1
Q
What are the aspects of tetralogy of Fallot?
A
- A group of four structural abnormalities within the heart
1. Pulmonary stenosis: a narrowing under or above the valve between the right ventricle and the pulmonary artery
2. Ventricle septal defect: hole between right and left ventricle
3. Overusing aorta: May be next to the ventricle septal defect which means that oxygen poor blood can through spray
4. Thick right ventricle: the heart has to work harder to lump blood through the narrower pulmonary artery, so the muscle thickens
2
Q
How do you fix tetralogy of fallot or treat it?
A
- Sometimes can be seen on a scan during pregnancy
- Sometimes after brith the sound of blood moving through the pulmonary cavalry can be heard as a heart murmur
1. May need shunt to increase blood flow to lungs by diverting an artery (one that takes blood to the left or right arm to the pulmonary artery (a BT shunt)
2. Ballon dilation: ballon catheter to increase blood to the lungs, inserted into narrow part of pulmonary artery and then inflated so stretch pulmonary valve and part of artery
3. Open heart using bypass (to make circulation through the heart and lungs near to normal) patch put over the hold and the narrow area around the pulomlnary artery enlarged
3
Q
What is patent ductus arteriosus?
A
- Condition here the ductus arteriosus faults to close after birth
- This hole is used for the baby to skip the circulation to the lungs as the blood does not need to go to the lungs to be oxygenated
- Usually closed within first few days
- Common in premature
- Extra blood get pumped from the aorta into pulmonary arteries, if big the lung may work harder as a result
4
Q
How can PDA be treated?
A
- Sometimes can be closed by inserting catheters into the blood vessel to reach the heart and the PDA and a coil can be inserted through catheters into the PDA
- In surgery suture with a small metal clip around the ductus to squeeze it closed
5
Q
Why do you want to study medicine?
A
- Love science subject
- Discovered from my work experience and volunteering that I really love helping people
- Everything is active which I found on my work experience and intense and constantly interesting
- You are always learning even after you qualified
- There are such a range of specialities
6
Q
What did you learn from work experience?
A
- Variety of work as no two patients and days are the same
- I’m very inquisitive and love problem solving for example from unclear symptoms
- Teamwork and leadership
- Intellectually challenging
- Love the constant learning
- Unpredictable and always prepare for
- Physically and emotionally challenging
- Importance of doctor patient relationship and how vital it is
- Importance of a multI disciplinary team
In surgery - Teamwork and leadership (being both a leader and part of a team)
- Good manual dexterity
- Resilient and high concentrations fb keeping calm under pressure
On ward rounds - Saw importance of good time management and how important to delegate and prioritise
7
Q
Why not a nurse?
A
- Acknowledge the importance of their role and have leadership and responsibility in patient contact
- But I also enjoy and want to do the problem solving side and diagnosing the patient
8
Q
What are your soft skills?
A
- From volunteering in a care home I really enjoyed it founding it humbling and the patients looked forward to seeing me and enjoyed beguiling a relationship and saw the importance and hard work and role of nurses
- Caring, compassionate, committed
9
Q
Qualities of a good doctor?
A
From my work experience..
- Compassiomate
- Communication
- Leadership,
- Academic
- Thinking on feet
- Resilient
- Knowledgeable and up to date
10
Q
What did you learn about yourself from work experience?
A
IMPROVE empathy, patience, communication skills and listening
11
Q
What are the problems with the NHS?
A
- Lack of funding
- Increasing and ageing population
- Obesity epidemic
- Bed blockage
- Antibiotic resistance
12
Q
What are the challenges of a doctor?
A
- Make decisions when unclear
- Bleepers constantly go off
- Long and unsociable hours
- Tell bad news
- Paperwork: discharge papers
- Difficult patients and relatives
- Working in the NHS budget
- Shortage of doctors and nurses
- Exams and wards
13
Q
What are your qualities?
A
- Hardworking
- Resilient and tough
- committed, compassionate caring and have communication skills
- Honest and integrity
- Good time management m, from juggling exams, sports volunteering and had to be organised and improve mental and physical strength and care home improved empathy
14
Q
What are true 4 pillars of medicine?
A
- Autonomy: patients have the right to refuse treatment
- Beneficence: always act in the patients best interest
- Non-malificence: do no harm
- Justice: treat all people equally and equitably
- Lots of concerns etc, BE LOGICAL
15
Q
How do you make a medical diagnosis?
A
- Medical history
- Detail physical examination
- Order tests
- When results come back confirm diagnosis (even though may have already had an idea, need to test to confirm)
16
Q
What is Alzheimer’s?
A
- Most common type of dementia greatest known risk factor is increasing age and is a progressive disease, at the start memory loss is mild, but become increasingly worse
- Current treatment can slow worsening of symptoms to improve quality of life
- Those with Alzheimer’s tend to develop more plaques which are deposits of a protein fragment called beta amyloid and tangles that are twisted fibres of the protein tau, and these form in a predictable pattern
- As develops can have confusion, difficulty planning or making decision and problems with language and speech estimated 1 in 14 over age of 65. Treatment can be medicine such as acetylcholinesterase inhibitors and memantine
17
Q
Who is current health secretary what do they do?
A
- Matt Hancock
- Overall financial control and oversight of NHS delivery and performance
- Oversight of social care policy
18
Q
What was the old structure of the NHS?
A
nitially and tripartite system of:
1. Hospital services organised into regional hospital boards in charge of administration
2. Primary care such as GPs dentist and opticains who worked as indepdnet contractors rather than salaried employees of the government
3. Community services, including maternity, child welfare, vaccination and ambulance services
1962, unified and build new distract general hospital
4. The NHS and Community Care Act 1990 gave regional health authorities budgets with which to buy health provision from hospital and other health organisations, putting hospitals in competition with each other to sell their services.
5. In 2003 the Labour government introduced Payment by Results, where NHS bodies are allocated money based on how many patients they see. Whilst this can be cost-efficient, it can also risk services being too target-driven and compromising on quality of care.
19
Q
What is the new structure of the NHS?
A
Now: after Health and Social Care Act 2012
- Department responsible for funding and coming up with policies to do with healthcare in the UK
- NHS England, umbrella body that oversees healthcare and is independent body
- Clinical Commissioning Groups (CCGs) responsible for commissioning healthcare for their local area and run by GPs, nurse and consultants and are in charge of 60% of NHS budget
- NHS foundation trust provide care that CCGs commission which include, hospital ambulance and mental health services
- Devolution: fours countries in UK now have own NHS services, and DevoManc, could mean services more aligned with needs to specific region, or could cause distraction in complex taking away focus from basic care provision, and risk of redundancies
20
Q
What is the course structure?
A
- Year 1 and 2 there is a focus on the scientific basis of medicine and introductory clinical experience where teaching is delivered through a range of lecture, tutorials and problem based learning session
- Year 3 there is a 10 week hospital attachments covering General Medicine, and Surgery complemented by a central teaching programme and e-learning
- Work toward BSc, series of modules and supervised research project or specialised course, opportunity to delve deeply into a subject that catches interest
- Dedicated pathology course, followed by a year of clinical specialities in rotation, unclosing obstetrics and Gynaecology, Psychiatry, General Practice and Paediatrics
- Year 6 is a range of clinical placements and lecture course designed to prepare for first job as a doctor and a student-selected specialist study module
21
Q
Describe the NHS
A
-Founding principles:Free at point of delivery, meet the needs of everyone, based on clinical need and not ability to pay
-NHS LaunchedMinister Aneurin Bevan
-Primary care: provide first point of contact in the healthcare system, GP, dental and optometry services
-Funding for NHS comes from: general taxation
-NHS launched: 1948
-NHS six C’s: care, compassion, competence, communication, courage and commitment
Approx every 36 hours NHS serves: over 1 million
NHS employ more than 1.5 million people
22
Q
What is the impact of Brexit on Healthcare?
A
- Scientific Research
- Impact on Universities
- Pharmaceutical products
23
Q
Qualities of a good doctor
A
- Knowledgeable and up to date
- Resilient
- Empathetic
- Caring
- Compassionate
- Good Communication skills
- Committed
- Honest with integrity
- From WE - Importance of being a team player and leader
- In surgery, importance of manual dexterity and resilience as stand for long hours in intense and high stress situation
- Non-judgemental
- Be humble and ask for help when needed
- Especially in neonatal unit being organised and having good time management
- Keep calm under pressure
24
Q
Learnt from WE
A
From my WE: IMPORTANCE THROUGHOUT (no ranting, love points)
- Realities and challenges of medicine
- Importance of a doctor patient relationship (repour and trust)
- Power of empathy and compassion especially when delivering bad news
- Adapt communication in a variety of different circumstances and different people
- Importance of being a team leader and player
- Importance of resilience and manual dexterity in surgery as standing for long hours
- Importance in the role of the MDT and importance of each person
- From care home, improve empathy and patience
- Importance of confidentiality
- Qualities of good doctor
25
Why Imperial?
1. Amazing student feedback
2. Intercalated course is perfect for me
3. Feel in love with it on the open day and it is my favourite school
4. Great reputation
5. Great for research
6. There are so many clubs and societies dance club, boxing, fashion and design, friends of Médecins Sans Fonrtières, Society for international medicine, TeddyBear Hospital and volunteering societies working for local SoupRun and with over 240 clubs societies and projects which are all student led and student run
7. Early patient from the first term
8. Location: vibrant and diverse and multicultural living and working in London, lots of opportunities and a range of cases
9. Great group of hospitals
10. Charity organising schemes which I would love to be involved with
11. Use cadavers
26
Why medicine?
1. Love science subject
2. Love helping people and discovered in volunteering/WE
3. From Work Experience everything is active
4. Always learning even after qualified
5. Variety of work: no two patients and days are the same
6. I am very logical and very inquisitive and love problem solving e.g. from unclear symptoms
7. Love working in a team and also leadership
8. Intellectually challenging
9. Love the constant learning
10. From in care home really enjoyed, humbling and patients looked forward to seeing me and enjoyed building a relationship and I also saw the importance and hard work and role of nurses
11. On work experience also spoke to lots of doctors and medical student who liked the course
12. Loved my research experience
27
What is resilience? When are you resilient?
1. Physical and psychological: being able to deal with stress and come up with solutions under pressure and stressful situations
2. Always, as juggle sports, music and volunteering in a care home and I need to be organised for example in a care home it can be upsetting to sit and listen to patients who may have no visitors and then hard to leave and walk away
28
How important is resilience for a doctor?
From WE:
1. Long unsociable hours
2. Lots of paperwork
3. Doctors and medical students all day in wards and then need to study
4. Bad new difficult as build a repour
5. Deal with difficult patients who may have high expectations
6. Deal with angry relatives
7. Issues around Brexit
8. Patients may not take advice
9. Patients not turn up to appointments
10. Working in NHS budget
11. Working with a variety of teams
12. Make decisions when unclear
13. Beepers constantly going off
29
When do you work in a team: PRESENT: I DO 5 or 6
1. Charity committee
2. Environment committee
3. Teaching in maths club for younger children
4. Netball
5. Hockey
6. Tennis
7. Drama
8. MedSoc
9. Athletics and running
10. Science committee
30
What are your qualities?
1. Caring
2. Compassionate
3. Considerate
4. Resilient
5. Honest with integrity
6. Last several years from juggling sports, volunteering, exams I am very organised have good time management and am resilient
7. From music and drama and volunteering learnt to multitask and taught me to be resilient
8. From care home I learnt empathy, compassion
31
What are qualities of a team player?
1. Communicate
2. Hardworking
3. Work well independently and in a team
4. Keep to goals and deadlines
5. Contribute to ideas
6. Good listener and approachable
7. Good sense of humour
32
What are the qualities of a team leader?
1. Good and hardworking
2. Know strength and weaknesses of everyone in the team
3. Motivate and encourage people
4. Good listener and approachable
5. A good sense of humour
33
What hospitals does Imperial involved in?
1. West Hertfordshire Hospitals NHS Trust:
- Watford Hospital
2. North West London Hospitals
- Northwick Park hospital
- Central Middlesex hospital
3. Hillingdon Hospital NHS trust
- Hillingdon hospital
4. Ealing Hopsital NHS trust
- Ealing Hospital
5. West Middlesex University Hospital
5. Imperial College Healthcare NHS trust
- Hammersmith
- St Mary's
- Charing Cross
6. Chelsea and Westimnster
34
Tell about a time you were a good team leader?
In Hockey:
1. Hardworking
2. I knew the strengths and weaknesses of my team and how to position them well
3. Able to motivate them and they could approach me: motivate by speaking individually to them and directly
4. Used humour to keep their spirits up when the rain would be pouring and the match may not have been going our way
35
Tell me a time when you were in a bad team
1. Leader did not turn up
2. Not good at listening and would shout so was very unapproachable
3. Not everyone was involved
36
What is empathy? When are you empathetic?
Putting yourself in someone else’s shoes and imagining the pain they might be in
-Always empathetic and I always listen to upset people at the care home, patients or relatives or people who are upset at school LISTEN not talk
37
How is empathy important in a medical situation?
Saw in Work Experience:
1. Saw how delivered bad new and how altered speech
2. Allows doctor to build a repour and trust with patients and relatives
3. Patients may be more honest e.g. how much they mock
4. See in care home importance of staff being empathic and being empathetic to them
38
How important is communication in medical situation:
From Work Experience
1. Saw in neonatal when parents were upset importance of communication and constant reassurance and adapting the communication and tone and technical terms
2. On ward rounds, consultant speaks to MDT using technical terms but then changes for patient
3. Adapt communication for child
4. Non-verbal communication: empathy, reassuring and guiding
5. Written communication: keeping up to date
6. Telephone communication: confidentiality
7. Constantly listen to their anxiety and fears before surgery
39
How important is being a team leader and player in medicine?
1. In surgery leading team and delegating
2. Ward rounds working in MDT
3. Importance of leadership and involving other team leaders
4. Team meeting constantly
5. Ethical: when to operate/ when not to/ when do discharge/admit
40
How did they break bad news:
Chemotherapy: folinic acid, fluorouracil and oxaliplatin (FOLFOX) or oxaliplatin and capecitabine (XELX+OX)
Bowel Cancer:
1. Turned bleeper off
2. Ensured privacy and asked patient if wanted wife present
3. Gentle and empathetic tone
4. At beginning asked patient how much they knew and how much they wanted to know
5. Told them do not hesitate to ask at any point and if too much ask doctor to leave and give time and stop them if anything is unclear
6. Appreciate that it is hard to process s and need time
7. Spoke using normal not too technical terms
41
How do you deal with stress?
- Because I juggle so much with sport, volunteering and drama
1. Keep diary, so rarely stressed
2. On the off occasion
3. Talk to my friends, go for a run, bake
42
Most proud moment?
1. Being here
2. Last two years in care home I found very humbling and built a repour with patient’s and they look forward to seeing me coming
3. Proud of how I juggle and time management
43
What are your weaknesses?
1. Sometimes I find it hard to say no so when helping out at Early Morning Maths club, if child struggling I stay longer
2. Sometimes I am a bit too overempathic for example when care home expecting visitors
3. Attention to detail
44
Greatest Challenge / Mistake / make important decision
1. One of best friends on hockey team was not turning up for practice and wasn’t committed
2. Allowed problem to escalate
3. Told them off in front of the team
4. Learnt if there is a problem within the team sort it out and not allow to escalate and talk to her individual and made leave and had to be honest and what was best for team
45
Thoughts on Euthanasia : painless killing of patient suffering from incurable disease or painful disease or in an irreversible coma
1. Who makes and regulates the decision
2. Elderly people may feel like a burden on society and family
3. Patients in pain may not realise that pain relief medication can help
4. Money for elderly research e.g. Alzheimer may be elsewhere
5. Hospitals may chose not to operate and doctors decisions may be affected and may take decision too quickly before considering all other options, or financially driven as cost of palliative care too high and affects trust in doctors
6. Cure may be available but never know and may take effort away for cures and research for terminally ill
7. Doctors not preserve life so morally unacceptable
8. No safe and accurate way to measure extent suffering and patients opition and and hard to regulate
9. Relatives and doctors may make assumptions when patient unable to express themselves
10. Maybe cure found so wrong to euthanize when possibility of recovery
However:
1. Arguably by not, doctors are doing harm
2. Die with dignity
3. End suffering
4. Proper legislation than no rules
5. Free up resources e.g. constant medication
6. Autonomy be able to asses what is best for them
46
Thoughts on Organ donation
-Delighted with opt out..
1. Reduce waiting times and many waiting for years and by the time available not well enough to receive
2. False hope
3. Makes such a difference to human life
4. Introduced 6 years ago and 35% increase
5. Lots of transplant surgeons and now able to transplant
6. Morally and ethically correct
-Show empathy!
Concerns:
-mental health, asylum seekers or refugees unaware but now do have option to opt out
47
What have you got to offer for imperial?
What have you got to offer to Imperial?
1. Involved in clubs and societies
2. Involved in Charities such as RAG
3. involved in sports and set up my own societies
48
What are the problems with NHS?
1. Lack of funding
2. Increasing and ageing population
3. Obesity epidemics (70% of people work into A and E from complications T2 diabetes, blood clots, osteoarthritis, High BP, Heart attacks, problems in surgery and now above BMI of 30 is obese)
-Obesity affect 1 in 4 adults and 1 in 5 children aged 10 to 11, 30-39.9 obese BMI and over 40 severely obese
Risk:
Type 2 diabetes, high BP, problems in surgery, osteoarthritis, blood clots, coronary heart disease, stroke, breast cancer
4. Bed Blocking, shortage and ageing population (more than 1 problem, more bed space, more nursing and care homes, more social care, more research into long term conditions e.g Alzheimer’s)
5. Antibiotic Resistance
6. Brexit
7. Not enough nurses
8. A and E
-HEALTH SECRETARY: Matt Hancock (what would you do) – preventative!
49
How do you control obesity epidemic?
1. Schools, stop vending machines
2. Educate mapernts
3. Encourgae sports
4. No adversitiing
5. No half price chocolates
6. At GP, weight and offer elafeats and weight watcher
- If more structured suggest dietician
7. Vending machines in NHS hospitals
8. Sugar Tax: decrease price of healthy items and increase price on unhealthy items
9. Educate population
50
How does doctor act professional / Integrity?
- follow GMC guidelines
1. Autonomy
2. Act in patients best interest
3. Respect patient
4. Stay up to date
5. Be a team player
6. Ask for help when needed
7. If doctor or nurse misbehave report and act on it
8. Involved patient in decision making and not use medical jargin
51
What is perfect research?
1. Right amount of people
2. Similar disease (no comorbidities)
3. Variety of age groups
52
What is problem with aging population?
1. Need more care homes, nurses, doctor, dentists and research into LT conditions such as Alzheimer’s and waiting lists in care homes now
2. Hard to deal with lots of people and comorbities
3. Bed blockage and waiting time
53
When is alternative medicine ok?
1. No as not scientifically based and cannot lie to patient and St Johns wort actually interacts with other medication and patient may be mislead e.g. chemo
2. Used in palliative when no other science based medicine work, and for therapeutic reasons
54
Thoughts on private healthcare?
- Lots of concerns
1. Amazing doctors not lost to America and Australia where may get greater wage
2. Ensure not too exhausted
3. If can afford reduce wiaiting times
4. Use NHS repsources but pay for e.g. scans so money into NHS
Z University
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