Take AIM

Just before Christmas, I spent a weekend down in Bristol at Take AIM, a conference aimed at junior trainees who have an interest in acute medicine.

The second year of core medical training is notable for a sharp uptick in the number of times per week a person is asked if they’ve had any thoughts as to the specialty training they might consider. I tell them that I’m applying to ST3 in Acute Medicine, and they’re startled — either by my questionable life choices or my level of decisiveness, I’m never quite sure.

“Oh, and — really?” asked my most recent clinical supervisor. “Do you think I could get you to change your mind?”

I should be clear, my choice of medical speciality is hardly the first time I’ve had a questioning eyebrow raised at my life choices. My life choices have, after all, led to me sitting on the M74 on my day off looking for exit signs to Lesmahagow with my only provisions being a boot full of wedding paraphernalia, and being in the back of a Jeep reversing backwards around the corner of the shelf of the Ngorogoro Crater while the part of my brain not occupied with screaming asked if this was really how it was all going to end, and nearly getting arrested in the middle of Tianenmen Square. And those things all turned out brilliantly. So.

The raised eyebrows can be flattering, in their way, if their purpose is to persuade me out of my specialty and into theirs, which is sometimes.

But — unspeakably frustrating in another way.

At this point in CT2, some people haven’t made up their minds, which is fine: that’s why staff grade posts and taking time off from training are good things to do. I have, though. I had my time off from training, remember, and I needed an Archimedean epiphany fuelled by sleep deprivation and adrenaline, but I’m done. I’m sure. I’m not a foundation trainee who ought to be prudently murmuring about keeping her options open. I’m in, and with my eyes wide open. If my mind wasn’t changed by perpetual backshifts in a hospital that was literally closing down around me and where we occasionally had to see patients in the cupboard for lack of bed space, it is unlikely to be changed by the prospect of thirty years as an oncologist.

I know when I was ten that I thought that a doctor was a doctor and it was all basically the same thing, but it’s not like that’s actually true.

Yes, isn’t it nice that we don’t have to all be the same thing?, I want sometimes to say.

I’ll be honest, mind: I understand in my brain why my particular thing isn’t for everyone. In my heart, I don’t really understand why anyone would ever do anything else.


Heart and Brain: TheAwkwardYeti.com

The frustration of being a core medical trainee is that it feels — and is — a terribly peripatetic existence. I don’t yet have my tribe, or whatever the collective noun for my specialty colleagues would be. An insanity of acute physicians, perhaps. I still don’t have that, five years in. My experience is that nor do most CMTs. You sort of have to go looking for it, and therefore my weekend in Bristol was precisely what I needed.

Take AIM was the initiative of registrars training in acute medicine and has the stated intent of promoting what is a still relatively new and rapidly expanding speciality to juniors. It gets funding from Health Education England and support from the Society of Acute Medicine, and it has consultant input, but it’s still principally led and run by senior trainees — which, as someone who isn’t yet but hopes soon to be in specialty training, is a helpful thing for me, to hear from people who are in a position to tell me what the next five years of my life are likely to look like and who are willing to do it in a warts and all kind of a way. My first real contact with them was in October 2015, when I joined in an hour-long discussion on a Sunday evening on Twitter and came away from it feeling that thing you feel when you have found your people and they get you.

Bristol was like that, too, but better.

It had a bit of careers advice in it, and a bit of debunking of the more commonly held myths of acute medicine. Personally, I’m considering getting the sentence No, I’m Not Just Going To Be The Med Reg Forever tattooed across my forehead. It was also very well populated with very lovely trainees who were keen to chat about training and careers between the main sessions.

A lot of the day was education on acute medical topics. The philosophy went something like: “We are going to expect you to engage in acute neurology teaching first thing on a Saturday morning, but we are going to make sure that you are very well caffeinated for it.” That’s basically what I mean when I call them my people.

I would not dare to speak for everyone on this, as training experiences vary across the UK and everyone’s experience of their own training is different anyway, but the topics covered are ones that in my experience are covered badly, not enough, or not at all. To take an example from one of the earlier national conferences, in 2015, a session on “The Pregnant Patient on AMU”. It is not a thing that I’ve ever been taught and yet is a patient demographic that I happen upon all the time. It is incredibly exciting to me to spend a day being taught useful things by people who understand what happens at the front door of the hospital and want to help make it happen better, and that was what that day felt like. The presentations from the Bristol conference are all available online for those of an acute medical inclination, and a Storify, which includes video of a hundred people doing the dermatome dance, still first thing on a Saturday morning, has been put together of the day as told via social media.

It didn’t convince me that I want to be an acute physician; I knew that already. I think it reinforced for me that I’ve made the right decision.

I apply for a job in a month. For those of you who have been on this particualr merry-go-round with me for the last five years: Yes. Again. It’s a bit scary, this time. I remember when I was an FY1 that I definitely thought the registrars were the Proper Grown Ups. If you need me, I’ll be taking deep breaths with my head between my knees.

Answering A White Space Question

At choir practice this week I was minding my own business (and in a very annual leave sort of headspace) when I was asked about white space questions and the Foundation Programme.

And do you know, I was so flustered by being asked that I couldn’t remember what any of my white space questions had been. It is three years ago this week since I applied for my first proper job as a doctor, and those three years feel like a lifetime and then some. Besides, I thought that my FY1 cohort had been the last to do white space questions and that after that they had gone the way of the Dodo and cassette tapes.

A little digging reveals that for the main intake of FY1s, white space questions have indeed gone and have been replaced by something called the Situational Judgement Test – a national multiple-choice exam of professionalism and common sense about which I can offer no advice whatsoever, having sat the pilot exam in 2012 and still been able to make neither heads nor tails of the thing. However, a little further digging reveals that the white space questions still very much form part of the assessment for those applying to the academic Foundation Programme.

A white space question, for the uninitiated, looks something like this (two real examples from 2011/12):

Two essential attributes of a foundation doctor are to deal effectively with challenge and to demonstrate initiative. Describe a clinical case in which you have been involved and use this example to demonstrate how you possess both of these qualities. How will you apply what you have learned from this experience to your work as a foundation doctor?

An understanding of appropriate professional behaviour is an essential requirement for a foundation doctor. You are a foundation doctor based on a busy medical ward. You are reviewing a patient for discharge when your bleep goes off. You excuse yourself to answer your bleep and return to find the patient reading your list of tasks that you have left on the bed. This includes patient names and diagnoses. What would your initial response be? What factors contribute to the pressure of the situation and how would you prioritise further actions? How may this scenario inform your professional behaviour as a foundation doctor?

As you can see, the questions come in two basic forms: the kind that poses a hypothetical scenario for you to answer some questions about, and the kind that asks you to use actual scenarios from your own experience to illustrate an answer to the question(s) that they have asked. Now, I haven’t seen the 2014/15 questions for the AFP and I wouldn’t offer any specific advice even if I had. But let me offer a few bits of general advice:

  • Answer the question.
  • Answer the whole question. You will see that in the two examples I’ve given, each one is actually asking three questions.
  • Focus. The word limit is (still, I think) 200 words per question. This is practically nothing.
  • A well structured answer is shorter to write, easier to read, and demonstrates organised thinking.
  • If you are asked to describe a clinical case that you have been involved in, there are no points for choosing an interesting case. The prudent thing to do is to choose a case that you can then use to effectively answer the rest of the questions. This might be a comparatively dull case, and that’s OK. (My worst score was on that first question, when I got fixated on an interesting thing that happened on my elective and then couldn’t really apply it to FY1.)
  • Officially, there are no buzzwords. Unofficially, you’ll not go far wrong with Good Medical Practice and particularly the GMC’s Duties of a Doctor.
  • If you are given a hypothetical case which is based on some kind of wrongdoing on your part, do at least three things: apologise, admit your wrongdoing, and tell your senior. And then apologise again. In some cases, you should also speak to your defence union.
  • If you are given a hypothetical case in which a patient could be said to have done something wrong, like reading your jobs list or even like refusing to take their medications, do not under any circumstances berate the patient. (I wish that wasn’t based on things I’ve seen actual people write.)
  • Get at least one proof-reader. By the end, you’ll have stared at the thing for so long that you could be reading the St Crispin’s Day speech for all the mistakes you’ll be able to identify.

… And Then My Head Exploded

My plan was to spend today sorting out the last bits of my job application to Core Medical Training, which closes on this coming Thursday evening.

If you imagine the state of my chewed fingernails and pulled out hair as they were during FPAS, two years ago, but on steroids.

The understanding of your average non-medical person of the whole business of medical jobs/postgraduate training is limited, and that’s because it’s a little bit insane. To illustrate, the conversation I had this afternoon with my stepfather: “Is it right that you don’t know where in Scotland you’re going to be working?” “Yes, and it might not even be Scotland.” “What? They could send you back to England?” “Er. Yes. Except for the part where I’m not actually guaranteed to be employed.” “So, but, if they do employ you, that’s permanent, like, is it?” “No, it’s for two years.” “And then you have to apply again?!” It’s not the first time I’ve introduced the concept to him. I keep on introducing it every time he asks why I’m not in the market to buy a flat. It’s difficult enough to wrap your head around when you’re one of the people on the inside of the system. And, in the background, my mother: “I DO KEEP TELLING HIM!”

My application form is more or less done.

The bits I had left to sort out were little things, like finding out my membership number for what used to be Disclosure Scotland, fixing a silly typo in my spiel about specialty commitment, and finding the bits of paper and digital files to prove that I’ve done the presentations and got the degrees and attended the conferences that I’ve said I have. At interview in January, I will be expected to prove all those things. If I can’t prove them in January, I can’t claim them on an application form in December.

That was pretty much where the wheels fell off the wagon.

I’m going to offer you a free piece of advice.

A little bit for medical students. Mainly for FY1s who, having acquired a salary, are starting to think about upgrading their computers from the ones that they kept running with bits of string and the power of prayer through the last days of medical finals.

This is my advice.

Make backups.

Keep everything.



If you have a piece of paper that shows that you’ve been on a training course, put it in a folder somewhere safe. If you have an email from someone complimenting you on a piece of work you did, download it and save it before they take away your university email account. If you gave a presentation as part of a Special Study Module, get a download of the electronic feedback from your supervisor before you graduate. If you went to a conference, don’t lose the certificate that says you went to the conference. Scan hard copies. Any digital copies of any posters or presentations or publications or teaching feedback or anything, dump them all in a file called “Job Application Evidence” and then make a backup and then a backup of your backup and then make sure your backups work.

If your hard drive is full and your flat is beginning to look like the flats of those people who are on the television show Hoarders, except with paperwork instead of ketchup bottles, you might be just about on the right lines.

And if all of that sounds a little bit excessively paranoid, let me tell you about the situation I found myself in tonight, when, before I managed to find anything useful, I found:

  • The transcript from my undergraduate degree
  • Three out of date Disclosure Scotland forms
  • Scanned copies of my last flatmate’s BSc and MSc certificates
  • The tenancy agreement for a flat that I have not lived in since April 2012
  • An invitation to Flo and Beanie’s wedding (which happened more than a year ago)
  • A budget for my last flatmate’s wedding (which also happened more than a year ago and also why?)

I mean, if you’re going to cull, these are the things you’d cull. The conference certificate? Is not the thing you’d cull.

In terms of what I’ve got for this job application, I get credit for the BSc, and then I actually don’t have a lot else except enthusiasm.

This makes the small amount I do have really important.

In the summer of fourth year, I gave a poster presentation of a case series that I’d seen when I was doing an SSC in Haematology at a national medical students conference in Bournemouth. It’s the only thing on this application that I’m getting a substantial(ish) number of points for. I’ve got a very little audit and I’ve got evidence of having taught medical students when I was an FY1 and I’ve got one publication in which I claim the smallest number of available points for publications and proceed to stretch, quote unquote, the broadest definition of medicine to quite frankly ridiculous extremes. That’s it. The poster that I presented at a national conference is my Thing.

I lost the conference certificate when I moved house. Last week when I emailed the conference organisers in a mad flap, they said that they could issue me with a new certificate if I could provide them with a copy of the poster.

In the spring, I got a new laptop.

I backed all my files up onto my iPod, wiped the hard drive of the old one, and gave it away to my mum. Today, I opened my iPod up and discovered that what I had actually backed up were a series of empty folders. Cue panic. The folders did not get any emptier when I opened them for the second time or the third time or the fourth time. In a flash of inspiration, I remembered that there was a time in medical school when I had software on my computer that automatically backed everything up to a virtual server called Sugar Sync (hat tip to Bean Blogger for recommending it to me, back in the day). I found the website. I remembered my username and password. I could not for the life of me see my files — and what I could see was that I had used 2.7GB of available space, so clearly they were somewhere.

At that point, I called the person who has become my partner in crime for MRCP and CMT and Also Good Things and I flailed down the phone. (“I have so little proof of anything, I’m wondering if I ever went to medical school.”) She sensibly pointed out that if I was using 2.7GB of space on a virtual server, I was using it for something. I gave her my username and password, and she too failed to see any of my files. We pondered whether I should try to download the software for it, to see if that helped, and I did. There was a folder called MBChB, which looked promising, so I synced it back to my current laptop. After it looked as if it was done syncing, I went on the hunt.

I did not find the poster.

I found a copy of the original version of the abstract that I had submitted. I also got a message from the friend I had gone to the conference with, saying, in response to a panicked text I had sent her, that she was fairly sure the poster that I’d displayed, the A0 version, was in her loft. I had no idea how I would get an A0 poster to conference organisers in England, but I was making progress.

The first email I sent to them explained the situation and said that I was attaching the abstract submission.

The second email, which I sent about fifteen seconds later, actually had the abstract submission. It also had a link to the blog post that I had written the day after the conference, should they have been in any doubt that I actually went to Bournemouth. It also apologised. Profusely.

Then, I took another look at the computer and realised that it had started syncing more files.

The third email had a digital copy of the poster attached.

There is no adrenaline left in my adrenal glands. I’m never doing this again. And first thing tomorrow morning (after, I’m guessing, the president of the UK Medical Students Association is done mocking me), I’m buying an external hard drive.