DISCLAIMER  I AM NOT A DOCTOR  Knowledge and experience still fairly limited  Have been through application process – research, work experience, personal statements  Good tips & aware of the concerns of prospective applicants  Do have SOME practical experience  Feel free to interrupt with questions

At the moment  Taking more responsibilities for your own studies  Thinking about your next steps after school  Obviously bright and enthusiastic  Might feel it’s impossible to pick one subject  Friends/teachers/relatives may be trying to push you down certain academic paths

Before long  You’ll have to decide what you actually want to do with your life  If medicine is what you want to study, then you will need to develop a genuine passion for the subject  You’ll have to find an answer to the question in the title

“So You Want To Be A Doctor?”

    

I was asked this on my first day of work experience My answer was terrible I was reminded of how competitive medicine is To succeed you need to KNOW this is what you want Do research into the profession – talks, reading, work experience  I am so grateful for the kick up the backside  The aim of today is to help you to answer the question yourselves  DON’T PANIC – you still have plenty of time

Ancient Medicine  Heavy reliance on herbal remedies e.g. bark of a willow tree  Mostly useless and no explanations as to why or how treatments were meant to work  Medicine as we know it began in Ancient Greece

The Father of Modern Medicine  Changed the way people thought about disease  Theory of the four humours  Milestone: One of the earliest substantial attempts to find a physical cause for disease, as opposed to a spiritual one  Realised and taught the importance of recording observations – research today is built on this

Galen • A Greek doctor working in Rome 500 years after Hippocrates died • Contributed a great deal to the field of anatomy through animal dissection • Introduced the Theory of Opposites • Wrote 350 textbooks • The Catholic Church endorsed his ideas

The Church’s Influence  The early Church only approved of ideas that fit in with the teachings of the Bible  They had a monopoly on medical education  For 1200 years medical students were taught Galen’s ideas in church funded institutions  The only observations that were allowed to be vocalised were those that supported Galen’s theories

Medieval Medicine

 Very little changed in terms of practical medicine  Blood letting and prayer were still seen as acceptable treatments up to and beyond the 16th Century  Urban growth, fatal infectious disease, overcrowding, ineffective medicine and poor public health  BIG PROBLEM  The reformation of the Church made a difference – there was a greater tolerance of new ideas

Great Progress         

First vaccinations for smallpox A comprehensive theory for the basis of infectious disease Targeted medications – magic bullets Antibiotics A whole host of imaging techniques Discovery of DNA Chemotherapy and radiation treatments for cancer Mapping of the human genome Surgery – anaesthetics, antiseptics, blood transfusions, laparoscopic technology

Huge Transition

Historically medical treatments were ineffective, but relatively harmless

Now medical treatments are, for the most part, effective, but potentially lethal when used incorrectly

Conditions We Know Of

      

Infectious disease – bacteria, viruses, fungi, prion Cancers Autoimmune diseases Hypersensitivity reactions Genetic disorders Endocrine disorders Neurodegenerative conditions – Alzheimer’s, Parkinson’s  Many more

Robust Scientific Evaluation

Robust Scientific Evaluation

 Not used properly for many, many years after Hippocrates’ death  Pre-existing bias’ and external pressures to get certain results prevented proper progress  In medicine today all that matters are your ideas and evidence for them, not who you are  Peer reviews are often anonymised

The Purpose of Medicine

 Not as obvious as: “to make people better”  Sigerist: “The task of medicine is to promote health, prevent disease, treat the sick when prevention breaks down, and to rehabilitate people after they have been cured”.  These are very social functions

Medicine as a Social Science  The means of practicing medicine have changed, but it’s ultimate goal has never changed  Hippocrates: “Cure sometimes. Treat often. Comfort always”.  Modern day doctors belong to Multidisciplinary Teams – decide on rounded treatment plans that are tailored to the individual patient’s needs

The Focus on Mental Illness

 Huge problem – particularly in the UK  Poor public understanding of diseases such as depression, probably because they are less visible  Still a long way to go in terms of trying to understand the physical origins of certain mental illnesses - it is possible more is known about our universe than how our brain works  That said our understanding is ever improving, with a lot of current research focussed on these areas

The Focus on Mental Illness

 For now though it is important to realise the enormity of the issue  Reduce stigmatisation of these conditions  Encourage people to seek the tremendous amounts of help that is available  Treatment is effective

Why Bring This Up?  Growing problem  Massively interesting field  Good example of the importance of individual approach – enormous case-to-case differences  Understanding the patient’s experience is vital  Rapport building is an important skill in healthcare professionals  It is important to treat patients as people and now just cases of a disease  Iona Heath: Medicine is becoming more about learning how “the biology common to all humans is modified by the biography unique to each one”.

Suggested Reading!

What Is a Doctor?  A question I was asked in my Cambridge interview  OED: Doctor: “a person who is qualified to treat people who are ill.”  Not a very complete definition

The Responsibilities of a Doctor 1. To treat the sick 2. To have a firm grasp of general medical knowledge 3. To keep up to date with the latest developments concerning the specific field in which they have specialised e.g. cardiology Doctors as the engineers of the body

The Responsibilities of a Doctor

4. To be able to relate to patients and understand their specific concerns and experiences 5. To attend Multidisciplinary Team meetings

Doctors as comforters and carers

This Is Really Important  Sometimes patients, especially in General Practice, might not actually have anything physically wrong with them  Putting the minds of patients at rest is vital  A huge benefit of the NHS is being able to book a GP appointment even if you are just unsure about something

The Responsibilities of a Doctor 6. Paperwork 7. Allocating parts of the NHS budget

Doctors as administrators

Government Changes  As part of wider public cuts, the coalition government pledged to reduce wastage within the NHS  This means doctors are required to take on a greater number of admin roles  The changes that have been implemented in recent years are outlined in the white paper  More to come!  Hot topic in interviews

NHS Privatisation  Another hot topic  Refers to the introduction of private third party companies into the healthcare system  Relieves public spending, BUT do we really want to go down this route?  DON’T need to know loads about it  The NHS is now a huge political battleground  There is a very good TED talk available on YouTube on the topic – more than you need to know

The Responsibilities of a Doctor

8. To conduct research on topic related to their specialist field 9. To serve as gatekeepers to the “sick role”

For those interested…

Tying All This Together  Our original definition was definitely lacking a doctor is more than just a healer  Being a physician requires a broad skill set  A number of stresses and demands associated with the job

Is the Medical Profession Depressing?

 Emotional strains of being around sick and dying people  Government quotas to meet  Regulatory bodies constantly reviewing your performances  The ever present fear of being sued

It’s Important to Acknowledge the Negatives

 Medicine isn’t perfect  You need to be realistic about what you expect to get out of a career as a doctor  A realistic personal statement is more likely to be successful

Pessimism

Realism

Optimism

Why Do People Go Into Medicine?

1. 2. 3. 4. 5. 6. 7. 8. 9.

To satisfy an interest in how the body works A desire to help people Respectable position in society Nice people to work with Good job security Good pay Variety of job prospects Lifelong learning A cool title to put on your business cards

The Qualities of a Good Doctor  Strong scientific understanding  Passionate interest in the subject  Empathy (not sympathy)  Interpersonal and leadership skills  Good organisation  Can cope well under pressure  Good ethical and social awareness  Well rounded

How Can You Demonstrate These Skills?

 Strong scientific understanding  Passionate interest in the subject  Empathy (not sympathy)  Interpersonal and leadership skills  Good organisation  Can cope well under pressure  Good ethical and social awareness  Well rounded

 Excellent academic record  What work experience have you done? What books/articles have you read?  What volunteering have you done? How can you relate to what patients are going through?  What teams have you belonged to? Head Boy / House captain / Prefect  How do you manage multiple responsibilities? Work/life balance? Part time job?  What hobbies do you have?

Warning!  All advice is generic  Annoyingly each medical school has its own take on what the “perfect” medical applicant should look like so…  GET TO KNOW YOUR MEDICAL SCHOOL!!!  You don’t want to waste a single one of your four options

The Three Types of Course

1. Traditional e.g. Cambridge, oxford, Nottingham 2. Integrated e.g. Imperial, UCL 3. Problem Based Learning (PBL) – Exeter, Manchester, Liverpool Be prepared to justify your choice at interview!

The Road to Medical School

GCSE

AS

UKCAT

Work XP/ Volunteer work

A2

Offer

Interviews

(BMAT)

Other things to think about: • Hobbies • Part time work • Wider reading

UCAS Form

Personal Statement

GCSEs  Some medical schools (e.g. oxford) really prioritise them  Others (e.g. Nottingham) look at a subset  Some (e.g. Cambridge) only require passes in Science, Maths and English  Standard > Requirement  Year 12’s don’t lose heart!

A Levels  All universities require Chemistry, and at least 2 of Biology, Maths and Physics  A fourth AS is also required in a subject of your choice (not general studies or critical thinking)  Should really aim for 4 A’s  Cambridge ask for UMS scores  If you want to get in to either Cambridge or oxford, then you MUST do four A2’s

UKCAT  Every medical applicant must sit this exam  Must book the test months in advance  Booking fee of £65 – support available  Nearest test centre is in Uxbridge  2 hour computer based exam in five parts  Testing runs from late June to October, and needs to be sat before UCAS form is submitted

Section One – Verbal Reasoning

Section Two – Quantitative Reasoning

Section Three – Abstract Reasoning

Section Four – Decision Analysis

Section Five – Situational Judgement

How Is It Marked?  Raw marks for each section are converted to give scaled scores from 300 – 900  Results printed as soon as you finish, then emailed to UCAS  Seems to be that those who do the test earlier perform better – BOOK EARLY

How Important Is the UKCAT?  VERY – probably the most common cause of rejection from UK medical schools is a poor UKCAT score  The way universities view your UKCAT result can vary – some care about an overall score, others just care about certain sections  Do your research! You get your results on the day of the exam, so can alter your choices depending on how you do

What’s a good score?

A mean score of 629 would be “above average”, but there is a school of thought saying that a score above 700 is needed to stand out.

The Trick to the UKCAT

 The difficulty lies in the timing, not the questions themselves  230 questions / 120 minutes = 31 seconds a question

The Trick to the UKCAT  Only way to guarantee success is to practice like hell  Full tests available online  Best revision resource BY FAR 

Work Experience

 Medical schools love this – some even expect you to have completed a minimum number of weeks  Shows commitment to the subject  More likely to be realistic about the job  Mixture of hospital and GP experience preferable

Work Experience

 Can be a nightmare to organise  Year 11s and 12s: sort this out ASAP  Look up departments at local hospitals (e.g. Hillingdon, Mt. Vernon etc.) and phone  Clinical experience is ideal, but experience of any caring environment will boost your application

Personal Statements  Part of UCAS form  4000 characters (700-800 words) in support of your application  Insight  Motivation  Why are you suited to the subject?

Personal Statements  Horrible task  The character limit makes it really difficult  I went through 11 drafts  Takes a long time to get right, but it’s worth getting right  Different universities want different emphases – personal or academic  Criticism is very hard to take

BMAT  Students applying to Cambridge, Oxford, Imperial, UCL, Bristol and Leeds have to sit this exam  Trickier than the UKCAT in some respects  2 hour handwritten paper  Taken in school in the middle of November (after UCAS submitted)  Apply for entrance through exams office at least 6 weeks before!!!

Section One: Aptitude and Skills

Section One: Aptitude and Skills

Section Two: Scientific Knowledge and Evaluation

Section Two: Scientific Knowledge and Evaluation

Section Two: Scientific Knowledge and Evaluation

Section Two: Scientific Knowledge and Evaluation

Section Three: Ethical Essay

How is the BMAT Marked?

 First two sections given a scaled score out of nine  The essay is marked out of 5, and is also scored for grammar and spelling (A-E)  Make sure any factual information you refer to in your essay is accurate  Get results online two weeks after sitting the exam

The Trick to the BMAT  You guessed it! PRACTICE!  Section two requires GCSE knowledge in all the sciences and maths – look over old notes  Practice essays and get teachers to give feedback

Interviews

 ALL medical schools interview now  Probably the most nerve-wracking part of the process  Helps to have a vague idea of what to expect

Typical Interview Questions

 What motivates you to study medicine, and why are you suited to the subject?  How well do you know yourself?  When have you demonstrated skills of leadership, communication, empathy etc. – can you give specific examples?

How Ethically Aware Are You?  Fictional situations  Think back to the example of a single mum in her twenties and the elderly married man in his seventies, except now they both have heart failure. You have one heart to transplant. They’re both viable recipients. Who do you give it to?  Don’t just jump to a conclusion – talk the interviewers through your thought process

“Whacky” Problem Solving Questions

 There are no trick questions, merely thought provoking ones  “How many toothbrushes are there in London”  A test of how you cope with the unexpected  Take a second, break it down, and keep figures simple

Just give it a go!

 The answer is of little importance compared to how you arrive at it  The worst thing you can do is seize up and shy away from the question  Stay open to alternative interpretations

The Format of the Interview

1. Normal 2. MMI 3. Oxbridge

The Nervous Wait

 Every year lots of very able students receive four out of four rejections  Most common reason – UKCAT/BMAT or lack research  Extremely disheartening

Applying is a Risk

 A lot of applicants could walk into other degrees  Some change their minds and do something else  Most reapply the following year, and a large proportion are successful – provided their academic credentials meet the standard  Perseverance demonstrates commitment  Important to do something useful with the year out  Very harsh and there is no shame in failure

On the Other Hand

 Receiving an offer is incredible!  All the hard work is suddenly worth it  Typical medical offers AAA – A*A*A  Meeting the offer isn’t actually that hard, given how far you’ve come

Medical School

 Most courses are five years long, though some are six  Standardisation by the GMC ensures all medical students are taught the relevant information

Year One

Year Two

Third Year

 Lab project or dissertation on medical topic of my choice

OR  Do a different subject altogether for the year

Years 4, 5, and 6

 Based at Addenbrooke’s Hospital  “Aim is to develop the practical knowledge, skills and attitudes required to actually practice medicine, by building on the scientific theory laid down in the pre-clinical years”  History taking, drawing blood, X-ray reading etc.  how to function independently

After Graduating

 Junior doctors learn on the job within NHS hospitals  Actually get PAID! Starting salaries ~ £23,000, which goes straight up to £29,000 in the second year  After two years of foundation training, you can train to become a specialist  Takes an additional eight or nine years, meaning you can be a consultant by your mid thirties  Possible to be a GP by 29

My Background  No one in my family had ever gone to university, let alone medical school, so I was never pressured into going  Always liked the idea of Oxbridge, from a very young age, but didn’t get particularly serious about trying until I was much older  Enjoyed Maths and Science  Topics covered in lessons or Gifted & Talented sessions concerning the body really struck a chord e.g. Phineas Gage

GCSE Years

 Picked subjects geared towards medicine  In Year 10 I did two weeks work experience at the ETC at Brunel University  Eventually achieved 8A*’s and 4A’s  Over the Year 11 summer I organised work experience for the following year

AS Levels

 Biology, Chemistry, Maths & History  4 A grades  UMS: 95, 97, 94, 90  Wanted to apply to Oxbridge, but waited to results day to decide which one  Got 95% average so went with Cambridge

UCKAT

 28th July 2012

 705 average

Work Experience  Frustrating to organise  Shadowed a psychiatric consultant at St. Charles Hospital  Spent a week on a Geriatric ward at St. Mary’s Hospital in Paddington  GP experience in Stanmore  All about getting that first contact  Allowed me to figure out whether I wanted to be a doctor or not

Work Experience

 Some of the most exciting weeks of my life  Daunting at first, but got over it  Shadowed on ward rounds, listened in on consultations, attended MDT meetings, sat in on strokes/falls clinics etc.  Witnessed a failed resuscitation attempt

Work Experience  Also saw mentors spend hours filling out paperwork and reading notes  Attended a target setting & budgeting meeting  Experiencing the tragic and dull aspects allowed me to gain a clear insight  Got to attend a lecture at Imperial

Other Stuff

 Worked as a tutor at Explore Learning  Head Boy  Drafted my personal statement and sent it to anyone willing to help  Applied to Emmanuel, Nottingham, Exeter, and Southampton

My BMAT

 6.2, 6.2, 4A  Top 11%  Convinced this is what earned me an interview at Emmanuel 0n 4th December

Offer  Gained a conditional offer of A*AAC on 4th January 2013  Window between starting year 13 and receiving the offer was the most stressful period of my life to date BY FAR  Hardest thing was not knowing anyone else in the same boat  Wanted to walk away so many times  Achieved A*A*A*B

Year One  Work load  Essays  Balance – rowing, football, union etc.  The people  Supervisions, dissections & other facilities  Stress of exam term  May Balls  Walked away with a solid 2i

Year Two

 More confident  Harder, but more interesting content  Try a lot more extra stuff – tennis, bar work, access work, talks  Enjoying it a whole lot more

Topics We’ve Covered  The history of medicine  The scientific methods that govern medicine  Mental health  The responsibilities of a doctor  Decision making in medicine  The sick role  NHS privatisation  Pathways in medicine  E- patients

On Top of That!

 Euthanasia  Revalidation

 The ethics of a doctor going on strike (June 2012)

 Pharmaceutical Companies

Key Reading

       

The Man Who Mistook His Wife For a Hat Brain Story Sociology As Applied to Medicine The White Paper (NHS) TED Talk: Privatisation of the NHS Bad Science The Selfish Gene Bad Pharma

Question: Will I Get In?

Answer:  Not if you don’t apply

 Aim for 4 A’s at AS and practice UKCAT/BMAT  Do anything else you can to maximise your chances

Question: Can You Have A Life Whilst Studying and Practicing Medicine? Answer:  Of course you can  Might be a bit harder for medics than those in other subjects, but BY NO MEANS impossible  Good planning and discipline is important  Met loads of doctors of both genders with families and hobbies outside of their job  Important to have a greater appreciation of life as a doctor

Question: Is there any point applying? I don’t stand a chance against private school students.

Answer:  There is NO truth in this  Two main differences between us and them: a) Confidence b) Focus  Be aware of what you’re up against, but feel inspired to beat them, not intimidated  Don’t let me hear anyone say that you have to go to Eton, and have parents who are doctors to stand a chance

Question: Do You Enjoy It? Answer:  Obviously, but I still can’t say why  Still have days when I question my choices in life – who doesn’t?  All things considered, I am very fortunate to be able to do what I do  “Why Medicine” is an impossible question to answer, much like this one

Email: [email protected]