Foundation Year 1
Those dreaded history questions
Posted on February 1st, 2009 by Rob
I personally never ask candidates about history of medicine as I think it’s slightly unfair and I’m not sure what relevance it has to a medical student applicant; however, many older interviewers love asking about history of medicine and debate that it shows a commitment to the career, a wider reading ability, and demonstrates intellectual ability.
History of medicine is certainly not a starting point and will usually only be asked if the interview is going well and the interviewers really want to push you a little. For example if they were considering a preferential offer. I therefore think that it would be unwise to spend lots of time researching this area for your interview. You should however have a key event and key person in mind.
Typical questions might be:
- What event in the history of medicine do you think has saved most lives?
- Who in the history of medicine do you think has contributed most?
- Do you know of any key events in the history of medicine?
It’s obviously safe to say that large drops in death rates can be contributed to public health measures such as underground sewerage systems and flushing toilets and it could be argued that these advances far outweigh anything that a doctor has achieved eg the advent of antibiotics.
A significant era in the history of medicine followed the Second World War. “Advances in surgical technique, new ideas about the nature of disease and huge innovations in drug manufacture vanquished in three short decades most of the common causes of early death” (James Le Fanu). ‘The Rise and Fall of Modern Medicine’ by James Le Fanu talks about twelve definitive moments in modern medicine. I highly recommend a read of this book.
- 1941: Penicillin
- 1949: Cortisone
- 1950: Streptomycin, Smoking and Sir Austin Bradford Hill
- 1952: Chlorpromazine and the Revolution in Psychiatry
- 1952: The Copenhagen Polio Epidemic and the Birth of Intensive Care
- 1955: Open Heart Surgery – The Last Frontier
- 1961: New Hips for Old
- 1963: Transplanting Kidneys
- 1964: The Triumph of prevention – The case of Strokes
- 1971: Curing Childhood Cancer
- 1978: The First ‘Test-Tube’ Baby
- 1984: Helicobacter – The Cause of Peptic Ulcer
Undeniably these were all key points in the history of medicine. Which do you think was most significant and why? For example hip replacements allow people that would have previously been immobile to continue leading a fulfilling and mobile life. Of course you don’t have to choose one of these as your personal favourite.
Allow me to explain number 3, 1950: Streptomycin, Smoking and Sir Austin Bradford Hill, (my favourite) a bit more. Before 1950 what doctors did and what we knew about medicine was determined by everyday practice – what doctors observed – what seemed to work. However, the curing of TB (streptomycin) and the link between smoking and lung cancer changed this because both required statistics to prove. This changed the way that medicine was practiced for good. This was the advent of ‘evidence based medicine’ – the use of statistics to prove the causality or decide which treatment works best. Therefore for me the biggest event in medical history was the realisation of evidence based medicine and the design of the double blind trail because this isn’t a cure for a single disease but a new way of working entirely that affects every new drug and the treatment of every disease. If I had to choose a single person to nominate as contributing the most to medicine it would have to be Sir Austin Bradford Hill as he was the leading force for this shift towards evidence based medicine.
I must stress to you that you shouldn’t just learn my answer and regurgitate it at interview. Remember that you are fairly unlikely to be asked about this but if you are have a key moment of your own that really does interest you and make sure you know why it interests you.
No Comments »How much do doctors get paid?
Posted on January 25th, 2009 by Rob
When during my medical school interview I was asked “Why do you want to be a doctor?” I didn’t reply “cos I wanna get paid loads of money”… but I thought it! However, if you do want to make buckets full of cash perhaps medicine isn’t the right career for you. It’s true that medicine is a well paid profession. After all you spend 4-6 years at university, amount thousands of pounds worth of debt, and generally work rubbish hours. There are better paid professions and jobs. How about accountancy or business? Your reasons for choosing a career in medicine are personal to you, however I wouldn’t imagine that money can possibly be a sole reason. I admit that you do get paid pretty well and that sweetens the deal.
The pay scale for doctors is rather complicated, but during this article I will attempt to give you an idea of what doctors get paid. Starting with my salary as a new house officer (F1):
| Month | Gross pay | Deductions | Net pay |
|---|---|---|---|
| August 2008 | ?1483.62 | ?256.70 | ?1330.60 |
| September 2008 | ?1703.41 | ?348.48 | ?1473.35 |
| October 2008 | ?4918.45 | ?1647.51 | ?3389.36 |
| November 2008 | ?1828.41 | ?603.83 | ?1343.00 |
| December 2008 | ?3810.81 | ?1316.03 | ?2613.20 |
The two things that stand out on this is table is firstly the amount you get paid varies greatly from month to month and secondly there are lots of deductions.
The reason that my gross pay varies so much is because I choose to work extra hours as a locum and also because NHS banding changes every 4 months. Most hospitals are short of all grades of doctors because the working hours have reduced so much recently, there simply aren’t the doctors to cover the new shift patterns. This means that if you are motivated by money you can give up your weekends, evening and even holidays to work. The locum rate for a house officer is ?20-30 an hour.
The deductions on a junior doctors pay include income tax (PAYE), national insurance, pension contributions, student loan re-payments, and payment for the doctors mess (?18 per month – see previous blog posting for explanation). Total deductions work out at about 30% of your gross pay.
The basic pay for junior doctors (taken from the NHS careers website):
Foundation House Officer 1 = ?21,862
Foundation House Officer 2 = ?27,116
Specialist Trainee = ?28,976 – ?44,562
GP (non partner) = ?52,462 – ?79,167
GP (partner) = ?80,000 – ?120,000
Consultant = ?73,403 – ?173,638
This is the very basic pay and does not include out of hours banding, locum pay, cremation forms (a major addition to house officers income) or private work (not for junior doctors).
If a person wishes to be cremated once dead a ‘crem form’ must be completed by two different doctors that don’t work together. It is generally the job of the house officer to complete part one of the form. Part one is filled in by a doctor that saw the patient while they were alive, during the illness that lead to their death and can state what the person died of. You must sign the form to say that they are sure that the person died of natural causes and not foul play. Part 2 is completed by the pathologist. The form takes about 20 minutes to complete (less if you knew the patient well) and you get paid ?70 per form. I have a friend who did his first F1 job in care of the elderly and he did an average of 3 forms per week – that’s an extra ?900 per month. Some people think it’s immoral to get paid for this. I even know a doctor that refused to cash the cheques! This is silly because even if you refuse payment the funeral director still charges the family and so by refusing payment you just line the pockets of the funeral director.
NHS doctors also get a salary banding that reflects the hours they work and how unsociable the hours are.
| Band | Hours per week | Unsociable hours | Amount added |
|---|---|---|---|
| 3 | >56 | any | 100% |
| 2a | 48-56 | Lots ( 1 in 3 weekends ) | 80% |
| 2b | 48-56 | Moderate ( 1 in 5 ) | 50% |
| 1a | 40-48 | Lots ( 1 in 4 ) | 50% |
| 1b | 40-48 | Moderate ( 1 in 6 ) | 40% |
| 1c | 40-48 | Some ( 1 in 8 ) | 20% |
The most common banding for a Foundation House Officer 1 is currently 2b (50%), making the average wage for a F1 ?32,793. Again this is before you do any locum shifts and it doesn’t include the cremation forms. However, fairly soon the most common banding will go down to 40% and then 20% and it won’t be long before all F1 jobs are unbanded.
Remember that during your F1 year you will do 3 four month rotations and each rotation (job) will have a different banding. My girlfriend started with a 40% banding for her first job but then her second job was unbanded resulting in a 40% pay cut. My first job (obstetrics and gynaecology) was unbanded but when I moved to my second job (surgery) I got a 40% pay rise. You will notice, however, that my actual monthly pay was more when I was doing obs and gynae. This is because during the unbanded job I had plenty of spare time to do lots of locum shifts.
3 Comments »Obstetrics ward week
Posted on August 16th, 2008 by Rob
Being a doctor is tiring and I?m afraid to say a little less fun than expected. My bleep never stops. I start work at 8am every morning and my bleep usually goes off before I’ve taken my coat off, adjusted my tie, and had my morning wee. It then goes off every five – ten minutes until I leave at about 7pm. I should finish at 5pm but I just don’t get all my jobs done. I feel that this might be my own fault. I haven?t found a natural flow to things. I start a to-do list each day and cross jobs off when they?re done. As people see me they quickly add as many jobs to my list as they can (midwifes, patients, SHOs and registrars). I just get started on a job and then my bleep goes and I have to apologize to the patient, go and answer my bleep, add the job to the list and then back to the patient. This was very exciting for the first few days but now it?s getting boring. I have so many forms to fill in. I?m hardly using anything that I learnt in the last 6 years ? I?m just filling in blood forms, writing the same old things in the notes, filling in TTAs (to take away (prescription)), and taking blood/putting in venflons.
In the last week I?ve made maybe three medical decisions on my own ? 1 yes this lady is constipated and needs and enema. 2 ? Her haemoglobin is low so let?s give her iron tablets. 3 ? This woman could get sick so I?ll call the registrar (times 100). The reg is always in theatre so I have to go down to theatre, and explain what?s wrong with the woman. He then tells me what to do and I go and do it.
The most fun I had was with a woman who had a caesarean section for twins. 5 days post-op the midwife bleeped me and said ? ?I?m just not happy?. This is a common midwife complaint. So I went down and had a look and her wound was oozing green horrible stuff. So I bleeped the reg ? he was in theatre. I went down and told him (I?d already taken the initiative to start antibiotics ? very brave of a young doctor as starting new drugs in any pregnant or breast feeding woman is dangerous. Anyway the reg said ? you better remove the sutures and lay it open ? very exciting ? So I went upstairs and on the ward cut open the stitches that were holding this poor woman?s tummy together. It was very smelly. I didn?t vomit (but almost). She?ll have to spend extra time in hospital and heal by secondary intention (new growth ? as oppose to primary intention where the two sides of a wounds stick back together. You can?t suture an infected wound.
On Tuesday we met my favourite member of staff so far ? Father Rodney is the cheerful, up beat Chaplin. He single handily tries to keep the moral of everyone high. It was Thursday when I first called Father Rodney. A 21 year old woman went into labour at 24 weeks gestation. 24 weeks is on the borderline of viability. The baby is alive on NICU where it has a 95% chance of dying. The neonatal doctors beat me to the room and explained the bad news to the family. I was next in. I had to explain that I was an obstetric doctor and here to look after mum only ? I know nothing about the care of babies. The baby was in a bad way but mum was also in need to care as she had lost lots of blood. The reg was (you guessed it) in theatre. He promised that he would be up as soon as he could. I needed to get IV access and start fluids to replace the blood loss, take bloods to make sure that she didn?t need a transfusion and start a drip of syntocinon. This is a drug that makes the uterus contact. She had a bit of placenta left in the uterus and it was making her bleed heavily. If the synto didn?t do its job she may have to go to theatre and that could end up in a hysterectomy which would end her chances of future pregnancies. It was all too much for her, her husband and her parents. It took me 4 attempts to get a line in ? she needed lots of fluids plus the synto drip fast. That means a very big needle ? little needles restrict the rate at which you can transfuse. However, this woman?s veins were just too small for the venflon. My flipping bleep going off every 2 minutes now ? the same midwife bleeping me until I answer. At last I remember Father Rodney. I bleeped him (almost in tears myself). After I finished the medical stuff he took over, meaning that I could answer my bleep to the stupid midwife that *urgently* needed me to fill in a form.
This was my ?ward obstetrics week?. Next week is ?gynae week?. I?m told that ?gynae week? is the hardest.
2 Comments »What you need to know
Posted on August 7th, 2008 by Rob
Today I had a further induction day. This was much more fun than my first day though. Today we were basically taught on two courses. We had a morning course on how to resuscitate a new baby. The afternoon was about how to resuscitate a pregnant woman. Even though I?ve done lots of resuscitation training before I really learnt a lot.
No Comments »The Doctors mess
Posted on August 7th, 2008 by Rob
Every hospital has a doctor?s mess. The mess varies greatly from hospital to hospital. As a med student I always thought that it was just a room to sit and drink coffee but now I know it?s so much more. I?ve seen about 10 messes during my 6 years at medical school and they have all been different. The worst was a tiny room with hard chairs and falling to pieces kitchen with dirty cups. My current hospital has the best mess I?ve ever seen. It has loads of room, nice soft sofas, massive TV, sky, play station, pool table, great kitchen and kind of a balcony.
The mess is where you go when you need to take 10. A place to chat to other doctors (about nothing really) or a place to sit and read the days paper. When I got my paperwork before starting work I had to fill in hundreds of forms. One of these forms was an agreement for the HR department to take ?18 from my wages every month for the mess. At the time I thought that was a bit steep, but not anymore. I did a few calculations based on observations. The mess gets a box of fruit delivered daily. I saw it being delivered and I counted the fruit. Based on Tesco prices the yearly fruit bill will be approximately ?4000. As well as fruit the mess is always stocked with tea, coffee, milk, cereal, fresh bread, margarine, daily newspapers, and peanut butter. The expenses must be massive.
After my last post on Tuesday night all the new doctors in the hospital went for a night out at Pizza Express in town. It was agreed that we would order what we wanted and then split the bill equally, however when the time came to pay the bill we were told that the doctors mess had already covered it! Cheers guys.
4 Comments »MedicalAdmissions.co.uk Blog is powered by WordPress.