To the neurology/neurosurgery avids, those who just can't get it and others

I would like to say "well done, Mark Zuckerberg" as Facebook tops 1 billion active users! But all this is while 1 billion people in the world never see a health worker in their entire lives. The internet is the most powerful tool of our generation and there is no doubt that its influence will increase further in the future. I think we can all recognise the success of an enterprise such as Facebook and it is certainly a commendable feat to bring 1 billion people closer together on a regular basis. Well done Mark Zuckerberg! But does this not highlight some bigger questions? When will we see the internet making a real difference? I don't mean to belittle any enterprise such as Facebook which excites and energises a huge community, but when will we see a movement that has such an impact to save and improve billions of lives every month? The WHO Global Health Workforce Alliance estimates that there are a billion people alive today who will never see a health worker in their lives... Ever! We are not short of the tools to change this. So, how will this movement come about? Will it be a political push? Will it be an established company that walks in the 'right' direction? Or could it come from the grassroots? I believe this is one of the greatest challenges of our generation, and the most exciting challenge I can think of. As a doctor and co-founder of Meducation, we have started a movement in the right direction. Meducation aims to unite the medical community - yes all of it, but we know our limits. You can not make such an impact in one step. Most of the charitable solutions and philanthropic activity takes us huge leaps in the right direction and these are of significant importance, but will we ever see the sort of impact possible if we can't maintain the ability to push forwards with the attrition needed to effectively get this right. I would assume that most of those who have set up an innovative and successful solution to a problem would say that they could not achieve this with an element of freedom to experiment, try different methods and approaches before finding the formula that works. Is it not the same with this problem? The solution is going to grow from the grassroots and for us at Meducation, although we are starting with health workers in the UK, we certainly see the hopeful future where the health workers in the developing countries can gain access to the educational material and support they need from the rest of the community. With the global medical community working closely together, we will be better placed to help the 1 billion people who would have never see a health worker in their lives. So well done Mark.... but there are still bigger fish to fry.  

Hypo-politicosis = A behavioral condition where political thought and action is dangerously below an optimal range. Leading to the ostrich phenomenon of delusionary belief that there is nothing outside of medicine. In an age of ever great openness, communication and democratic rights, the population of the western world is disengaging with political ideology, political debate and political engagement. This disengagement is nowhere more prevalent than in the UK. The total membership of all the political parties are at the lowest since they were formed. There are less trade unionist today than a century ago. And most importantly the proportion of people that vote regularly is at an all-time low. Surely, this is a sign of a dysfunctional democracy? Can we truly call it a democracy if the state’s citizens have no interest or control over how the state is run? What worries me even more than this dire situation, is the lack of interest in politics from fellow medical students. If you were to sit in a bar in a medical school city, I am sure you would be able to hear groups of medical students unwinding over a pint and discussing some political issues. But those political issues almost always evolve around medicine, such as abortion laws, public health initiatives, doctor’s pay and the re-structuring of the NHS. This insular mind set worries me because there is more to life than medicine! And while so much of our lives may be taken up with the learning and practice of medicine, our lives will be affected by so much more, and before medical school we all had to take an interest in so much more just to get an interview. Do you remember having the time and inclination to take an interest in something that wasn’t medicine? Like reading history or poetry? This insular mindset is detrimental because it means that as a demographic group we may not engage as fully as we should do with the rest of society, this could be bad for us but more importantly bad for the greater society. If medics become too disengaged in the greater political debates then we may find that society decides that doctors are easy targets and easy scapegoats. We may find our working lives extended, our social lives curtailed, our pensions decimated and our earning power diminished because we did not engage with the public and discuss these issues openly. We may also lose influence with the government if medics don’t vote for their local MPs, question their local party officials and fight our corner over important issues via the BMA. The other side of this coin is that medics are selected from some of the brightest in the country, educated at great expense by the state, trained and employed by the state and pay a huge amount of tax to the state. If we engage in politics less then society as a whole may suffer from a lack of highly intelligent, highly educated individuals, who should hopefully have a strong social conscience and interest in well run state, from putting their thinking skills to good use on societal problems. Dr Liam Fox is a conservative back-bench MP and use to be in the shadow cabinet. He has used the skills he developed as a doctor to try and follow an evidence based political career. He recently released a book called “Rising tides” (http://www.amazon.co.uk/Rising-Tides-Facing-Challenges-New-ebook/dp/B00CUE0DKQ) which analyses many of the world’s current political issues and I would highly recommend as many people as possible read it. I also hope that in future I can walk into a bar, meet some medical colleagues and talk about an issue that affects more of society than just medics! How about using a scientific approach to discuss how Britain’s education system could be improved? Or how Britain could use its welfare resources better to decreased homelessness (which would also reduce a burden on A and E’s)?  

I am an Anatomy Professor who has taught anatomy to the medical school students in discipline based medical education system for first 10years of academic life. When I started teaching Anatomy in system-based medical education in the later half of my academic life I was surprised to find out that my students in system-based education can retain a lot of anatomy knowledge as they can visualize the application of the contents in the pathology, clinical science contents, PBL triggers and clinical skills sessions. Surprisingly, medical schools in India still follow the discipline-based medical education. Mostly the students are forced to retain the factual knowledge of Anatomy in this system. When they are in Year 1,they study only Anatomy,Physiology and Biochemistry. Hence it is very difficult for the student to imagine the application of the knowledge of Anatomy learnt in lecture or dissection room. For example, the students in discipline-based system learn the gross anatomy of the sternum and anterior thoracic wall. They need to memorize the importance of sternal angle without visualizing it as they are still not practising palpation of anterior thoracic wall for apex beat. I know that they learn it provided they are lucky to get a tutor who is a medical doctor, who obviously takes them to the task of palpating intercostal space through palpation of sternal angle in skeleton or over their own body surface marking. But the lack of Clinical skills practice in traditional discipline based medical education in year 1 does not allow the student to apply their anatomy knowledge automatically. Dr Nilesh Mitra  

There are roughly 7000 medical students graduating each year from 33 medical schools in the UK. Medical degrees take either 4, 5 or 6 years depending on the route you take. The government via the Student Finance Company will pay for your tuition fees for the first 4 years of any undergraduate degree. After this the NHS will pay for the last year or 2 years of the undergraduate medical tuition fees. The maintenance loan depends on family income. The figures aren’t easy to find for the background of most UK medical students but a ‘guestimate’ based on my medical school is that 50% went to a private school, 30% went to selective state schools and 20% went to a comprehensive. Of the private school kids probably about half had a scholarship or bursary. So, a rough guess would be that 70% of med students come from a “middle class” family who have a decent income but not huge wealth and are therefore eligible for a ‘maintenance loan’ above the minimum. This majority therefore rely on there loan to get through the year. An average student income is between £1000 and £1500/term (£1200 average-ish). Most university terms are 10 weeks, hence average income is about £120/week. As a preclinical medical student this is fine and we are on par with everyone else. As soon as we become clinical med students the game changes! Clinical years are far longer, more like 40 weeks a year rather than 30. Students are on placement, have to dress professionally and travel to placement daily. This adds additional costs and requires the money to stretch further. Doubly bad! Once, the NHS starts paying the tuition fees, the Student Loans Company starts reducing the maintenance loan, by half! Why? A final year student or a 4th year who has intercalated now has to survive at University for one of their course’s longest years with half the money they had previously. >40 weeks on a loan of roughly £1500/year. This situation is pretty much unique to medical students. Some students are lucky enough to have parents who can afford the extra couple of thousand pounds required for the year. Some students get selected into the military and get a salary. A greater proportion find part time jobs to help cover the cost and the rest have to resort to saving money where they can and taking out loans. When I was a member of the BMA medical student committee I did a project as part of the finance sub-committee investigating the loans available for medical students. Many banks used to “professional development loans” which allowed medical and law students to borrow money for a year before they had to start repaying the loan. Hardly any banks now offer this service, so the only loan available is an overdraft or a standard loan that requires you to have a regular income. This means that final year medical students with limited family support may have to live for a year on less than £2000. Does this seem fair? Does this seem sensible government policy? Medical students are 99% guaranteed to be earning over £25 thousand pounds within a year. We will be able to repay any loans. So why isn’t the Student Loan Company allowing us to continue having a ‘normal’ maintenance loan? And why aren’t banks giving us the benefit of the doubt and helping us out in our time of need? When I was on the BMA MSC there was talk of having a campaign to lobby government and the banks to rectify this situation but I can’t say I’ve been aware of any such campaign. Are the NUS, BMA, UKMSA or anyone else doing anything about this? Please do leave a comment if you do know if there has been a progress and if there hasn’t why don’t we start making a fuss about this!