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A medical mystery for Mother's Day...

I'd like to tell you a curious story. Jane was a 52 year old woman in need of a kidney transplant. Thankfully she had three loving sons who were all very happy to give her one of theirs. So Jane's doctors performed tests to find out which of the three boys would be the best match, but the results surprised everyone. In the words of Jeremy Kyle, the DNA test showed that Jane was not the mother of two of the boys... Hang on, said Jane, child birth is not something you easily forget. They're definitely mine. And she was right. It turns out Jane was a chimera. Chimerism is the existence of two genetically different cell lines in one organism. This can arise for a number of reasons- it can be iatrogenic, like when someone has an organ transplant, or it can be naturally occurring. In Jane's case, it began in her mum's womb, with two eggs that had been fertilised by different sperm creating two embryos. Ordinarily, they would develop into two non-identical twins. However in Jane's case the two balls of cells fused early in development creating one person with both cell lines. Thus when doctors did the first tissue typing tests on Jane, just by chance they had only sampled the 'yellow' cell line which was responsible for one of her sons. When they went back again they found the 'pink' cell line which had given rise to the other two boys. This particular type of human chimerism is thought to be pretty rare- there are only 30 case reports in the literature. (Though remarkably both House and CSI's Gil Grissom have encountered cases.) What happens far more frequently is fetal microchimerism- which occurs in pregnant women when cells cross the placenta from baby to mum. This is awesome because we used to think the placenta was this barrier which prevented any cells crossing over. Now we've found both cells and free floating DNA cross the placenta, and that the cells can hang around for decades after the baby was born. Why? As is often the case in medicine we're not sure but one theory is that the fetal cells might have healing properties for mum. In pregnant mice who've had a heart attack, fetal cells can travel to the mum's heart where the develop into new heart muscle to repair the damage. Whilst we're still in the early stages of understanding why this happens, we already have a practical application. In the United States today, a pregnant woman can have a blood test which isn't looking for abnormalities in her DNA but in that of her fetus. The DNA test isn't conclusive enough to be used to diagnose genetic conditions, but it is a good screening test for certain trisomies including Down's syndrome. Now, we started with a curious tale, so lets close with a curious fact, and one that's appropriate for Mother's Day: This exchange of cells across the placenta is a two way process. So you may well have some of your mum's cells rushing through your veins right now. In my case they're probably the ones that tell me to put on sensible shoes and put that boy down... (FYI: This is a story I originally posted on my own blog)  
Dr Catherine Carver
over 4 years ago
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Antibiotics

A blog post to help first year medical student remember those pesky antibiotics!  
Mrs Malaika Smith
almost 4 years ago
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A 21st Century Map of the Brain

Can you imagine being able to search for locations in the human body in the same way you can on Google Maps? This thinking lead Programmer Rich Stoner to create this amazing video of a 21st Century Map of the Brain which was our most popular tweet last week. A 21st Century Map of the Brain http://t.co/tkojzJBW55 via @brianglanz #openscience— Meducation (@Meducation) October 18, 2013 Rich writes in his blog - “Now we can quickly search Google Maps for a location, ask what is nearby, and even see what it looks like using StreetView. Now, imagine if something like that existed for the human brain: an interactive environment to search, visualize, and explore layers upon layers of neuroanatomy. This is the dream of cortical cartographers (also known as neuroanatomists). 10 years ago, one of the largest brain mapping initiatives was founded by Paul Allen with a single goal: to build a 21st Century Map of the Brain.” Click here to read more. The mapping of the brain is a working progress and therefore not 100% accurate. Even so the video gives us an insight into the innovate ways we will be able to interact with science in the future. You can follow Meducation on twitter to see more tweets like this at twitter.com/meducation.  
Nicole Chalmers
about 4 years ago
6cf7a4ab4825634634e1aca2e9177dba
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I can't get my head around pharmacology

Maybe it’s just me, but I cannot get my head around pharmacology and antibiotics are certainly doing their best to finish me off! My group at uni decided that this was one area that we needed to revise, and the task fell on my hands to provide the material for a revision session. So, the night before the session I began to panic about how to come up with any useful tips for my group, or indeed anyone at all, to try to remember anything useful about antibiotics at all. If only Paracetamoxyfrusebendroneomycin was a real drug, it would make our lives so much easier. Come on Adam Kay and Suman Biswas, get the trials started and create your wonderful super drug. For the mean time I guess I will just have to keep blissfully singing along to your song. However, that is not going to help me with my task in hand. After a lot of research that even took me beyond the realms of Wikipedia (something I do not often like to do), I found various sources suggesting remembering these Top 10 Rules (and their exceptions) All cell wall inhibitors are ?-lactams (except vancomycin) All penicillins are water soluble (nafcillin) All protein synthesis inhibitors are bacteriostatic (aminoglycosides) All cocci are Gram positive (Neisseria spp.) All bacilli are Gram negative (anthrax, tetanus, botulism, diptheria) All spirochetes are Gram negative Tetracyclines and macrolides are used for intracellular bacteria Pregnant women should not take tetracyclines, aminoglycosides, fluroquinolones, or sulfonamides Antibiotics beginning with a ‘C’ are particularly associated with pseudomembranous colitis While the penicillins are the most famous for causing allergies, people may also react to cephalosporins If those work for you, then I guess you can stop reading now… If they don’t, I can’t promise that I have anything better, but give these other tips that I found a whirl… Alternatively, I have created a Page on my own blog called Rang and Dale’s answer to Antibiotics, which summarises their information, so please take a look at that. Most people will suggest that you can categorise antibiotics in three ways, and it’s best to pick one and learn examples of them. Mode of action: bactericidal (kill) bacteriostatic (stop multiplying) 2 mnemonics to potentially help you remember examples: We’re ECSTaTiC about bacteriostatics? Erythromycin Clindamycin Sulphonamides Tetracyclines Trimethoprim Chloramphenicol Very Finely Proficient At Cell Murder (bactericidal) - Vancomycin Fluroquinolones Penicillins Aminoglycosides Cephalosporins Metranidazole Spectrum of activity: broad-spectrum (gram positive AND negative) narrow (gram positive OR negative) Mechanism of action Inhibit cell wall synthesis Inhibit nucleic acid synthesis Inhibit protein synthesis Inhibit cell membrane synthesis If you have any more weird and wonderful ways to remember antibiotics, let me know and I will add them! As always, thank you for reading.  
Mrs Malaika Smith
almost 4 years ago
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My Top 5 Tips to Use Social Media to Improve your Medical Education

Introduction Hello and welcome! I am finally back to blogging after having a brief hiatus in order to take my final exams. Whilst the trauma is still fresh in my mind, I would like to share with you the top 5 social media tips that helped me through the dark days of undergraduate medicine. Some of you may have already read my old essay on 'How Medical Students should interact with Social Media Networking Sites' and this document deals with some of the problems with professionalism surrounding the use of social media. This blog will not cover such issues, but will instead focus on how you can use social media to benefit your learning/ revision processes. Top Tip 1: YouTube For those of you who are unaware, YouTube is a video-sharing website. Sometimes the site is overlooked as a 'social media' resource but if you consider the simple definition of Social Networking Sites as 'those with user led content,' you can quickly see how YouTube definitely falls into the social media category. It wasn't until I got to University that I realised the potency of YouTube as an educational tool. It has a use at every stage of medical education and it is FREE. If you are still in your pre-clinical training then there are a wealth of videos that depict cellular processes and 3D anatomy - very useful content for the visual learner. For the clinical student, there are a number of OSCE demonstration videos that may be useful in honing your examination skills. There are also a number of presentations on clinical topics that have been uploaded, however, YouTube has no quality control measures for these videos (to my knowledge) so it may be best to subscribe to a more official source if you like to use podcasts/ uploaded presentations for your revision. Another reason YouTube comes in as my number 1 top tip is because I find it difficult to procrastinate whilst using the site. Sure, you can start looking up music and videos that have nothing to do with medicine but personally I find that having a little bit of music on in the background helps me work for longer periods, which is a definite bonus during the revision period. On the other hand, there are many that find YouTube difficult to harness due to the draw of funny videos and favourite Vloggers (Video Bloggers) that can distract the unwary from revision for hours on end. At the end of the day, YouTube was created for funny videos (predominantly of cats it seems) and not for medical education, and this should be kept in mind if you choose to use it as a tool for your learning. Top Tip 2: Facebook Yes, the dreaded Facebook comes in at number two for me. Facebook is by far and away my largest source of procrastination when it comes to writing / working / revising or learning. It is a true devil in disguise, however, there are some very useful features for those who like to work in groups during their revision... For example, during the last six months I have organised a small revision group through Facebook. We set up a 'private page' and each week I would post what topics would be covered in the weeks session. Due to the nature of Facebook, people were obviously able to reply to my posts with suggestions for future topics etc. We were also able to upload photos of useful resources that one or more of us had seen in a tutorial in which the other students hadn't been able to attend. And most importantly, we were able to upload revision notes for each other via the Facebook 'files' tab. This last feature was invaluable for sharing basic notes between a few close colleagues. However, for proper file sharing I strongly recommend the file sharing service 'Dropbox,' which provides free storage for your documents and the ability to access files from any computer or device with internet. Coming back to Facebook, my final thoughts are: if you don't like group work or seeing what your colleagues are doing via their statuses or private messages then it probably isn't a useful resource for you. If you have the motivation (unlike myself) to freeze your Facebook account I can imagine you would end up procrastinating far less (or you'll start procrastinating on something else entirely!). Top Tip 3: Twitter Twitter is a microblogging site. This means that users upload microblogs or 'Tweets' containing useful information they have found on the internet or read in other people's tweets. Twitter's utility as an educational resource is directly related to the 'type' of people you follow. For example, I use Twitter primarily to connect with other people interested in social media, art & medicine and medical education. This means my home screen on twitter is full of people posting about these topics, which I find useful. Alternatively, I could have used my Twitter account to 'follow' all the same friends I 'follow' on Facebook. This would have meant my Twitter home page would have felt like a fast-paced, less detailed version of my Facebook feed just with more hashtags and acronyms - not very useful for finding educational resources. With this in mind, consider setting up two twitter accounts to tease apart the useful tweets about the latest clinical podcast from the useless tweets about what your second cousin once removed just had for lunch. A friend suggested to me that if you really get into twitter it is also possible to use one account and 'group' your followers so that you can see different 'types' of tweets at different times. This seems like a good way to filter the information you are reading, as long as you can figure out how to set up the filters in the first place. Like all Social Media Sites, Twitter gets its fair share of bad press re. online professionalism and its tendency to lure users into hours of procrastination. So again, use with caution. Top Tip 4: Meducation It would not be right to write this blog and not include Meducation in the line-up. Meducation is the first website that I have personally come across where users (students, doctors etc) upload and share information (i.e. the very soul of what social networking is about) that is principally about medicine and nothing else. I'm sure there may be other similar sites out there, but the execution of this site is marvellous and that is what has set it apart from its competitors and lead to its rapid growth (especially over the last two years, whilst i've been aware of the site). When I say 'execution,' I mean the user interface (which is clean and simple), the free resources (giving a taste of the quality of material) and the premium resources (which lecture on a variety of interesting clinical topics rather than sticking to the bread and butter topics 24/7). One of my favourite features of Meducation is the ability to ask 'Questions' to other users. These questions are usually asked by people wishing to improve niche knowledge and so being able to answer a question always feels like a great achievement. Both the questions and answers are mostly always interesting, however the odd question does slip through the net where it appears the person asking the question might have skipped the 'quick google search' phase of working through a tough topic. Meducation harnesses social networking in an environment almost free from professionalism and procrastination issues. Therefore, I cannot critique the site from this angle. Instead, I have decided to highlight the 'Exam Room' feature of the website. The 'Exam Room' lets the user take a 'mock exam' using what I can only assume is a database of questions crafted by the Meducation team themselves (+/- submissions from their user base). However, it is in my opinion that this feature is not up to scratch with the level and volume of questions provided by the competitors in this niche market. I feel wrong making this criticism whilst blogging on Meducation and therefore I will not list or link the competitors I am thinking of here, but they will be available via my unaffiliated blog (Occipital Designs). I hope the Meducation team realise that I make this observation because I feel that with a little work their question database could be improved to the point where it is even better than other sites AND there would also be all the other resources Meducation has to offer. This would make Meducation a truly phenomenal resource. Top Tip 5: Blogging Blogging itself is very useful. Perhaps not necessarily for the learning / revision process but for honing the reflective process. Reflective writing is a large component of undergrad medical education and is disliked by many students for a number of reasons, not least of which is because many find some difficulty in putting their thoughts and feelings on to paper and would much prefer to write with the stiffness and stasis of academic prose. Blogging is great practice for breaking away from essay-writing mode and if you write about something you enjoy you will quickly find you are easily incorporating your own personal thoughts and feelings into your writing (as I have done throughout this blog). This is a very organic form of reflection and I believe it can greatly improve your writing when you come to write those inevitable reflective reports. Conclusion Thanks for reading this blog. I hope I have at least highlighted some yet unharnessed aspects of the sites and resources people already commonly use. Please stay tuned in the next week or two for more on social media in medicine. I am working together with a colleague to produce 'Guidelines for Social Media in Medicine,' in light of the recent material on the subject by the General Medical Council. Please feel free to comment below if you feel you have a Top Tip that I haven't included! LARF Twitter Occipital Designs My Blog As always, any views expressed here are mine alone and are not representative of any organisation. A Worthy Cause... Also, on a separate note: check out Anatomy For Life - a charity medical art auction raising money for organ donation. Main Site Facebook Twitter  
Dr. Luke Farmery
over 4 years ago
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Estimating Burn Size

See this in context on [our blog post](https://www.meducation.net/blog_posts/118-Assessing-Types-of-Burns-and-their-Severity). The image is from "Wound Care Made Incredibly Easy! 1st UK Edition" by Julie Vuolo For more information, or to purchase your copy, visit: http://tiny.cc/woundcare. Save 15% (and get free P&P) on this, and a whole host of other LWW titles at http://lww.co.uk when you use the code MEDUCATION when you check out!  
Lippincott Williams & Wilkins
over 4 years ago
2257fe0ee21c3622a3e45cdaf279d4c3
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Is ADHD a difficult diagnosis?

In a recent article in the BMJ the author wonders about the reasons beyond the rising trend diagnosing Attention Deficit Hyperactivity Disorder (ADHD). The article attempts to infer reasons for this. One possible reason was that the diagnostic criteria especially DSM may seem for some to be more inclusive than ICD-10. The speculation may explain the rise of the diagnosis where DSM is used officially or have an influence. In a rather constructive way, an alternative to rushing to diagnosis is offered and discussed in some details. The tentative deduction that the Diagnostic Statistical Manual (DSM) may be one of the causes of rising diagnosis, due to raising the cut-off of age, and widening the inclusion criteria, as opposed to International Classification of Diseases, 10th revision (ICD-10), captured my attention. On reading the ICD-10 diagnostic criteria for research (DCR) and DSM-5 diagnostic criteria, I found them quite similar in most aspects, even the phraseology that starts with 'Often' in many diagnostic criteria, they seem to differ a bit in age. In a way both classification, are attempting to describe the disorder, however, it sounds as if someone is trying to explain a person's behaviour to you, however, this is not a substitute to direct clinical learning, and observing the behaviour, as if the missing sentence is 'when you see the person, it will be clearer'. El-Islam agrees with the notion that DSM-5 seems to be a bit more inclusive than ICD-10. A colleague of mine who is a child psychiatrist and she is doing her MSc. thesis in ADHD told me, that DSM-5 seems to be a substantial improvement as compared to its predecessor. The criteria - to her - though apparently are more inclusive, they are more descriptive with many examples, and she infers that this will payback in the reliability of the diagnosis. She hopes gene research can yield in biological tests for implicated genes and neurotransmitters in ADHD e.g. DRD4, DAT, gene 5,6,11 etc. One child psychiatrist, regretted the fact that misdiagnosis and under-diagnoses, deprive the patient from one of the most effective treatments in psychiatry. It is hoped the nearest forthcoming diagnostic classification (ICD-11), will address the issue of the diagnosis from a different perspective, or else converge with DSM-5 to provide coherence and a generalised newer standard of practice. The grading of ADHD into mild, moderate, and severe seem to blur the border between disorder and non-disorder, however, this quasi-dimensional approach seems realistic, it does not translate yet directly in differences in treatment approaches as with the case of mild, moderate, severe, and severe depression with psychotic symptoms, or intellectual disability. The author states that one counter argument could be that child psychiatrists are better at diagnosing the disorder. I wonder if this is a reflection of a rising trend of a disorder. If ADHD is compared to catatonia, it is generally agreed that catatonia is less diagnosed now, may be the epidemiology of ADHD is not artefact, and that we may need to look beyond the diagnosis to learn for example from environmental factors. Another issue is that there seems to be significant epidemiological differences in the rates of diagnosis across cultures. This may give rise to whether ADHD can be classified as a culture-bound syndrome, or whether it is influenced by culture like anorexia nervosa, or it may be just because of the raising awareness to such disorders. Historically, it is difficult to attempt to pinpoint what would be the closest predecessor to ADHD. For schizophrenia and mania, older terms may have included insanity, for depression it was probably melancholia, there are other terms that still reside in contemporary culture e.g. hypochondriasis, hysteria, paranoia etc. Though, it would be too simplistic to believe that what is meant by these terms was exactly what ancient cultures meant by them, but, they are not too far. ADHD seems to lack such historical underpinning. Crichton described a disorder he refers to as 'mental restlessness'. Still who is most often credited with the first description of ADHD, in his 1902 address to the Royal College of Physicians. Still describes a number of patients with problems in self-regulation or, as he then termed it, 'moral control' (De Zeeuw et al, 2011). The costs and the risks related to over-diagnosis, ring a warning bell, to enhance scrutiny in the diagnosis, due to subsequent stigma, costs, and lowered societal expectations. They all seem to stem from the consequences of the methodology of diagnosis. The article touches in an important part in the psychiatric diagnosis, and classifications, which is the subjective nature of disorders. The enormous effort done in DSM-5 & ICD-10 reflect the best available evidence, but in order to eliminate the subjective nature of illness, a biological test seems to be the only definitive answer, to ADHD in particular and psychiatry in general. Given that ADHD is an illness and that it is a homogeneous thing; developments in gene studies would seem to hold the key to understanding our current status of diagnosis. The suggested approach for using psychosocial interventions and then administering treatment after making sure that it is a must, seems quite reasonable. El-Islam, agrees that in ADHD caution prior to giving treatment is a recommended course of action. Another consultant child psychiatrist mentioned that one hour might not be enough to reach a comfortable diagnosis of ADHD. It may take up to 90 minutes, to become confident in a clinical diagnosis, in addition to commonly used rating scales. Though on the other hand, families and carers may hypothetically raise the issue of time urgency due to scholastic pressure. In a discussion with Dr Hend Badawy, a colleague child psychiatrist; she stated the following with regards to her own experience, and her opinion about the article. The following is written with her consent. 'ADHD is a clinically based diagnosis that has three core symptoms, inattention, hyperactivity and impulsivity in - at least - two settings. The risk of over-diagnosis in ADHD is one of the potentially problematic, however, the risk of over-diagnosis is not confined to ADHD, it can be present in other psychiatric diagnoses, as they rely on subjective experience of the patient and doctor's interviewing skills. In ADHD in particular the risk of under-diagnosis is even more problematic. An undiagnosed child who has ADHD may suffer various complications as moral stigma of 'lack of conduct' due to impuslivity and hyperactivity, poor scholastic achievement, potential alienation, ostracization and even exclusion by peer due to perceived 'difference', consequent feelings of low self esteem and potential revengeful attitude on the side of the child. An end result, would be development of substance use disorders, or involvement in dissocial behaviours. The answer to the problem of over-diagnosis/under-diagnosis can be helped by an initial step of raising public awareness of people about ADHD, including campaigns to families, carers, teachers and general practitioners. These campaigns would help people identify children with possible ADHD. The only risk is that child psychiatrists may be met with children who their parents believe they might have the disorder while they do not. In a way, raising awareness can serve as a sensitive laboratory investigation. The next step is that the child psychiatrist should scrutinise children carefully. The risk of over-diagnosis can be limited via routine using of checklists, to make sure that the practice is standardised and that every child was diagnosed properly according to the diagnostic criteria. The use of proper scales as Strengths and Difficulties Questionnaire (SDQ) in its two forms (for parents SDQ-P and for teachers SDQ-T) which enables the assessor to learn about the behaviour of the child in two different settings. Conner's scale can help give better understanding of the magnitude of the problem. Though some people may voice criticism as they are mainly filled out by parents and teachers, they are the best tools available at hands. Training on diagnosis, regular auditing and restricting doctors to a standard practice of ensuring that the child and carer have been interviewed thoroughly can help minimise the risk of over-diagnosis. The issue does not stop by diagnosis, follow-up can give a clue whether the child is improving on the management plan or not. The effects and side effects of treatments as methylphenidate should be monitored regularly, including regular measurement height and weight, paying attention to nausea, poor appetite, and even the rare side effects which are usually missed. More restrictions and supervision on the medication may have an indirect effect on enhancing the diagnostic assessment. To summarise, the public advocacy does not increase the risk of over-diagnosis, as asking about suicidal ideas does not increase its risk. The awareness may help people learn more and empower them and will lead to more acceptance of the diagnosed child in the community. Even the potential risk of having more case loads for doctors to assess for ADHD may help give more exposure of cases, and reaching more meaningful epidemiological finding. From my experience, it is quite unlikely to have marked over-representation of children who the families suspect ADHD without sufficient evidence. ADHD remains a clinical diagnosis, and it is unlikely that it will be replaced by a biological marker or an imaging test in the near future. After all, even if there will be objective diagnostic tests, without clinical diagnostic interviewing their value will be doubtful. It is ironic that the two most effective treatments in psychiatry methylphenidate and Electroconvulsive Therapy (ECT) are the two most controversial treatments. May be because both were used prior to having a full understanding of their mechanism of action, may be because, on the outset both seem unusual, electricity through the head, and a stimulant for hyperactive children. Authored by E. Sidhom, H. Badawy DISCLAIMER The original post is on The BMJ doc2doc website at http://doc2doc.bmj.com/blogs/clinicalblog/#plckblogpage=BlogPost&plckpostid=Blog%3A15d27772-5908-4452-9411-8eef67833d66Post%3Acb6e5828-8280-4989-9128-d41789ed76ee BMJ Article: (http://www.bmj.com/content/347/bmj.f6172). Bibliography Badawy, H., personal communication, 2013 El-Islam, M.F., personal communication, 2013 Thomas R, Mitchell GK, B.L., Attention-deficit/hyperactivity disorder: are we helping or harming?, British Medical Journal, 2013, Vol. 5(347) De Zeeuw P., Mandl R.C.W., Hulshoff-Pol H.E., et al., Decreased frontostriatal microstructural organization in ADHD. Human Brain Mapping. DOI: 10.1002/hbm.21335, 2011) Diagnostic Statistical Manual 5, American Psychiatric Association, 2013 Diagnostic Statistical Manual-IV, American Psychiatric Association, 1994 International Classification of Diseases, World Health Organization, 1992  
Dr Emad Sidhom
almost 4 years ago
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Medical MindMaps for USMLE Step 1: Kidney Embryology

Funny and Creative Mind Maps & Mnemonics that really help you better understand the magic and abstract medical world. Specially for USMLE Step1 students... Don't forget to buy your First Aid Step 1 Book, watch the videos with your Fantabolous MindMaps printed. Enjoy this blog!  
imindmaps.blogspot.co.uk
over 2 years ago
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6
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Beyond ACLS: From CPR to Cath - The New ACC/AHA Cardiac Arrest Algorithm - R.E.B.E.L. EM - Emergency Medicine Blog

Cardiac Arrest: Should we cath all patients with Out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) who are still comatose?  
rebelem.com
over 2 years ago
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5
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Clinical Skills: Respiratory Examination MRCP PACES

This is a blog about clinical skills or bedside skills. That is the skills needed for a successful doctor patient relationship. The skills are history taking skills, physical examination skills and communication skills. The discussion on this blog is based on the book: ACES for PACES advanced clinical evaluation system for practical assessment of clinical examination skills by ajith jayasekera  
clinical-skills.blogspot.co.uk
about 2 years ago
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A Medical Intern Writes to His Future Self

Dear future Pranay, By the time you read this, time will have passed with the same explosive inevitability that C diff diarrhea passes from unfortunate ...  
huffingtonpost.com
about 2 years ago
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Top 6 Med Student Survival Guides

There are loads of survival guides out there to help medical students adapt well to university life but which ones should you be taking notice of? I’ve put together a list of my top 6 must reads - I hope you find them useful. 1. BMJ’s Guide for Tomorrow's Doctors If you don’t read anything else, read this. It covers everything from the pros and cons of using the library to essential medical websites (check out number 6 on the list :D). http://doc2doc.bmj.com/assets/secure/survivemedicalschool.pdf 2. Money Matters Ok, this isn’t the most exciting topic but definitely a stress you could do without. The Money Saving Expert gives some great advice on how to make money and manage your finances. http://www.moneysavingexpert.com/students/student-guide 3. Studying This guide includes 4 simple but essential study tips relevant throughout your years at university. http://blog.auamed.org/blog/bid/291655/Survival-Guide-for-First-Year-Medical-Students-Study-Strategies 4. Dos and Don’ts Some great advice from Dundee University here on the dos and don’ts of surviving medical school. http://lifeofadundeemedstudent.wordpress.com/dundee/life-in-dundee/medical-student-survival-tips/ 5. Advice to Junior Doctors Karin shares some of her hospital experiences and gives advice to junior doctors. http://www.medscape.com/viewarticle/808795 6. Looking after yourself To get the most out of university it’s important that you look after yourself. The NHS provide some great tips from eating healthily on a budget to managing stress during exam time. http://www.nhs.uk/Livewell/studenthealth/Pages/Fivehealthsecrets.aspx If you know of any other useful survival guides or would like to create your own please send them across to me nicole@meducation.net. Nicole  
Nicole Chalmers
about 4 years ago
8c68f084791aaf5f4475d6c9c0266737
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Problem based learning - Friend or Foe?

What is Problem Based Learning? During my time at medical school, I enjoyed (at times) a curriculum delivered through the traditional model. As the name suggests, this is an approach experienced by the majority of doctors to date. The traditional model was first implemented by the American Medical College Association and American Academy of Medicine in 1894 (Barr, 2010) and has been used by the majority of medical schools. It traditionally consists of didactic lectures in the initial years covering the basic sciences followed by clinical years, where students learn clinical medicine while attending hospital placements. Is It Better? A few years after my graduation I found myself teaching at a university which had fully adopted the use of problem based learning (PBL) in the delivery of their curriculum. PBL is a philosophy of teaching that has increasingly been used in medical education over the past 40 years. It has rapidly been replaced or supplemented in medical education as opposed to the traditional model. PBL seeks to promote a more integrated and active approach to learning right from the first year with less reliance on didactic lectures. Having been involved in these two different approaches to medical education, I was interested to explore what the evidence was for and against each. For the purposes of this blog, I have looked at four specific areas. These include student attitudes, academic achievement, the academic process of learning and clinical functioning and skills. Student Attitudes Student attitudes to PBL have been highly featured in studies and many show that there is a clear favourability towards this philosophy of teaching. Blumberg and Eckenfel (1988) found that students in a problem based preclinical curriculum rated this three times higher than those in the a traditional group in terms of what they expect to experience, what they would like, and what they actually experienced. Heale et al (1988) found physicians in the problem-solving sessions rated a Continuing Medical Education short course higher compared to others who attended traditional lectures and large-group sessions. Vernon and Black (1993) performed a Meta analysis on 12 studies that looked at attitudes and towards PBL and found PBL was favored in some way by all studies. PBL appears to be preferred by the majority of students at a range of academic levels. However, Trappler (2006) found that converting a conventional curriculum to a problem based learning model for part of a psychopathology course did not show complete favourability. Students preferred the conventional lectures given by experts, rather than PBL groups run by mentors and not experts. They did however show preference towards PBL small group sessions run by experts Academic Achievement Academic achievement is an important factor to assess. Vernon and Blake (1993) compared a number of studies and found that those, which could be compared, showed a significant trend favouring traditional teaching methods. However, it was felt this might not be reliable. When looking at the heterogeneity of the studies there was significant variation that could not be accounted for by chance alone. Interestingly, they found that there was significant geographical variation across the United States such that New Mexico showed consistently negative effects and Michigan State showed consistently positive. Other studies have shown that the traditional method may show a slightly better outcome when assessing academic achievement. Schmidt et al (1987) looked at the same progress test taken among students in six different Universities in the Netherlands and found that those taught by a traditional approach showed slightly better outcomes. Baca et al (1990) compared performances of medical students in two separate tracks, one PBL the other a traditional model. Baca et al found that PBL students scored slightly lower in the National Board of Medical Examiners (NBME) examinations. Dochy et al (2003) conducted a meta analysis comparing 43 studies and found that when considering the effect of PBL on the knowledge of students the combined effect size is slightly negative. The academic process of learning It is important in medical education to enable people to continue life long learning, to overcome problems and fill in knowledge gaps. Coles (1990) and Entwistle (1983) found that PBL students would place more emphasis on understanding and meaning compared to just rote learning, seen more in those taught by a traditional approach. Students on a PBL course also place more focus on using resources such as the library and online sources rather than those taught in a traditional approach (Rankin, 1992). Students taught by a traditional model place more emphasis on the resources supplied by the faculty itself. It has also been shown that students who learn through a process of problem solving, are more likely to use this spontaneously to solve new problems in the future compared with those taught in a traditional way (Bransford et al, 1989). Clinical functioning and skills Clinical competence is an important aspect in medical education and has been measured in studies comparing PBL and traditional methods. The traditional model focuses acquisition of clinical competence in the final years of a program with hospital placements. In a PBL course it may be more integrated early on. There are however, only a few studies that look at clinical competence gained in undergraduate PBL courses. Vernon and Blake (1993) compared some of these studies and found that students obtained better clinical functioning in a PBL setting compared to a traditional approach. This was statistically significant, however there was still significant heterogeneity amongst studies and for conclusive results to be made 110 studies would have to be compared, rather that the 16 samples they were able to use. They also found that in contrast to the NBME I giving better results in the traditional model, PBL students score slightly higher in NBME II and federation licensing examination which related more on clinical functioning than basic sciences. On reflection, this evidence has indicated to me that PBL is a very valuable approach and it has a number of benefits. The traditional model in which I was taught has provided a good level of academic education. However, it may not have supported me as well as a PBL course in other areas of medical education such as academic process, clinical functioning and satisfaction. On reflection and current recommendations are for a hybridisation of the PBL and traditional approach to be used (Albanese, 2010) and I would support this view in light of the evidence. References Baca, E., Mennin, S. P., Kaufman, A., and Moore-West, M. A Comparison between a Problem-Based, Community Orientated track and Traditional track Within One Medical school. In Innovation in Medical Education; An Evaluation of Its Present Status. New York: Springer publishing Barr D. (2010) Revolution or evolution? Putting the Flexner Report in context. Medical Education; 45: 17–22 Blumberg P, Eckenfels E. (1988) A comparison of student satisfaction with their preclinical environment in a traditional and a problem based curriculum. Research in Medical Education: Proceedings of the Twenty-Seventh Annual Conference, pp. 60- 65 Bransford, J. D., Franks, J. J., Vye, N. J., & Sherwood, R. D. (1989). New Approaches to Instruction: Because Wisdom Can't Be Told. In S. Vosiadou & A. Ortony (Eds.), Similarity and Analogical Reasoning (pp. 470 297). New York: Cambridge University Press. Coles CR. (1990) Evaluating the effects curricula have on student learning: toward a more competent theory for medical education. In: Innovation in medical education: an evaluation of its present status. New York: Springer publishing; 1990;76-93. Dochy F., Segersb M., Van den Bosscheb P., Gijbelsb D., (2003) Effects of problem-based learning: a meta-analysis. Learning and Instruction. 13:5, 533-568 Entwistle NJ, Ramsden P. Understanding student learning. London: Croom Helm; 1983 Heale J, Davis D, Norman G, Woodward C, Neufeld V, Dodd P. (1988) A randomized controlled trial assessing the impact of problem-based versus didactic teaching methods in CME. Research in Medical Education.;27:72-7. Trappler B., (2006) Integrated problem-based learning in the neuroscience curriculum - the SUNY Downstate experience. BMC Medical Education 6: 47. Rankin JA. Problem-based medical education: effect on library use. Bull Med Libr Assoc 1992;80:36-43. Schmidt, H G; Dauphinee, W D; Patel, V L (1987) Comparing the effects of problem-based and conventional curricula in an international sample Journal of Medical Education. 62(4): 305-15 Vernon D. T., Blake R. L., (1993) Does Problem-based learning work? A meta-analysis of evaluated research. Academic Medicine.  
Dr Alastair Buick
over 4 years ago
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4
533

Development of the heart

Heart is the most important part in the human body Today, we explain how it is formed before birth For more information, please visit my blog http://adf.ly/f...  
YouTube
over 2 years ago
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4
172

Glasgow Coma Scale (GCS) | LITFL: Life in the Fast Lane Medical Blog

Glasgow Coma Scale (GCS) or score  
lifeinthefastlane.com
over 2 years ago
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3
401

Internal Medicine Topic Review: Leukemia

USMLE Step Exam & ABIM Board Review Blog | Tips and strategies to pass the Internal Medicine Board Exam | Internal Medicine Flashcards | Medical Mnemonics  
knowmedge.com
almost 2 years ago
6f205ae1fc379ad763151fb96f3b0d57
4
901

So you want to be a medical student: READ THIS!

There are so many sources for advice out there for potential medical students. So many books, so many forums, so many careers advice people, and so many confusing and scary myths, that I thought it might be useful to just put up some simple guidelines on what is required to become a medical student and a short book list to get your started. I am now in my 5th year at university and my 4th year of actual medicine. Since getting into Medical School in 2009 I have gone back to my 6th form college in South Wales at least once a year to talk to the students who wanted to become medical or dental students, to offer some advice, answer any queries that I could. This year, I tried to to do the same sort of thing for high achieving pupils at my old comprehensive, because if you don't get the right advice young enough then you won't be able to do everything that is required of you to get into Medical school straight after your A-levels. Unfortunately, due to some new rules I wasn't allowed to. So, since I couldn't give any advice in person I thought that a blog might be the easiest alternative way to give young comprehensive students a guide in the right direction. So here goes... How to get into medical school: You must show that you have the academic capacity to cope with the huge volume of information that will try to teach you and that you have the determination/tenacity to achieve what you need to. To show this you must get good grades: a. >8A*s at GCSE + separate science modules if possible = you have to be able to do science. b. >3A’s at A-Level = Chemistry + Biology + anything else you want, as long as you can get an A. 2. You must have an understanding of what Medicine really involves: a. Work experience with a doctor – local GP, hospital work experience day, family connections, school connections – you should try to get as much as you can but don’t worry if you can’t because you can make up for it in other areas. b. Work experience with any health care professional – ask to see what a nurse/ physio/ health care assistant/ phlebotomist/ ward secretary does. Any exposure to the clinical environment will give you an insight into what happens and gives you something to talk about during personal statements and interviews. c. Caring experience – apply to help out in local care homes, in disabled people’s homes, at charities, look after younger pupils at school. All these sorts of things help to show that you are dedicated, motivated and that you want to help people. 3. Be a fully rounded human being: a. Medical schools do not want robots! They want students who are smart but who are also able to engage with the common man. So hobbies and interests are a good way of showing that you are more than just a learner. b. Playing on sports teams allows you to write about how you have developed as a person and helps you develop essential characteristics like team work, fair play, learning to follow commands, learning to think for yourself, hand-eye co-ordination etc. etc. All valuable for a career in medicine. c. Playing an instrument again shows an ability to learn and the will power to sit and perfect a skill. It also provides you with useful skills that you can use to be sociable and make friends, such as joining student choirs, orchestras and bands or just playing some tunes at a party. d. Do fun things! Medicine is hard work so you need to be able to do something that will help you relax and allow you to blow off some stress. All work and no play, makes a burnt out wreck! 4. Have a basic knowledge of: a. The news, especially the health news – Daily Telegraph health section on a Monday, BBC news etc. b. The career of a doctor – how does it work? How many years of training? What roles would you do? What exams do you need to pass? How many years at medical school? c. The GMC – know about the “Tomorrow’s Doctor” Document – search google. d. The BMA e. The Department of Health and NHS structure – know the basics! GP commissioning bodies, strategic health authorities. f. What the Medical School you are applying to specialises in, does it do lots of cancer research? Does it do dissection? Does it pride itself on the number of GPs it produces? Does it require extra entry exams or what is the interview process? These 4 points are very basic and are just a very rough guide to consider for anyone applying to become a medical student. There are many more things you can do and loads of useful little tips that you will pick up along the way. If anyone has any great tips they would like to share then please do leave them as a comment below! My final thought for this blog is; READ, READ and READ some more. I am sure that the reason I got into medical school was because I had read so many inspiring and thought provoking books, I had something to say in interviews and I had already had ideas planted in my head by the books that I could then bring up for discussion with the interview panel when asked about ethical dilemmas or where medicine is going. Plus reading books about medicine can be so inspiring that they really can push your life in a whole new direction or just give you something to chat about with friends and family. Everyone loves to chat people – how they work, why they are ill, what shapes peoples' personalities etc and these are all a part of medicine that you can read into! Book Recommendations Must reads: http://www.amazon.co.uk/Trust-Me-Im-Junior-Doctor/dp/0340962054/ref=sr_1_1?s=books&ie=UTF8&qid=1374240729&sr=1-1&keywords=trust+me+i%27m+a+junior+doctor http://www.amazon.co.uk/Rise-Fall-Modern-Medicine/dp/0349123756/ref=sr_1_1?s=books&ie=UTF8&qid=1374240763&sr=1-1&keywords=the+rise+and+fall+of+modern+medicine http://www.amazon.co.uk/Selfish-Gene-30th-Anniversary/dp/0199291152/ref=sr_1_1?s=books&ie=UTF8&qid=1374240793&sr=1-1&keywords=the+selfish+gene http://student.bmj.com/student/student-bmj.html http://www.newscientist.com/subs/offer?pg=bdlecpyhvyhuk1306&prom=1234&gclid=CLT0tZ3Wu7gCFfLHtAodWwUAyA http://www.amazon.co.uk/Man-Who-Mistook-His-Wife/dp/B005M1NBYY/ref=sr_1_3?s=books&ie=UTF8&qid=1374240909&sr=1-3&keywords=the+man+who+mistook+his+wife+for+a+hat http://www.amazon.co.uk/Better-Surgeons-Performance-Atul-Gawande/dp/1861976577/ref=sr_1_1?s=books&ie=UTF8&qid=1374240987&sr=1-1&keywords=better+atul+gawande http://www.amazon.co.uk/House-Black-Swan-Samuel-Shem/dp/0552991228/ref=sr_1_1?s=books&ie=UTF8&qid=1374241124&sr=1-1&keywords=the+house+of+god+samuel+shem http://www.amazon.co.uk/Bad-Science-Ben-Goldacre/dp/000728487X/ref=sr_1_1?s=books&ie=UTF8&qid=1374241298&sr=1-1&keywords=bad+science+ben+goldacre Thought provokers: http://www.amazon.co.uk/Complications-Surgeons-Notes-Imperfect-Science/dp/1846681324/ref=sr_1_1?s=books&ie=UTF8&qid=1374241026&sr=1-1&keywords=atul+gawande+complications http://www.amazon.co.uk/Checklist-Manifesto-How-Things-Right/dp/1846683149/ref=sr_1_1?s=books&ie=UTF8&qid=1374241049&sr=1-1&keywords=atul+gawande+checklist http://www.amazon.co.uk/Brave-New-World-Aldous-Huxley/dp/0099518473/ref=sr_1_1?s=books&ie=UTF8&qid=1374241067&sr=1-1&keywords=aldous+huxley http://www.amazon.co.uk/Island-Aldous-Huxley/dp/0099477777/ref=sr_1_1?s=books&ie=UTF8&qid=1374241093&sr=1-1&keywords=aldous+huxley+island http://www.amazon.co.uk/Mount-Misery-Samuel-Shem/dp/055277622X/ref=pd_sim_b_4 http://www.amazon.co.uk/Psychopath-Test-Jon-Ronson/dp/0330492276/ref=sr_1_1?s=books&ie=UTF8&qid=1374241180&sr=1-1&keywords=the+psychopath+test http://www.amazon.co.uk/Drugs-Without-Minimising-Harms-Illegal/dp/1906860165/ref=sr_1_1?s=books&ie=UTF8&qid=1374241197&sr=1-1&keywords=drugs+without+the+hot+air http://www.amazon.co.uk/How-Win-Friends-Influence-People/dp/0091906814/ref=sr_1_1?s=books&ie=UTF8&qid=1374241222&sr=1-1&keywords=how+to+win+friends+and+influence+people http://www.amazon.co.uk/Bad-Pharma-companies-mislead-patients/dp/0007350740/ref=pd_bxgy_b_img_y Final Final Thought: Just go into your local book shop or library and go to the pop-science section and read the first thing that takes your interest! It will almost always give you something to talk about.  
jacob matthews
over 4 years ago
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5
353

History taking for MRCP PACES

medical interview. note the steps:introduction,hostory of presenting compliant,past medical history,family history,drug and social history and then systematic review. note the use of open and close ended questions,facilitation and summerization. for more tips on history taking, visit my blog.  
MRCP Videos
almost 4 years ago
0cf57ac2f6bcc17aa0bc3a107739f2f7
9
337

Death by Powerpoint.

Introduction Computerised presentations are a part of every medical student's / junior doctor's life. Sometimes we give them, often we sleep through them and occasionally we even listen to them. They are the backbone of medical education besides traditional bed-side teaching, having rapidly replaced the now extinct OHR (Over Head Projector) acetate-sheet presentations of years gone-by. The problem is that Doctors and medical students often struggle with creating and presenting coherent slides. This is most probably due to the general apathy most have for actually talking in front of an audience, or because those asked to present are often taken unawares, and therefore have little time to prepare. In these times of avolition or last-minute hurriedness, people often reach out for the industry standard of presentation production: PowerPoint. PowerPoint is the most commonly used tool for making presentations because it is simple to use and comes with a whole load of free templates. Unfortunately, most of these templates look disgusting. If a template doesn't look disgusting, then it is most certainly overused and you run the risk of having a presentation that looks identical to the student before you at the weekly seminar teaching - a scenario that can be easily likened to turning up to a lecture wearing exactly the same clothes as another person in the room, which would just be awkward. Another problem with PowerPoint is the phenomenon of 'Death By Powerpoint,' which refers to the general boredom and apathy experienced by those who have received way too much information in way too short a space of time via a series of over-cramped, poorly stylised slides. But why on earth do you care? People should care about 'Death By Powerpoint' because if your presentations cause people to zone out, then you are not getting your message across. And if you aren't getting your message across then you. are. not. presenting. at. all. (take a moment to reflect on that particularly Zen statement). Let me explain using a metaphor, if I am a sales person and I present my talk with well-designed slides, in an enthusiastic and well-rehersed manner to an appropriate audience I will make more sales than if I present using poorly designed slides at the last minute. Similarly, in Medicine if I present well designed, aesthetic slides I am more likely to convey accurate information to my colleagues that may very well be retained and enjoyed by all involved. Of course, this blog assumes a degree of presentation-related Altruism. The recommendations I am about to make require you to 'step out of the mould' and say 'no' to poor presentations. They require you to forgive others for the presentations they have inflicted on you in the past. You will 'lead by example'. Unfortunately I am not capable (or qualified) to make you an excellent designer, nor can I give you the motivation to feel as passionately about design aesthetics as i do when all you've got to do is slam some slides together for your monthly journal club. But what I can do is present to you a series of resources that might tempt you away from the horrific PowerPoint templates that currently infest medical student seminars and young doctors presentations. If you really couldn't care less, then I suggest using Prezi, a website where you can make quite eccentric looking presentations rapidly and for free. The only problem is that Prezi became cliched even before its debut and you risk inflicting travel sickness on your poor audience, what with all the funky zooming in and out of slides that occurs during a typical Prezi presentation (you will know what I mean if you've ever seen one). So, without further ado, here are my top 5 tips for making your presentations look smoother and more polished... Irrespective of whether the contents of your talk are any good. Step One: Typography Get yourself a good font. Typography is really important, when you speak to someone you use a variety of tones and gestures to convey the meaning of the words you are using. Fonts are effectively the printed version of your tone and gestures. Good font choice can help give 'umph' to a particular point in your presentation and help give character to what you are saying. Of course, it's important to remain professional so 'Wingbats' might not be your first choice, but anything that you could envisage on a nice business card is probably a good shout. Fonts are usually something you have to pay for if you want anything beyond the set given to you when you download Microsoft Word (for example). However, there are whole hosts of free fonts available from sites like [dafont])(http://www.dafont.com). The key is to be willing to trawl through these sites to find fonts that are actually useful! Beware those fancy fonts unless you know your audience can take it! If you are stuck on choosing a font, which is a common complaint, then maybe this flow diagram will help! Oh yeah, and never ever use Comic Sans. Ever. Step Two: Colour A good font isn't going to get you very far on its own. You need a solid colour scheme to bring your presentation alive. It seems blunt to say, but some people are not very good at picking colours that go well with one another. This is well evidenced in PowerPoint presentations where the yellow-text-on-blue-background is far too common. I mean yeah, in theory blue and yellow 'compliment' each other, but thats where the relationship between blue and yellow should stay... in theory. Luckily there are some useful colour palette websites available out there, which will match colours for you... Step Three: Structure After you've picked a sensible font and a suitable colour scheme, it's time to think about the structure or layout of your slides. It's absolutely crucial that you avoid putting too much information on your slides even if you are giving an academic presentation. An overloaded slide is about as useful as a dead cat. At this point, some of you may be tempted to resort to those dodgy PowerPoint default templates but there is another way! There are sites out there that have some pretty fresh templates you can use and they are completely free! They are sure to add a bit of spice to your slide's aesthetic. There will probably be a separate tutorial on this in the future, but basic principles apply. As a general rule stick to Left Alignment *and avoid *Central Alignment like the plague. Step Four: Imagery Images help to spice up a presentation, but try and keep them related to the topic. Google Images is a great resource but remember that most images will be a low resolution and will be poorly suited to being shown blown up full-size on a presentation screen. Low resolution images are a presentation killer and should be avoided at all costs. For high-quality images try sites like Flikr or ShutterStock. Step Five: Consider Software The interface of Powerpoint does not lend itself well to having images dropped in and played with to make nice looking layouts. I would recommend Adobe Photoshop for this kind of work, but not everyone will have access to such expensive software. Cheap alternatives include Photoshop Elements amongst others. Once you have created slides in Photoshop it is quick and easy to save them as JPEG files and drag and drop them into PowePoint. Perhaps that can be a tutorial for another time... Step 5: Additional Stuff Presentations typically lack significance, structure, simplicity and rehearsal. Always check over your presentation and ask 'is this significant to my audience?' Always structure your presentation in a logical manner and (it is recommended you) include a contents slide and summary slide to tie things together. Keep your verbal commentary simple and keep the slides themselves even more simple than that. Simplicity is crucial. Once you have produced your beautiful slides with wonderful content you will want to practice them. Practice, Practice, Practice. Rehearsing even just once can make a good presentation even better. Conclusion: This blog entry has covered some basic points on how to improve your medical presentations and has given a series of useful online resources. Putting effort into designing a presentation takes time and motivation, for those without these vital ingredients we recommend Prezi (whilst it is still relatively new and fresh). Perhaps the rest of you will only use these tips for the occasional important presentation. However, I hope that soon after you start approaching presentations with a little more respect for their importance and potential, you too will find a desire to produce high-quality, aesthetically pleasing talks. LARF - Mood: damn tired and feeling guilty that I just wrote this blog instead of revising haematology notes. Follow me on Twitter. Follow the Occipital Designs original blog. Check out my Arterial Schematic.  
Dr. Luke Farmery
over 4 years ago
71349e910c9a4176d3777c81989ae38b
14
232

Chronic: How one word can change everything

So, I think its about time I posted another blog post! A few weeks ago I received the results from my most recent scan. I was both nervous and excited to find out my results, after months of tests and being misdiagnosed several times I just wanted to know what was wrong with me. However, as I read through the letter from my consultant I realised that my journey was just beginning. I was diagnosed with a rare stomach condition. Gastroparesis. A chronic illness. There is no known cure, just various treatments with limited success. I didn’t really know how to react to this news. Shouldn’t I be happy that I finally knew what was wrong? I had convinced myself for months that as soon as the doctors found out what was wrong, they could fix it and I’d be better in no time, but this wasn’t to be. I couldn’t understand how this could happen. Slowly the reality began to sink in, I’ll probably be fighting this battle for the rest of my life. I think the mental aspect of chronic conditions is so commonly overlooked. I’ve sat through endless lectures about the pathophysiology of illnesses but I’ve never once stopped to think what it must be like to actually have it. The way it can limit your life, from not being able to go for a drink with friends because you’re in too much pain to the countless hospital appointments that your life seems to revolve around. The thing that hit me the most is the amount of medications I have to take on a daily basis just to make my symptoms bearable. I no longer have full control of my life and that's the worst part. This experience has given me an invaluable insight into how patients with chronic illness feel. It affects almost every aspect of your life and you can never escape. It scares me to think of the future, I never know when I’m going to get my next flare up or how long its going to last. I just have to take one day at a time and hope that when I wake up tomorrow I won’t be too nauseous. After spending a few weeks feeling down about it all, I’ve realised that I just have to enjoy life when I can and be grateful that I can still live a normal-ish life. It doesn’t matter how much I complain, it's not going to go away, and I think I’ve finally accepted that fact. If anything, this experience has made me more determined to achieve my dream of becoming a doctor. I’ve been a lot more motivated to work harder so that one day I can help others like me through some of their toughest times, hopefully bringing them some comfort and relief.  
Nicole Mooney
over 3 years ago