing fees and annu-al charges from the Royal Colleges, BMA and GMC has started to turn ‘GMC cuts fees for all doctors’ (Iss 23, p4). I calculated that last year I paid over £3,500 in fees and exam charges - and that’s without all the extra courses and training.ALEX WARD ST4, PSYCHIATRY

PRINCESS ALEXANDRA, HARLOW

Help us help the NHS

Your article ‘Doctors for hire’ (Iss 23; p6)

suggests that there has been a record 90%

increase in the number of doctors going

‘freelance’. I’ve recently gone ‘freelance’ but

not out of choice - and I suspect it’s a sim-

ilar story for many junior doctors. "ere

simply isn’t enough jobs out there for us at

that moment. I’m not complaining but one

thing that has become apparent to me is that

the NHS is not set-up for this flexible work-

ing. We’re a valuable workforce for the NHS

but they need to help us help them.

AVINASH GUPTA

GP LOCUM, LONDON

Hot chocolate (small)

WARD ESCAPE28

WHERE TO STAY?

Like any capital city staying in Madrid is expensive. Visiting at the weekend does let you take advance of reduced rates when all the business travellers have left. Try the centrally located Petit Palace Arenal (Calle Arenal) approx £60 a room. If you’re still waiting for your paycheck you could try the Barbieri Internation Hostel (Calle Barbieri), just a short walk from the centre, which offers double rooms from under £30. Or if you’re planning a really special weekend away you could splash out on Hotel Santo Mauro (Calle Zurbano) - the choice of resi-dence for the Beckhams at £250 per night.

EATING

Tapas will become addictive whilst in Madrid. Pop into a bar, order a drink and nibble the night away with the locals - it’s how they can stomach drinking until the early hours of the morning.

"e top tapas treats can be found at Juana la Loca (Plaza Puerta de Moros) or Alhambra (Calle Victoria) which offers a more lively experience with heavy music and a younger crowd.

For a more sedate sit-down meal con-sider La Viuda Blanca (Calle Campomanes) which offers a modern take on Spanish cuisine.

KEY ATTRACTIONS

Palacio Real - Arguably the most impres-sive building in Madrid with fantastic gar-dens which are perfect for a spot of lunch. "ere’s 3,000 rooms to the Royal Palace, many of which you can wander through.

El Teleférico de Madrid - "is is a 10 minute cable car ride that departs from the park behind the Royal Palace. It’s a great way to see the city from afar and also ends at a welcome restaurant.

Prado Museum - "is is Madrid’s most popular tourist attraction and claims to have a higher concentration of masterpiec-es than anywhere else in the world. At any time there’s 1,500 works of art on display out of an impressive collection of 9,000.

Parque del Retiro - Retiro means retreat and is the most popular park in Madrid. With a large lake, monuments and shad-ed areas it’s the perfect place to relax after stomping around the Prado - which is con-veniently situated close to the main entrance.

NIGHTLIFE

Plaza de Toros de Las Ventas - Wheth-er you amazed or are appaled by bullfight-ing it’s certainly a big part of Madrino cul-ture and increasingly popular. Tickets can cost from a few quid to over fifty depend-ing on where you sit in this massive 25,000 seater stadium with the action kicking off from 7pm.

Casa Patas (Casa Canizares) - Flamen-co is the other great Madrino passion and certainly worth an evening’s viewing. Casa Patas offers one of the more authentic expe-riences. Entrance is approximately £25 and includes a complementary drink.

Find the full Madrid guide at JuniorDr.com

With bullfighters, women who

dance clapping metal cymbals

and huge 30 inch plates of paella

there’s no doubt Madrid sees

itself as a macho city. Hardly a

place for a relaxing weekend away

you may think. Wrong, Madrinos

also have a strong reputation for

enjoying themselves ... you just

have to let them take the lead.

WEEKEND WARD ESCAPE TO

MADRID

KEY FACTS

POPULATION - 2,905,100

LANGUAGE - SPANISH

CURRENCY - EURO

MADRID IS EUROPE’S

HIGHEST CITY (2,100

FEET)

TAPAS

BULFIGHTING AT PLAZA DE TOROS DE LAS VENTAS

PALACIO REAL

CLASSIFIED 29

The Medical Journalist’s Association

brings together medical writers, the media,

health professionals, and health charity

workers.

> Meetings on major health and medical

topics of the day

> A forum to meet colleagues

> Recognition and cash awards for distinguished work

> A website with your own address. Visit www.mja-uk.org

> Professional advice when you need it

Wish to join? For more information visit www.mja-uk.org

Queensland Health

Search for vacancies or send an online Expression of Interest today at

www.health.qld.gov.au/medical

Fill your gap yearDOWN UNDER

A medical career with Queensland Health includes outstanding salary packages, exceptional

training and development opportunities and a DREAM QUEENSLAND LIFESTYLE.

“I undertook my medial training at Glasgow University and worked in the NHS for a few

years, but decided to fi ll my gap year with some sunshine and work experience Down

Under. I took a job with Queensland Health and relocated to Australia. I’ve now been

accepted on to the Queensland Health world-renowned emergency medicine training

program which gives me exposure to an unparalleled scope of practice.” Principal House

Offi cer, Dr Stephen Elliott enjoys the training programs with Queensland Health.

M3

00

81

1

GET YOUR NEURAL INPUT TO JUNIOR DOCTORS.

ADVERTISE HERE. CALL US ON 020 7684 2343.

JOURNALISM

From !" # acorns mighty oaks grow

$%&'()#&*+,#&-%+,&.(,##,&/,%0*&*1,%2/&

(23&1,+#4&(23&( 0(-*&%2&(2&+50(,3*&

1,(6#.1%,-4&6%!27

$8#&9%.!#1-&:%,&

Acute Medicine

;$8#&'%*1&!'5%,1(21&<%3-&.8('5!%2!2/&

18#&.(+*#&%:&(.+1#&'#3!.!2#=& 9>?&'#'<#,4&2011

$%&6%!2&%,&1%&@23&%+1&(<%+1&18#&'(2-&<#2#@1*&9>?&'#'<#,*&#26%-&A!*!1&

000B(.+1#'#3!.!2#B%,/B+)&%,&#'(! &*('C,.5#B(.B+)B

RECRUITMENT

RECRUITMENT

EVENTSDR.COM30

!!"#!$%&$'#(#)*+,+$-''#.!*,#/%+0'###12#

#

$334#56#7839:#;<5=#>7?#####09@@#ABBB#CCC#DCDE##

!"##$%&#'(!#$)'*'+$ *,#-$).!

!"#$#%&'$(

!"#$%#&%'())) *+, -,&% .,(%/0,&1!

!*,#(+'$2 3#& ,4(,..,$%1!

!5,06 (.,#0 7,8% '% &'98.,: %+#$7&1! $

!"#$#%&'$)$

!;.,#0: <,06 7$=3.,>2,#-., #$> ,$2#2'$21!

!?==> >,.'<,06 @ 2==> ,48.#$#%'=$ #$> ,4#9 A=(/&,>1!

!B4(,..,$%: (.,#0 #$> A/$1! $

!"#$#*"+,$

!51 80=A,&&'=$#.: 7$=3.,>2,#-., C %=/2+)) D.. <,06 2==> %,#(+,0&1!

!?==> (=/0&, =<,0#.. @ 3=/.> 0,(=99,$> %= 96 (=..,#2/,&)!

!B4(,..,$% &,.,(%'=$ =A (#&,&1 D.. &%#%'=$& (=<,0,>1!

$

*-.'/$ /01-12/$

!B4(,..,$% &,.,(%'=$ =A (#&,& #.. (.,#0.6 80,&,$%,>1!

!"#$%#&%'(: '$%,0#(%'<,: 0,.,<#$% '$A=09#%'=$1!

THE MEDICAL COURSE AND CONFERENCE DIRECTORY

A s doctors we hate scouring the web to find where and when we can attend the next

exam revision course, training event or conference.

We think they should all be in one place - which is why we launched EventsDr.com as part

of the JuniorDr network.

We’re aiming to build the most comprehensive database of medical events. Below you’ll

find just a selection of the full listings at EventsDr.com.

!"#$ %&'()*+$ ,%-.#'$ /'*,!'#$ /!'$

0 * # " ,$ 0 " %1',!*& " , * 2$ * &)$

'&3"&''."&3$4."&,"42'#$ "&$ .*-1*$

5$ 6./!%4*')",$ #-.3'.+7$ 8/$ "#$

*"1')$ */$ 9-&"%.$ )%,/%.#$ :;<=(

> ;(?<@ ?A$ 0-/$B"22$ 0'$ -#'C-2$ /%$

*&+%&'$$B*&D&3$/%$"&,.'*#'$/!'".$

-&)'.#/*&)"&3$%C$6./!%4*')",#7$

$

>%-.#'$ "&,2-)'#$ 2-&,!E$ /'*<

,%F''E$ 4.*,D,*2$ )'1%&#/.*D%&#$

*&)$*$,'.DG,*/'7$

$

"&C%H"&#/.-1'&/*21')","&'7,%1$

BBB"7"&#/.-1'&/*21')","&'7,%1$$$

@*/-.)*+$;I/!$J4."2$=K;=7$ !'$L%+*2$@%,"'/+$%C$M')","&'E$$

;$N"14%2'$@/.''/E$O%&)%&$N;P$KJQ7$

:;<:=$ $ $R;SK$

> #<@ #A $R;TU$

$

:%.$C-./!'.$"&C%.1*D%&$42'*#'$

."&3$@!'..+V$ AII$WU=$WTT$U=K$S

MEDICINE

MRCP PART 1

Mon 16th Apr(5 DAYS)

£810 London

Fri 27th Apr(3 DAYS)

£549 London

Sat 21st Apr(2 DAYS)

£390 Sunderland

Hammersmith MedicineMon 28th May

(4 DAYS)£695 London

MRCGP

Tue 27th Mar(1 DAY)

£475 Birmingham

Tue 17th Apr(1 DAY)

£475 London

MRCP PACES

Sun 13th May(4 DAYS)

£1395 London

Thu 17th May(4 DAYS)

£1395 London

Sat 26th May(2 DAYS)

£820 Manchester

Sat 26th May(2 DAYS)

£680 Ealing

Mon 28th May(4 DAYS)

£1499 London

Sat 9th Jun(2 DAYS)

£680 Ealing

Sat 9th Jun(2 DAYS)

£600 Manchester

MRCPCH PART 1

Sat 26th May(2 DAYS)

£250 London

EVENTSDR.COM 31

GOT AN EVENT TO ADD?DO IT FREE AT EVENTSDR.COM

Wed 30th May(3 DAYS)

£549 London

MRCPCH CLINICAL SKILLS

Sat 26th May(2 DAYS)

£820 Hillingdon

Sat 9th Jun(2 DAYS)

£820 Kingston

SURGERY

MRCS PART B

Fri 20th Apr(2 DAYS)

£365 Cardiff

Sat 5th May(2 DAYS)

£820 London

Sat 5th May(2 DAYS)

£549 Leeds

Hammersmith MedicineMon 2nd Jul

(4 DAYS)£595 London

PSYCHIATRY

MRCPSYCH CASC

SPMM Course

Sat 28th Jul(2 DAYS)

£650 London

Superego CafeSat 28th Jul

(2 DAYS)£595 Manchester

OTHERS

LEADERSHIP & INTERVIEW SKILLS

Management Excellence for Junior & Middle Grade

Doctors

Wed 14th Mar(1 DAY)

£358.80 London

SpR Management for Doctors

Wed 25th Apr(1 DAY)

£599 London

Leadership and Management Fundamentals for SAS Doctors

Wed 9th May(2 DAYS)

£468 London

Leadership masterclas for Health Professionals

Thu 21st Jun(2 DAYS)

£588 London

!"# $%%&'(%!"#

)*"&'+!&,)*"&'+!&,

-./'(&-./'(&

!"#$%&#'()$#)*$*"&+!(,+$(

*--(.$*/#0(12(&!"#$%&#'(

#3)#$&#!4#/(5+!06-"*!"0

0"# 1&2'/$'30 1&2'/$'3

4'5 6$'7#4 6$'7#

48(" 6$'7#48 6$'7#

9"# 6$39 6$3

7 - & 89:; : <734-60&%#(89:;(:"*.#(<(

4+6$0#0

88"# 1 288"# 1&2'/$'3

8:"# 1&2'/$'38:"# 1&2'/$'3

=#()$+)#$-2()$#)*$#/(,+$(2+6$(&!"#$%&#'(

> / / &">+6$(4*$##$(/#)#!/0(+!(&"

?+$#(&!,+$@*"&+!(A(1++B&!.(+!('#10&"#

''' @#/&4*-4+@@6!&4*"&+!0B&--0 4+@'''C@#/&4*-4+@@6!&4*"&+!0B&--0C4+@

;<=;>?8=8?>8>;<=;>?8=8?>8>

@/AA.'"&5?23?"#&?AA 3

6&5!7$B?C'."&7"!.*?@.7!&"3

MEDICAL PROTECTION SOCIETY

PROFESSIONAL SUPPORT AND EXPERT ADVICE

We have a unique team of more than 100 specialist lawyers and medicolegal

advisers – doctors with legal training. MPS supports members through the

world’s largest network of medicolegal experts.

We will always be here for members whenever

their professional reputation is threatened.

When members face a crisis, they can turn to

us for guidance, reassurance and empathy.

We support 270,000 members and

take more than 18,000 calls a year.

MPS is the world’s leading medical defence

organisation, putting members first by providing

professional support and expert advice

throughout their careers.

T: 0845 718 7187 E: info@mps.org.uk W: www.mps.org.uk

The Medical Protection Society Limited – A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS, UK.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.

The right choice for professional supportWe are committed to providing members with professional support and expert advice throughout their careers

e committed to providing meemmmmmbbbeerrrss wwiitthhh pppprrrroofffeeeeeessssssssssssiiiooonnal ort and expert advice throughhhoooooouut thheeeiirrrr careeeerrssssssss

Members can find out more about the support we provide

by visiting: www.mps.org.uk/JuniorDr

Non-members can sample some of our support and publications

by registering their details at: www.whymps.org.uk