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!
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Severe CNS Infections are time dependent diagnoses! You must have a high index of suspicion, a good plan for your work-up, and rapid provision of treatment. After seeing a severely ill meningitis patient, I figured I would do a podcast on some tips and pearls on this topic.
During our antibiotics teaching at medical school we were told that a recent survey of junior doctors had revealed that a significant proportion didn't realise that augmentin, tazocin, and carbopenems were penicillins and as such should not be given to those with known allergies. I devised a "mind-map" summarising the main antibiotics in use using information from the BNF and my own lecture notes. For me, seeing the information laid out in this manner, pinned above my desk as I work, helps me remember the major classes, their relationships with one another, and their major side-effects.
Resistance to insulin is a normal physiological response in pregnancy, thought to be induced by maternal hormones. However, in some women, this is severe enough to result in gestational diabetes. In these women, there is reduced ability of the pancreas to produce enough insulin to overcome the insulin resistance. Gestation diabetes is defined as - Any hyperglycaemia with first onset or presentation during pregnancy
Commencing the first clinical year is a milestone. Things will now be different as your student career steers straight into the unchartered waters of clinical medicine. New challenges and responsibilities lie ahead and not just in an academic sense. After all this is the awaited moment, the start of the apprenticeship you have so desired and laboured for. It won’t be long before these clinical years like the preclinical years before them, will seem just as distant and insular, so why not make the most of it?
The first days hold so much excitation and promise and for many they deliver, however, it would be wise not to be too optimistic. I am afraid your firm head standing abreast the doors in a prophetic splaying of arms is an unlikely sight. In this new clinical environment, it is natural to be a little flummoxed. The quizzical looks of doctors and nurses as you first walk in, a sure sign of your unexpected arrival, is a recurring theme. If the wards are going to be your new hunting ground, proper introductions with the medical team are in order. This might seem like a task of Herculean proportions, particularly in large teaching hospitals. Everyone is busy. Junior doctors scuttling around the ward desks job lists in hand, the registrar probably won’t have noticed you and as luck would have it your consultant firm head is away at a conference. Perseverance during these periods of frustration is a rewarding quality. Winning over the junior doctors with some keenness will help you no end. What I mean to say is that their role in our learning as students extends further than the security of sign-off signatures a week before the end of the rotation. They will give you opportunities. Take them! Although it never feels like it at the time, being a medical student does afford some privileges. The student badge clipped to your new clinic clothes is a license to learn: to embark on undying streaks of false answers, to fail as many skills and clerkings as is required and to do so unabashed.
Unfortunately, the junior doctors are not there purely for your benefit, they cannot always spare the time to directly observe a history taking or an examination, instead you must report back. With practice this becomes more of a tick box exercise: gleaning as much information and then reconfiguring it into a structured presentation. However, the performance goes unseen and unheard. I do not need to iterate the inherent dangers of this practice. Possible solutions? Well receiving immediate feedback is more obtainable on GP visits or at outpatient clinics. They provide many opportunities to test your questioning style and bedside manner. Performing under scrutiny recreates OSCE conditions. Due to time pressure and no doubt the diagnostic cogs running overtime, it is fatefully easy to miss emotional cues or derail a conversation in a way which would be deemed insensitive. Often it occurs subconsciously so take full advantage of a GP or a fellow firm mate’s presence when taking a history.
Self-directed learning will take on new meaning. The expanse of clinical knowledge has a vertiginous effect. No longer is there a structured timetable of lectures as a guide; for the most part you are alone. Teaching will become a valued commodity, so no matter how sincere the promises, do not rest until the calendars are out and a mutually agreed time is settled. I would not encourage ambuscaded attacks on staff but taking the initiative to arrange dedicated tutorial time with your superiors is best started early. Consigning oneself to the library and ploughing through books might appear the obvious remedy, it has proven effective for the last 2-3 years after all. But unfortunately it can not all be learnt with bookwork. Whether it is taking a psychiatric history, venipuncture or reading a chest X-ray, these are perishable skills and only repeated and refined practice will make them become second nature. Balancing studying with time on the wards is a challenge. Unsurprisingly, after a day spent on your feet, there is wavering incentive to merely open a book. Keeping it varied will prevent staleness taking hold. Attending a different clinic, brushing up on some pathology at a post-mortem or group study sessions adds flavour to the daily routine. During the heated weeks before OSCEs, group study becomes very attractive. While it does cement clinical skills, do not be fooled. Your colleagues tend not to share the same examination findings you would encounter on an oncology ward nor the measured responses of professional patient actors.
So ward time is important but little exposure to all this clinical information will be gained by assuming a watchful presence. Attending every ward round, while a laudable achievement, will not secure the knowledge. Senior members of the team operate on another plane. It is a dazzling display of speed whenever a monster list of patients comes gushing out the printer. Before you have even registered each patient’s problem(s), the management plan has been dictated and written down. There is little else to do but feed off scraps of information drawn from the junior doctors on the journey to the next bed. Of course there will be lulls, when the pace falls off and there is ample time to digest a history. Although it is comforting to have the medical notes to check your findings once the round is over, it does diminish any element of mystery. The moment a patient enters the hospital is the best time to cross paths. At this point all the work is before the medical team, your initial guesses might be as good as anyone else’s. Visiting A&E of your own accord or as part of your medical team’s on call rota is well worth the effort. Being handed the initial A&E clerking and gingerly drawing back the curtain incur a chilling sense of responsibility. Embrace it, it will solidify not only clerking skills but also put into practice the explaining of investigations or results as well as treatment options. If you are feeling keen you could present to the consultant on post-take.
Experiences like this become etched in your memory because of their proactive approach. You begin to remember conditions associated with patient cases you have seen before rather than their corresponding pages in the Oxford handbook. And there is something about the small thank you by the F1 or perhaps finding your name alongside theirs on the new patient list the following morning, which rekindles your enthusiasm. To be considered part of the medical team is the ideal position and a comforting thought. Good luck.
This blog post is a reproduction of an article published in the Medical Student Newspaper, Freshers 2013 issue.
Microorganisms that cause disease in humans and animals enter the body at different sites and produce disease symptoms by a variety of mechanisms. Microbial invasion is initially countered by innate defenses that preexist in all individuals and begin to act within minutes following encounter with the infectious agent. Only when the innate defenses are bypassed, evaded or overwhelmed is an adaptive immune response required. The innate immune system (IIS) is usually sufficient to prevent the body from being routinely overpowered by these organisms. However, once they have gained a hold, they require the concerted efforts of both the IIS and the adaptive immune system (AIS). In the first part of this chapter, different arms and principles of the IIS and the AIS will be briefly discussed. The second part of the chapter will discuss the process of fighting a bacterial and a viral infection, with an emphasis on the cross talk between the two parts of the immune system.
I completed this article in collaboration with a senor registrar whilst studying as an undergraduate medical student in Dundee.
This article outlines the proposed introduction of a technique that employs ultrasound to visualise the femoral nerve whilst performing a femoral nerve block. This procedure is performed on patients in both the emergency dept and surgical theatres. Traditionally this procedure has been performed using a 'blind technique' which has an increased association with side effects including inadvertent damage to local structures and systemic toxicity related to local anaesthetic. In the article we give a brief outline of both the the traditional and ultrasound guided techniques and allow readers to understand the benefits of using the proposed technique. We believe that this article will be of great interest to senior medical student and junior doctors who are interested in careers in emergency medicine and anaesthesia.