On Friday, Applican hosted a fully booked UKCAT course in Edinburgh - here is what the students who attended thought about the course!!
Again, 100% of students thought the course was beneficial for their UKCAT prep
Again, 100% of students would recommend the course to a friend.
Thursday marks GCSE results and last week many of our 2016 Applican students received their A-Level results. We were delighted that 89% of students in our 2016 season received at least one offer for UK medical school.
Receiving results is always a time filled with questions. It can be hard to know what your results mean for your future - which universities you have ruled in, which you have ruled out. For some people, they want to know whether medicine is an option, and what they need to do to increase their chances of a place. Others, want to know how to maximise their strong results and apply to the places that weight their results as highly as possible. Sometimes, knowing the inside track is what you need. At Applican, we can give your realistic advice about how to use your strengths and weaknesses to succeed in the application process. Each year we contact every UK medical school to find out exactly how they select their applicants. Then we sit with your application and ensure that you meet every cut off that they set the previous year. This advice is crucial and is why our success rates are so high.
Therefore on Monday, Applican HQ will be running a Bank Holiday Q&A Clinic. Call our team for any question you have and you can get your answer. What do your results mean? Or if you are kicking off the application process when you go back to school, get in touch for any questions you have about the process!
To register for your consultation, either call 07702246407 or fill in the form below and we will get back in touch with you.
Also, Applican season is just kicking off with spaces still available on some of our courses. To have a look at where our 2 day application & interview prep courses are running, or to book a place on our UKCAT course, then have a look here: www.applicancourses.com/book .
100% of students thought the course was beneficial for their UKCAT preparation
100% would recommend the course to a friend
The review wall from our very first Intense UKCAT course!
A Level results are out - but what next?
The Applican Courses take you through all of the following:
- Strategic University choices
- Crafting the perfect personal statement
- Full preparation for the UKCAT with strategies and over 450 unique UKCAT questions
- A full mock UKCAT exam
- Preparation of medicine in the news
- MMI preparation and practice
- Panel interviews preparation and practice
Last year, 89% of our students received at least one offer for medicine, so we know that our content is effective.
To celebrate A Level results, we are offering a flash 20% discount on all of our courses, starting now, and ending at midnight on 19th August 2017. Book your spot before the places fill up!
20% DISCOUNT CODE: RESULT20
Team Applican have been working all year to prepare a comprehensive and affordable UKCAT course. With over 450 original and fresh UKCAT questions, our full guided workbook and mock exam is now complete and ready to go!
If you don't have time to come to come to our full course, but would still like to see Applican's strategies for each section and have a go at a full UKCAT mock exam, you can buy our complete UKCAT package for £15.
As we say at Applican, a news article a day, a doctor you may [be]. Ok, it doesn't quite work but the point is browsing a regular health column on a news website is a great way to get exposure to what's going on in health globally.
One of the big cases across the news is that of Charlie Gard. Whilst, there are many points of view on this topic, the key role in a medical school interview is to appreciate the role of the different parties in one of these cases.
Have a look at this article which provides a nice overview of the case and this would be a good example of understanding the principles of medical ethics.
More to come...
With the bliss of summer feeling like it might be soon coming to an end, your mind might be moving towards the first hurdle you will face next year. Without doubt the UKCAT is one of these huge hurdles, especially when there is a new section this year with few available resources to practice for it. The new Decision Making section requires an astute understanding of logical rules and a disciplined approach. All at a rapid pace.
Applican has created a new UKCAT course this year that is the most accessible and best valued in the UK. Below is a flavour of several mock questions from the new Decision Making section of the UKCAT.
Attempt these in your own time, but remember, in the real exam you have only..
1 MINUTE PER QUESTION...
For answers and queries, please email email@example.com and we will send you the solutions.
At Applican we believe that the UKCAT is a test that requires planned preparation and a strategic approach to achieve excellent results. Therefore, we advise setting aside at least 4 weeks of preparation time before the big day.
These questions are a small glimpse of the practice questions you will receive at the Applican Intense UKCAT Course which is taking place in Edinburgh, Glasgow and Belfast.
Incase you can't make it to our UKCAT course, you can purchase the Applican UKCAT booklet which contains all of our practice questions, solutions and a mock exam. This booklet will be available from 1st August 2017. Buy it here.
Applican were delighted to welcome over 140 students across Scotland to a free practical day in Edinburgh on 4th June! The day was hosted at the Anatomy Lecture Theatre, Edinburgh Medical School and the Edinburgh Royal Medical Society and saw students learning about the entry pathway to Medicine before learning some useful clinical skills such as blood pressure, neurological examination and first aid!
A special thank you must go to the medical students who helped with clinical teaching over their summer holidays, to Scope Tutors Edinburgh for sponsoring the event and for Edinburgh Medical School for the use of these special venues. The day was hugely enjoyable - thank you to everyone who came along! Hopefully course organisers, Jack and Erin, will see some familiar faces at Applican courses running in Edinburgh this summer.
The final set of offers for this year's medical applications are in and we have been catching up with all of the students who attended Applican courses last year. We are delighted with the results and would like to thank everyone for getting back to us and congratulate the lucky offer holders!
Over 80,000 applications to Medicine in 2016
But only 9% of them received an offer
80 students attended the 2016 Applican Courses
89% of Applican students received at least one offer for Medicine
We believe that the Applican model works. As we prepare to support a new cohort of students this upcoming summer, we are really excited about offering brand new courses, introducing new Applican mentors and supporting new future medics through the application process!
Come along to Applican's FREE practical day held at the prestigious Royal Medical Society (est 1784) at the University of Edinburgh on the 4th June 2017.
Current medical students at the University of Edinburgh will be taking you through some of the best clinical skills that you learn at medical school including: taking blood pressure, using a stethoscope and using first aid to treat sick patients. We will then be learning about some of the most important aspects of preparing a medicine application.
Here is the plan!
10:00 - 10:15 - Registration & Welcome
10:15 - 11:15 - Stethoscope, blood pressure and casting workshop
11:15 - 11:30 - Break & refreshments
11:30 - 12:30 - First Aid & simulated patients
12:30 - 13:00 - Lunch
13:00 - 14:00 - The medicine application process, bolstering a PS & PS writing
14:00 - 15:00 - The UKCAT
15:00 - 15:15 - Break & refreshments
15:15 - 16:00 - Mock interview & questions
This is a first come, first served event - so please reserve your spot as soon as possible!
We are really excited to announce that Applican will be delivering UKCAT courses this year across the UK!
We think that the mysterious UKCAT is one of the most unfair aspects of medicine application process - students can feel the pressure to attend extortionate courses that cost over £300.
So we decided to do something to change that.
Applican's Intense UKCAT course only costs £100 and has been designed to fully prepare students for every challenge of this crucial test.
Our Intense UKCAT course includes:
Access to Applican's unique answering strategy for each section in the UKCAT
Guidance, tips and short cuts of the best strategies for tackling the questions
200 page workbook including over 400 original practice UKCAT questions
A FULL TAKE HOME MOCK UKCAT EXAM
30 days of personal support with one of our experienced UKCAT mentors
We will be running 3 courses across the UK in August 2017 - book your space now!
The Future Fertility Trust teamed up with Applican and offered a Medicine Insight Day to students across the UK as a way to get young people across the UK involved in the programme's scientific research. As a 5th year medical student and founder of Applican, I am really passionate about engaging students in stuff that interests them, gets them buzzing about medical science and inspires them for their applications. We have now uploaded the videos from the Insight Day to YouTube so students who missed out on the day can see them. You can find them here:
And here is some information to accompany the talks:
Talk 1: Expanding on Biology
The biology talk looked at AS Level cell division. Most textbooks will give you some more information but our talk focused on the cell checkpoints which have an essential role in cell division at assessing the integrity of the DNA and whether it is good enough to be passed on to the next stage of cell division. It is worth looking through the cycle of cell division and making sure you understand each aspect of the process with respect to cell division. This links into the checkpoints and understanding the role of cyclins and CDKs in creating downstream pathways: this is a series of reactions (like a domino effect) that result in an effect: in the case of the cell cycle, moving on to the next phase. We then link this to cancer biology and understanding how the cells work. Normal cells require growth factors to stimulate their replication. However, experiments show cancer cells will continue to replicate without growth factors. Similarly, normal cells will be inhibited by contact with other cells but it is shown that this does not occur in cancer cells. In other words, cancer cells are uncontrolled growth. Even so, scientists are understanding that within certain cancers, certain faults are driving the uncontrolled growth. For example, a cell which has a mutation in the receptor to the growth factor means that the series of downstream reactions leading to uncontrolled growth keep occurring even in the absence of the growth factors themselves. This means that with certain cancers, we can target them with drugs that block this from happening by targeting, in this case, the receptor that is problematic. We used Herceptin (Trastuzumab) as an example of this. We then discussed how this could extend to interview discussions and how it is important to understand the issue of funding with monoclonal antibodies, hormonal therapy, immunotherapy: also known as targeted therapies. You can expand on this with the help of a number of online resources found on Youtube, Khan Academy, the Applican blog and more.
Expanding on Chemistry
The chemistry talk looked at the organic chemistry you will cover in AS/IB. We looked at chemotherapy and highlighted that it can be used as adjuvant treatment (to cure cancer) but it can also be used to relieve the symptoms and extend life in cancers that cannot be completely cured. We discussed how chemotherapy can be used before surgery to shrink tumours and can be used in either a mono/combo therapy approach. This looks at how to use different chemotherapy drugs along with our other cancer-treating techniques like surgery, radiotherapy and the targeted therapies we discussed in the last talk to attack cancer cells and preventing them from mutating to become resistant to the form of chemotherapy given. We also looked into where chemotherapy came from. It is always interesting to understand the history behind some of medicine and this can apply to many topics. It is interesting to consider how a lot of successful drugs were found as remedies for certain conditions by accident. Thinking about chemistry, it is important to understand the chemistry regarding alkylating agents and also thinking about stereoisomerism: in particular cis/trans or E/Z stereoisomerism. Cisplatin is an example were the effective from of this molecule for treating cancer is the cis stereoisomerism. Thinking about how alkylating drugs work, there are classical alkylating agents )e.g. cyclophosphamide) which work by binding to the alkyl group of the guanine (G) bases in the DNA and crosslink them. Alkylating agents (e.g. cisplatin) do not have an alkyl group and instead work by affecting DNA repair - linking in to the previous talk. However, it is very important to note how if we target actively dividing cells with chemotherapy we can get a lot of side effects: some of which are well known like hair loss, GI upset (nausea, vomiting, diarrhoea), but some less known such as infertility.
Expanding on Physics
The physics talk focused on radiotherapy as the remaining form of treatment that had not been greatly discussed. Radiotherapy works by damaging the DNA of the cancer cells and destroying their ability to replicate. Radiotherapy will affect both the cancerous cells and the healthy cells; but the healthy cells can repair the damage but because the cancerous cells have faulty checkpoints, the cancer cells are less good at repairing themselves and die. It is important to get the right ‘level’ of radiotherapy to kill cancer cells but only damage healthy cells to a point where they can still repair. This dosage process is called fractionation: and works on the principle of ‘little and often’ in order to allow healthy tissues to repair and regenerate. Radiotherapy can be used to cure cancer, generally not on its own. Often radiotherapy is used after surgery to kill of any residual cells or it can be used in combination with chemotherapy. However, radiotherapy can also be very useful in palliative care for cancer patients as it can receive symptoms greatly - particularly the symptom of bone pain that can occur when cancer spreads to the bone. The order of treatment is also important to discuss. Whether radiotherapy is given before or after surgery is important, for example, in cervical cancer where if a patient is going to need radiotherapy, they do this before/instead of surgery as surgery would weaken healthy tissues and cause the radiotherapy to be less effective. It is important to note that radiotherapy is painless but can cause side effects by damaging healthy cells. The most common side effect is the skin problems people encounter. However, another important side effect from total body irradiation, given before a bone marrow transport, is infertility. In the talk, we also touched on the different types of radiotherapy - this is beyond the knowledge you would be expected but you can read up more by researching online including Youtube, Khan Academy, the Applican blog and many more!
Research spotlight: Ovarian Cryopreservation
The three talks on the science subjects were designed to give you an introduction to Ovarian Cryopreservation - they key topic we wanted to discuss during our Insight Day.
Some deeper information: Scientific Papers
We wanted to provide you with some papers you could have a look at. Be aware that these are ‘high brow’ and you would not be expected to know this level of knowledge at all but we just thought it might be interesting after hearing the talks.
Fertility Preservation: A Key Survivorship Issue for Young Women with Cancer; published in Frontiers in Oncology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843761/
This paper talks about the various methods of fertility preservation in young females with cancer, it also discusses the effects of chemotherapy, radiotherapy and surgery on fertility and the importance of understanding fertility preservation as a key issue in the treatment plan of young females with cancer.
Ovarian tissue cryopreservation and transplantation: scientific implications: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5171890/
This paper talks about the scientific techniques involved and is far higher in detail of the science for those interested in a deeper understanding of the evidence and techniques behind the work
86 successful births and 9 ongoing pregnancies worldwide in women transplanted with frozen-thawed ovarian tissue: https://link.springer.com/article/10.1007/s10815-016-0843-9
This paper demonstrates the success of the techniques in almost 100 pregnancies and deliveries across the world.
Relating this to your application: Our #smash500 fundraising challenge!
Actions always speak louder than words. Thinking about the Applican model for personal statements: think about ‘what did you do about it?’. If you really are ‘passionate’ about something, your actions will show and prove it to the person interviewing you. Fundraising for a cause that means something to you is a great way to become even more passionate about the science and medicine at the heart of the cause. This project is special because it is cutting edge research but you can see how every £500 raised makes a huge difference. It also touches on some of the very real and challenging aspects of healthcare in terms of funding within the NHS. Together, this project would be a brilliant one to discuss at interview and fundraising for the Future Fertility Trust will show how much learning about it meant to you. It would be wonderful to have your support and we are here to support you in any way that we can. Even better, together, schools across the country can make this happen. Check out our campaign https://www.justgiving.com/campaigns/charity/oxfordradcliffe/futurefertility and set up your own JustGiving page for your upcoming event by clicking the orange ‘Start Fundraising’ button!
Some weekend reading for our incoming Applicans!
An interesting article today in the Guardian looking at increasing cancer rates in the UK. Click here to read.
Remember that NICE look at cost-effectiveness of treatment looking at QALYs (Quality-adjusted life years). If you are interested in the drug (palbociclib) that is mentioned, you can also have a look at this article to look at the studies which suggest the drug could almost double the median survival time of advanced breast cancer compared to the currently used treatment. Click here to read.
If you have any questions please contact Molly on firstname.lastname@example.org
The longer the saga continues, the more confused we are all becoming about what exactly is going on. Unfortunately, due to the involvement of various media sources, untrusted information from the Department of Health and often unclear messages from interviews with junior doctors, many of us are left very confused. As a medical school applicant, you need to keep the key facts in mind and we will sum these up.
1. What are the main issues about the contract?
- One of the policies of the Conservative Government’s election campaign a number of years ago was David Cameron’s 7 day NHS.
- We already have a 7 day NHS for emergency care but this policy meant extending elective, non emergency care to weekday evenings and weekends.
- Elective care includes routine outpatient clinics and elective (non-emergency) surgeries.
- Doctors WANT a 7 day NHS. They agree that extending services would be good but their frustration is that no extra funding or staffing is available to ensure this expansion can occur safely.
- Rota gaps already occur across 5 days with many departments understaffed leading to closure of many A&E departments, maternity departments and more across England over recent months.
- Doctors are therefore arguing that extending an already over-stretched NHS without proper planning and funding is ludicrous and ultimately unsafe for patients.
- Recent documents leaked by the Department of Health highlighted severe risks associated with these developments leading to the most recent outcry that this imposition on junior doctors has not been sufficiently planned or worked through and is risking patient safety.
2. Is pay a factor in the dispute?
- The pay of doctors is undeniably a factor in the contract but it is definitely not the main one.
- Junior doctors are currently paid a standard rate for shifts where the hours fall between 7am and 7pm on Mondays to Fridays.
- They earn an extra supplement for hours worked outside of this called ‘banding’.
- Currently, junior doctors boost their basic pay anywhere between 40 to 50% because of banding – reflecting the antisocial hours worked.
- It has been proposed that the hours which are considered as ‘standard’ will be increased by 30 hours per week to include 7am to 10pm on Mondays to Saturdays.
- This means that junior doctors will be paid the same rate for working on a Saturday evening as they would on a Tuesday morning.
- The government is increasing the standard pay of a junior doctor which is currently just over £22,000. However, the loss of banding will result in a pay cut for the majority of junior doctors.
- A typical salary of a Year 1 junior doctor in Australia begins at £55,000.
- Many worry this means junior doctors will be discouraged from choosing specialties where there are a high number of antisocial hours required such as A&E or GP - both of which are facing huge recruitment crises as it is.
- Therefore, doctors believe that the pay issues could deter people from essential specialties and ultimately affect patient safety.
3. Is the NHS sustainable?
- The NHS is dreamy - we all want it to work, we believe in it. In principle it is brilliant - healthcare available to all from every background.
- However, the NHS was established in 1948 - just after world war two. Since then there have been two big changes.
- Demand is increasing - there has been a huge shift in the disease burden on the NHS from acute illness to chronic disease. Obesity, cancer and conditions of the ageing population are on the rise, these cannot be solved quickly or cheaply and these patients are long term users of health services and expensive drugs and treatments.
- Expectation is increasing - patients now expect pain free existence for as long as possible. They go to their doctor with minor ailments that never were deemed necessary just after the war when the NHS was established. Society expect more and that is ok! We should expect a better quality of life - we have discovered treatments, drugs and methods to increase our life expectancy and we are far better educated about how to recognise the signs of disease and seek help.
- However, the money is not increasing.
- It is very simple: if demand and expectation increase but the money available to provide the service does not, it is not sustainable.
- This is not even including the desire to EXPAND the non-emergency services to 7 days and still not increase the funding going in.
4. If more people are dying at weekends, do we not need to do something about this?
- In July 2015, Jeremy Hunt claimed that 6,000 excess deaths occurred due to the ‘weekend effect’ in our hospitals.
- Hunt claimed that according to a study based on an analysis of hospital records, it was found an admission on Fridays led to a 2% increased risk of death compared with Wednesdays, on Saturdays it was 10%, on Sundays 15% and Mondays 5%.
- These statistics underpinned the push for a 7 day non emergency NHS.
- However, the author of the paper wrote to Jeremy Hunt saying: "I am writing to register my concern about the way in which you have publicly misrepresented an academic article published in The BMJ. This clearly implies that you believe these excess deaths are avoidable which cannot be confirmed without much further research”.
- Moreover, research by Oxford University in May 2016 showed that the data used for this study was flawed.
- Patients admitted during the week were for routine, non-emergency cases and therefore had a lower risk of death following operations.
- This is compared to hospital in-patients at weekends who were more sick because they were had undergone emergency procedures and therefore, were more likely to die.
- This discounted the weekend effect as false, tearing apart the motivation for the shift to a 7 day non emergency NHS.
5. Even so, Is a 5 day strike really the best option?
- According to the GMC, the first duty of a doctor is to their patient and keeping this in mind there are two sides of the argument regarding whether a strike is the right thing to do: short term vs long term.
SHORT TERM: Of course, short term the risk to patients should be avoided.
- It is not right to grossly understaff the NHS for these 5 consecutive days 9am to 5pm.
- The risk of huge emergencies and the vulnerable state that hospitals would be placed in is not acceptable.
- However, only non-emergency care would be cancelled to allow all emergency care to still be covered with sufficient staff levels from consultants who will be working.
- That said, a lot of scheduled operations would be cancelled leading to huge turmoil for patients scheduled for non-emergency (but necessary) operations during the 5 day period.
LONG TERM: Does the long term risk to patient safety outweigh this short term risk?
- If the already understaffed NHS is stretched further in order to expand non emergency care to all 7 days of the week, patient safety could be at a far greater risk.
- An understaffed hospital environment means the standard of care will reduce and ultimately patient deaths could rise.
- Doctors are trained in evidence based medicine: research into drugs to ensure they are the best for a certain disease; the 7 day NHS has not been researched, funded or staffed appropriately for it to be a safe consideration.
- A staffing crisis in the UK could lead to the closure of many A&E units and by further expanding an already under-funded, under-resourced and under-staffed NHS, the emergency care that is most important could crumble leading to the dissolve of the NHS.
An excellent overall summary infographic:
1. The 7 day NHS for emergency care already exists. This contract is about increasing non-emergency care to weekday evenings and weekends.
2. These changes are being pushed through without increased funding or staff which is concerning due to the understaffing crisis that is already occuring.
3. There is no model for how this is going to be rolled out and all research by the Department of Health has highlighted 5/5 severity risk of a staffing crisis suggesting more planning, funding and staff are required before this can become a reality.
What do you think? Has this helped you understand the key points better? Get in touch and let us know your thoughts and let’s get the discussion going. Contact email@example.com via email.
For the next two weeks following the release of AS/A2 results tomorrow, Applican are running a special offer.
This is for any of our upcoming courses:
OXFORD: 20-21 AUGUST
MANCHESTER: 10 -11 SEPTEMBER
LONDON (HAMMERSMITH): 3-4 SEPTEMBER
BELFAST: 2-3 SEPTEMBER
BELFAST 10-11 SEPTEMBER
For your unique discount code in a pair please email firstname.lastname@example.org or telephone 07702246407. Bookings can be made at www.applicancourses.com/book
We are very excited to announce that Applican will be hosting its first course in Edinburgh this summer on the 10th and 11th September 2016.
At team Applican we are looking forward to meeting new Scottish students - and what better a time than during Edinburgh’s fringe festival! As always our 2 day courses will cover the application and selection processes to UK medical schools. Day 1 will look at how to pick the right medical school for you, matching your strengths, writing a stand out personal statement, understanding medicine in current affairs and the admissions tests for medical school. Day 2 will focus on interview technique, ethical scenarios, problem solving questions, group activities and with a big focus on MMI (multiple mini interview) preparation with a full set of mock stations.
With our huge success rates of 92.5% of Applican students receiving an offer for medicine we can't wait to begin spreading the word in Scotland.
Jack Henderson will assist in delivering the course in Edinburgh this season. Jack is a second year medical student at the University of Edinburgh who is coming to the end of his preclinical years at University and is excited at the prospect of learning more about clinical medicine next year. Outside academic study, Jack is a keen hockey player and competes with the University team 1XI whilst also spending his time travelling, scuba diving and hiking. Having tutored school students for over 4 years, Jack is now looking forward to working with medical applicants with Applican over the summer!
For more information please do not hesitate to get in touch at email@example.com.
The New Scientist contains a great range of articles relevant for students applying to medical school. It pitches ideas and features at exactly the right level for everyone to understand and the pieces are written in a way that is easy to digest. It is worth picking up a copy of it from your local newsagent about once month or even better speak to your school careers teacher and see if there is any chance that the school could get a subscription.
This feature will be based on one of the featured articles in the 12th March edition of the New Scientist - "The Power of Mind". Shannon Fischer reviewed the latest discoveries relevant to 'The Placebo Effect' - a topic that is excellent to read up on to use in an interview discussion.
So what is the placebo effect?
According to science daily, "the placebo effect is the phenomenon that a patient's symptoms can be alleviated by an otherwise ineffective treatment, since the individual expects or believes that it will work." Pretty cool, eh?
The New Scientist article talked about a patient, Linda Buonanno, who had been sick with irritable bowel syndrome for 15 years when she watched a TV advert recruiting participants for a new study. She was so desperate to get involved even though she was fully aware that the treatment she would be offered would either be nothing or pills filled with nothing. In other words, this trial was testing the placebo effect against nothing. She had what she described as "fantastic" results: "I felt almost like I was before I ever had IBS. It was the best three weeks of my life". Since the trial has ended, she has been trying to get hold of the pills (which she knows are filled with nothing!).
This adds a new dimension to the placebo effect. The term 'placebo' refers to the use of a substance that has no therapeutic effect as a control when testing new drugs in drug trials. It is meant to be the thing that has no effect in order to measure the benefit of the new drug. However, instead of obeying the rules and feeling no different, many patients report beneficial effects.
The New Scientist article discusses how perhaps the placebo effect needs to be given more weight. The vision of the future would be to exploit this ability of the mind to heal itself and body without the use of drugs which often result in side effects that can nearly be as much of a problem as that trying to be solved in the first place.
A researcher at a Boston Medical Centre described to the New Scientist the latest research that suggests that when a person is given a pill that they believe is real medication, their body creates a real physiological effect. In fact, in pain studies, placebos have been shown to dampen activity in the brain's pain-processing ares and increase the production of the body's own analgesic chemicals.
The counter-argument that may be brought up in an interview if you discuss this is that pain has a psychological element. However, a follow up point that you could make in response, is that the placebo effect has been shown to work on conditions that would not be considered to have a psychological component. For example, people being treated for Parkinson's disease with apomorphine, were only told that they might receive a dose of the drug. Amazingly, they showed more dopamine activity in parts of their brain normally affected by the real drug!
Remember, a key thing to remember, is that if you bring up a disease at interview, be prepared for them to question you about it. For example if you mention the study above make sure you know that Parkinson's disease is the degeneration of the basal ganglia (part of the brain) and deficiency of the neurotransmitter dopamine.
So pain can be improved, Parkinson's disease can be improved and an even more recent experiment showed that the immune system can also be affected by the placebo effect! In this study, healthy participants spent 3 days taking pills containing the immunosuppressant cyclosporin A alongside a fruit flavoured drink. (FYI cyclosporin A is a drug used to help stop the body rejecting an organ transplant.) 5 days later, the participants took the same drink but with fake (placebo) drugs instead of the actual ones. And guess what? Blood tests showed that immune compounds suppressed by the actual drugs remained dropped with the placebo drug.
In other words, the placebo effect works when the patient expects the improvement that can be seen. Similar experiments have shown the same result when the reverse is carried out. For example, people are told their pills are placebo pills and their pain relief is dulled even though they are still taking the active medication. It seems a no-brainer that we use this effect to our advantage - huge amounts of money could be saved, patients could be spared nasty side effects of drugs and still have relief from some disease symptoms that are extremely difficult to manage.
However, there is one large problem that stands in the way. Using placebo requires deceit and this goes against some of the major pillars of medical ethics such as patient autonomy and informed consent. This is what has led to the development of the study that we opened with about Linda Buonanno. Here, she was fully aware that she was taking a placebo medication and yet, she had "fantastic effects". So how do we explain this?
Well, in the previous studies, patients believed in the medication they were taking. In this case, so did Lisa Buonanno. She believed in "everything that surrounded the drug". This has led to much excitement. Simply believing in the placebo effect itself (!!) is enough to mean patients still believe in the medication they are taking. They know it is a placebo but they know that the placebo effect can occur and therefore believe in that! Moreover, certain conditioning methods such as taking the medicine at exactly the same time every day and making the pills brightly coloured seemed to exert real effects on the patient's body.
So now, the honest placebo could even work! Verbal suggestion, classical condition can also be combined with a lifetime's associations learned about the medical ritual. Can you think of what these might be? Here are some ideas - any or all of which could cue the body's self-healing powers!
- Popping the pill packet
- Swallowing it with a glass of water
- Believing in the drug's ability to have an effect
- Believing and trusting in the doctor that has suggested the treatment
As wannabe medical students, one of the most intriguing aspects of the list that could be causing the effect is the trust and belief in the doctor. Lina Buonanno described her doctor as "such a good doctor". Some studies are now implicating personality traits such as optimism as factors that determine the benefit of the placebo effect in different people. However, a very interesting study is one by a neuroscientist at Massachusetts General Hospital. She looks to analyse the doctor-patient consultation using fMRI studies to visualise which parts of the doctor's brain could be responsible for whether the placebo effect works on the patient. In other words, good people skills, empathy and communication skills could be what determines whether the placebo effect is successful for a person.... now your minds are definitely blown!!
Keep updated on the blog about ways to prepare for your medical application and to book your place on one of the Applican courses this summer go to www.applicancourses.com/book.
This is a common question asked at medical school interviews. According to Atul Gawande's international bestseller "Better", one of the most important qualities of a doctor is diligence.
Atul Gawande's books are absolutely brilliant reads and I recommend them to all Applican students. His writing style is gripping and the way he bases his comments on clinical cases makes his words memorable and engaging. Over the next few weeks the Applican blog will be focusing on this book. We will discuss key interview questions and how to relate extra reading you do into your answers. The most important point when preparing for interview is to consider exactly how each piece of extra reading you do relates to the key questions you are likely to be asked. Today we will be looking at Chapter 1 of his book - in this blog post I will summarise some of the points and cases he uses. For a more comprehensive view, I would recommend you read the chapter yourself.
Gawande talks about how people underestimate the importance of diligence as a virtue. He claims it is something to do with how supremely mundane the word seems. I can see his point. There is nothing new or fresh about this term. Defined as "the constant and earnest effort to accomplish what is undertaken", Gawande says that if diligence was an individual's primary goal in life then that person's life would be narrow and unambitious. This is because diligence stands for commitment, dedication and relentlessness to the task at hand. The reason it seems mundane is that often sticking to the task at hand can be boring. We all know that new projects are the most exciting. Newly set goals seem attainable, regardless of how ambitious. However, maintaining high energy and effort input into a goal that is only slowly improving is far more trying.
I am a current medical student and on my most recent placement, I began to realise the diligence required in hospitals for infection control. This is discussed in depth in the first chapter of Gawande's book where he quotes the US Centres for Disease Control that state,
"Each year, two million Americans acquire an infection while they are in hospital and 90,000 of them die from that infection."
Gawande goes on to explain how, when talking to an infectious disease specialist, the greatest difficulty the infection-control team has is getting clinicians to wash their hands. Everyone always assumes it is stronger pathogens (germs) or resistance to treatments that is responsible for infectious disease rates. In fact, it is simply washing hands. I can't say I am shocked. OSCE examinations are a common way that medical students are tested on their clinical skills in a station-like structure similar to MMI interviews set ups. Here, students fail a station if they forget to wash their hands. The aim of this is to really drill into students the importance of this procedure that consistently halts the spread of infections. Nevertheless,
"hospital statistics show that doctors and nurses wash their hands one-third to one-half as often as they are supposed to."
It is unsurprising, and as Gawande himself says "embarrassing", that this concept of diligent hand washing is far from novel. In fact, knowledge of the impact of hand washing dates back to 1847 where the Viennese obstetrician Ignac Semmelweis identified that the high rate of maternal death due to childbed fever was due to inconsistent hand washing.
Childbed fever is also known as puerperal fever and was the leading cause of maternal death in the pre-antibiotic era. It is a bacterial infection most commonly caused by Streptococcus bacteria that ascends through the vagina to the uterus after childbirth. Back in the 1800s, about 20% of women who gave birth in hospital in a year died of this disease. However, of mothers that delivered their babies at home, only 1% died. This led to Semmelweis concluding that doctors themselves must be carrying the disease between patients. He mandated all doctors and nurses to scrub their hands with a nail brush and chlorine between patients. The death due to childbed fever reduced to 1% immediately. This was clear proof that he was right.
However, even with this proof, Semmelweis really struggled to get his colleagues on board. In fact, many were offended and Semmelweis ended up being sacked! This was because of Semmelweis' approach. He would stand by the sink and "berate anyone who did not scrub or wash their hands". On the contrary, John Lister (another famous historical medical name), published a "much more respectful plea for antisepsis in surgery" in the Lancet (a British Medical Journal). In his book, Gwande discusses how "striking the difference is between the history of the operating room after Lister has been compared to that of the hospital ward after Semmelweis". He speaks the truth - consider an operating theatre where 100% compliance with scrubbing his only one intervention that occurs. Sterile gloves, gowns, masks, head caps, antiseptic wiping of the patient's skin - nearly every element of the operating theatre has been considered.
It is actually pretty crazy how even 140 years later this diligent approach to antisepsis in the operating theatre has not transferred to hospital wards. Well there are a few key reasons. The largest one is time. If for example, there are 20 patients on a ward and the team have to get round them within two hours on ward round. Washing hands would take up to a third of the staffing time. Moreover, washing hands that often commonly causes dermatitis - skin irritation.
The introduction of antiseptic gel has been one of the greatest advancements, increasing complaint rates from about 40% to 70%. However, the most demoralising aspect of this statistic is that the rates of resistant bacteria such as MRSA (methicillin-resistant staph aureus) or VRE (vancomycin-resistant enterococcus) have not changed. This shows that the 30% of the time that doctors and nurses don't wash their hands is enough to maintain infection transmission.
So what is the answer? If individual diligence cannot over come this then how what next? Diligence of the individuals in LEADERSHIP.
Gawande discusses how a surgeon, Jon Lloyd, came across a Save the Children programme used to reduce malnutrition in Vietnam. The programme discussed how getting outside sources to bring in solutions to villages with malnourished children failed time and time again. People were reluctant to change when simply told how to do so. Instead, the programme asked local villagers to identify what had helped bring about the best-nourished children. The villagers discovered that, of course, there were some well nourished children amongst them and found certain methods that these mothers were using that seemed to work. These ideas began to spread and took hold.
Within two years malnutrition had dropped up to 85% in every village undertaking this programme.
This is referred to as "positive deviance". It works on the concept of building on capabilities people already have rather than simply telling them how to change. Lloyd decided to try this approach towards hospital infections. He held a series of 30 minute discussion groups with healthcare workers at every level: from food service to porters, nurses, doctors and even patients themselves. As Gawande discusses in detail, ideas began flowing. These people had been encouraged to use their own skills of innovation and creativity. When action was taken to solve the issues that had been discussed, the individuals that had brought up the problems took responsibility to ensure the action was carried out. The teams then began to carry out self surveillance.
As these small group sessions were held they were very repetitive for Lloyd who was leading them - he wasn't learning anything new. But nevertheless he continued to hold them for every team. He realised that by empowering the teams, results would happen. And he was right.
"One year later, the entire hospital saw its MRSA wound infection rates drop to zero."
In conclusion, diligence is essential in a doctor. By using the first chapter of Gawande's book and the examples he uses regarding hand washing, we can see that diligence on an individual level is important. Individuals need to strive to 100% comply with washing their hands before and between patients. However, diligence as a team is required. Pushing for higher standards and working together to make this possible is required. That said, what I think is the most interesting consideration, is that diligence as leaders is essential. Leaders of healthcare systems need to realise that empowering change by listening to the opinion of those on the ground and actioning them, empowers the individuals and motivates the team.
In many ways, this parallels perfectly to the junior doctor contract dispute. As long as the healthcare team of doctors are pushed away, as long as they feel like nobody is listening to them and that their opinions are not valued, the more that the challenges facing medicine will put more and more pressure on the NHS. By listening to doctors and actioning what they are think are the solutions, real progress can be made.
What is the most important quality of a doctor? Diligence is a good one to start with.
Diligence as a school student to gain your place in medicine is also required. Keep updated on the blog about ways to prepare and to book your place on one of the Applican courses this summer go to www.applicancourses.com/book.
An increasingly common question in medical interviews over recent months has been on the topic of 'globalisation of health'. This is a term that is often used but when asked directly what it means, many students can find it difficult to put their finger on it. So let's split it up, work it out and think of a five key points to show your interviewer you are worldly wise about medicine as a subject and a future career.
What is globalisation?
According to WHO (the World Health Organisation - if you don't know who they are and what they do then look it up now!), globalisation means
- The growth of international trade
- Improving global communications
- Increasing flows of goods, services and people
So more things are being sold between countries, communication across the world is better and more efficient and more goods (products), services and people are moving between countries. Cool. But what does this mean for health? Well, it has both a direct effect and also an indirect effect. In other words, it affects how we approach health but it also affects the health status of each individual.
1. Technology: Better sharing of information about disease outbreak
Through the improvement of communications technology, it is much easier for healthcare staff and even the general public to alert the relevant authorities to the outbreak of diseases. Furthermore, it is easy for people to share ideas and information on health issues and inherently, increased sharing of information leads to increased progression in how we approach these issues.
The huge rise in e-health is changing how we view medicine. Electronic communications, websites and apps are not limited by boarders and offer many potential benefits particularly from the point of view of medical education and professional training.
2. Migration and tourism: More people moving = more disease spread
The more that trade, tourism and migration increase (in other words the more that people move), the easier it is for diseases to spread. More than two million people cross international boarders every day and many will also be carrying disease into the new area they are entering. This isn't a new thing. In fact, it dates back to the 14th century where the example of the Black Death can be used as an example of how disease spread followed shipping routes.
*What is the Black Death? (You were thinking it, we said it!) The Black Death was one of the most devastating pandemics in human history resulting in the death of about 100 million people! It is thought to have been caused by a bacteria that caused several forms of plague.*
In fact, the spread of HIV across the world can be attributed to the globalisation that occurred during the 20th century.
3. Trade: Animals and Tobacco
More recently, the most concerning factor has been the spread of food borne disease. The increased trade (buying and selling) of live animals and animal products has led to diseases that previously started in animals mutating into variants that can be infectious, and often deadly, in humans. An example of this is Creutzfeldt-Jacob disease which is often referred to as 'foot and mouth'. This is a fascinating disease and keep your eyes peeled for an upcoming blog post dedicated to it!
The increasingly globalised production and marketing of cigarettes has a majorly negative impact on health. Firstly, transnational tobacco companies have increased the sales of tobacco in developing countries. Secondly, the variation in the rules and regulations between countries and more importantly, the differences in their willingness to control tobacco usage has made it harder to crack down on cigarette usage.
*Useful facts: Over 100,000 deaths a year are due to cigarette-related illnesses; 9 in 10 people wish they had never started smoking (Source: The Times)*
4. Environment: The effect of climate change on our health
Higher temperatures, more CO2, more greenhouse gases, ozone breakdown. From respiratory infections to higher rates of skin cancer, the changes in the global environment are affecting our health without a doubt, and not for the better!
5. Global public goods: Making change global
The concept of globalising public goods creates the potential to improve the health effects of globalisation itself by maximising the benefits of globalisation to benefit worldwide health.
I know everyone is thinking, what on earth is a public good? A public good is a service that once provided is available to all and people using/consuming the service does not prevent others from using/consuming it. These are often hugely beneficial to health. For example, water services, sanitation services, health education and many more. Normally, these services are provided on a local level - mostly due to the difficulty in financing them when they extend further than this. However, there are many examples where by expanding the services to global level would have greater benefits and impact than simply providing the services on a national level in individual countries.
Immunisation is a particularly important example of how this has worked in the past. Polio eradication is a perfect example. Only universal eradication of polio demonstrates the full benefits of the money and resource savings of preventative programmes and re-vaccination. Moreover, once polio is eradicated, everyone will benefit!
An example of something that could benefit from this is international coordination to reduce antimicrobial resistance. Combining and sharing knowledge about this issue could allow a united approach, increasing efficiency and could allow us to overcome this extremely pressing issue.
So, what does Applican think? What does globalisation mean for health?
Well, we think globalisation is cool. Huge increases in our ability to share information is the particularly exciting part. Look at this blog post - anyone around the world can read it! It is pretty exciting. However, as our approach to life shifts, so should our approaches to services and in particular health. Anyone who has been on an Applican course or is thinking about it, get one phrase into your head: "The shift from acute illness to chronic disease". Healthcare 100 years ago was focused on acute illness. Today, our issue is chronic disease: cardiovascular problems, cancer, obesity, diabetes, the list goes on. These issues require long term treatment and are expensive. More importantly, the longer that people live, the more of these chronic problems they are likely to accumulate. In other words, chronic disease and the ageing population go hand in hand. They also make our traditional model of healthcare completely outdated. We need a life approach to healthcare. What do we mean by a life approach to healthcare?
1. Primary health care: less specialist doctors, more generalists
Currently, the traditional model of healthcare is hospital centred with lots of doctors that strive for specialist niches that they can be experts in. This doesn't really lend itself to a situation where patients have problems from LOTS of specialities with issues arising from all of them. More than ever, we need doctors that are generalists in multi-tasking with diseases. We need generalists not specialists! People who can look at someone with 5 problems and know which order of priority they should be treated in and how to treat one problem without having knock on effects on the other underlying issues (also commonly referred to as 'co-morbities).
2. Intervening earlier: prevention rather than cure
Less fight fighting, more fire prevention. By intervening earlier in a person's life, we can truly impact future health and disease. A recent study looked at mice embryos that are just 4 days old. The study demonstrated how if the mothers of these mice were fed high fat diets the baby mice had higher blood pressure and higher BMIs later in life than the baby mice born from mothers fed a high protein diet. How crazy is that?! This has led to many studies looking at similar factors in humans with the consideration that many illnesses could be based on behaviour between conception and birth.
In conclusion, a life approach to healthcare would be the shift needed to meet the changes occurring due to globalisation. It is essential that globalisation allows for increased health promotion, rather than deterioration. This means managing globalisation to minimise the potential for the negative effects we have discussed above. This will inevitably mean designing international policies and rules that optimise health outcomes. It is essential that we also realise the sectors that are indirectly important to health and ensure funding is maintained in these areas. These include education, production of health-sector equipment and facilities and most important the producers of goods with positive and negative effects on health (such as foods, tobacco, alcohol and so on). For example, one suggestion is increasing tax on the goods that cause detrimental effects for health and increasing access to the positive ones.
Here at Applican, we are passionate about breaking down terms. Globalisation is one of those that people think they know about but actually have no idea. We hope that after reading this article you could give an excellent answer to any question regarding globalisation of health. Moreover, we hope you could give a passionate, insightful and balanced answer.
Don't be an Applicant, be an Applican! To book your place on one of our courses this summer season then go to www.applicancourses.com/book or contact firstname.lastname@example.org.