Suzy Stethoscope

See one, do one, teach one: My guide to getting into graduate-entry medicine

goingonabearhunt-trailwalker2012 — Sat, 02 Mar 2013 18:18:00 -0500

In the spirit of the old medical education adage, after spending a year learning about graduate-entry medicine (‘see one’) and obtaining a coveted place (‘do one’), this represents my attempt to impart what I have learnt along the way about how to get on to a graduate-entry medicine course (‘teach one’). There are four main hurdles - (1) work experience (2) entrance exams (3) the personal statement, and (4) interviews – the musings below might help those of you applying to clear these.

1. Research the courses thoroughly

There are about 15 institutions in the UK offering graduate-entry medicine programmes and the entry requirements and styles vary enormously. I come from a psychology background and consequently was only eligible to apply for a handful of these courses. Most stipulate that a 2:1 is necessary in your first degree, but a few do permit 2:2s and Birmingham is (currently) the only course that requires a 1^st. Don’t waste one of your choices (you get 4 choices through UCAS) on a course that you don’t meet the eligibility criteria for. If you buy one book on getting into medical school, I thoroughly recommend ‘So you want to be a doctor?’ by Stephan Sanders, David Metcalfe, and Harveer Dev. It was really useful for reading about individual courses (e.g. it has what’s the best/worst part for each course, the number of applicants/interviews/offers, entry requirements, etc.). The other reason it is super is that it not only does this for the undergraduate five/six-year courses, but also for the graduate-entry courses.

2. Talk to doctors and healthcare professionals

I quietly whispered to a doctor friend that I wanted to apply for graduate-entry medicine. Dr B called an emergency sushi date, during which I was subjected to a thorough interrogation about why I wanted to embark on this journey. Although this grilling was unpleasant at the time, this and the countless other similar conversations I have had during the past year really clarified in my mind exactly why I want to be a doctor – a massive help given that the guaranteed question at interviews is ‘So why do you want to be a doctor?’ What is more, you can learn an enormous amount about what being a doctor is like by (shock horror) talking to doctors. The friends I have who are doctors and medical students also provided valuable assistance in terms of reading my personal statement and practising interviews (special thanks to Dr B and Thom O’Neill). I found it useful to talk to friends and family who work in allied professions (nursing, pharmacy, speech and language etc.) to find out the ways that they work with doctors.

3. Gain some experience in a healthcare setting

The amount of work experience you are required to have varies for the different courses. Get ready to use all your annual leave on open days and work experience! I was able to shadow Dr B for a couple of days, and I also managed to enrol on a free week-long psychiatry summer school. The summer school was designed for current medical students with an interest in psychiatry but I emailed the organisers to ask if I could come along as a potential medical student and they agreed – so be bold – if you don’t ask, you won’t get! For the past eight months I have volunteered at my local hospital. This experience was very pain-free to organise (totally different to the experience of trying to get clinical psychology work experience!) – Hospitals are used to arranging similar schemes for A-Level students applying for the traditional medicine courses. Even if there isn’t a formal voluntary department at your local hospital, it probably has a League of Friends that you can get involved with as a first step.

4. Swot up for the entrance exams

There are three different entrance exams currently in use: The UKCAT, the GAMSAT, and the BMAT. Different courses use different entrance exams, and some don’t use any entrance exams at all. In my case, I applied to a combination of courses that meant I ended up sitting all bloody three. The solution for passing them is simple: practise, practise, practise.

In terms of prep for the UKCAT ‘Get into medical school: 600 UKCAT Practice Questions’ is brilliant. I used ‘How to Master the BMAT’ for my BMAT prep, which was ok, although I didn’t find the revision material that helpful - I had to substitute it with the trusty CGP A Level/GCSE revision guides. For the GAMSAT, see the website where you can buy preparatory materials. These materials and entrance exams all costs £££ so bear this in mind when choosing which courses you apply to and which exams you will need to sit.

5. Read about being a doctor and what is going on in medicine

Books that I read and really enjoyed because they gave a flavour of the highs and lows of being a doctor include: Atul Gawande’s ‘Better: A surgeon’s notes on performance’ and ‘Complications: A surgeon’s notes on an imperfect science’; Max Pemberton’s ‘Trust me I’m a junior doctor’, ‘Where does it hurt?’, and ‘The doctor will see you now’; Nick Edwards’ ‘In Stitches’; Benjamin Daniels’ ‘Confessions on a GP’.

I also attended free medical talks at the Royal Society of Medicine (check out their website, and that of any other Royal Colleges that you are interested in) and my local medical school (BSMS). I follow lots of doctors on Twitter - it can be good to get their (often heated) views on topics such as the Liverpool Care Pathway and NHS restructuring. I also try to read BMJ articles when I get a chance, but if you don’t have access, keeping up to date with BBC Health stories is probably a good start. You are very likely to be asked about some current medical hot topics at interview.

6. Ponder ethical issues

My interviews included being presented with hypothetical situations where I was required to make decisions. These weren’t straightforward decisions; these were situations with ethical dilemmas. For example, should you give one available hip replacement slot to an 80-year-old sole carer or a 40-year-old marathon runner? If you don’t like the idea of this, you probably won’t like medicine, where such dilemmas occur frequently. For a really accessible introduction to medical ethics, read Hope’s ‘Medical Ethics: A very short introduction’.

7. Start thinking about your personal statement early on

Having a clear idea of what the gaps are in your dream personal statement will help you focus on which areas you need to put extra work in. Given I was working, writing up my PhD and trying to cram for exams, I didn’t have that much of a life outside of my office last year. I know that interviewers are keen to give places to well-rounded individuals who will not burn out in the challenging world of medicine. So, I signed up for a 100 km charity walk. This gave me the perfect excuse to get away from my desk, spend time with some good friends, and have something extracurricular to talk about at interview. And while we’re on the topic of interviews, Lee and Picard’s ‘Medical School Interviews: A practical guide to help you get that place at Medical School’ was very helpful - especially in terms of making sure you cram lots of relevant (and ditch irrelevant) points into your answers.

8. Think about finances

Studying graduate-entry medicine is expensive (£70,000+ for fees and living costs) and my interviewers were keen to find out if I had thought about how I would afford to study medicine if I were to get a place. In my case, I found out as much as I could about what financial support was available (including going to a talk at the Royal Society of Medicine) and made changes to my lifestyle to save as much money as possible. What is more, bear in mind that the entrance exams all have hefty fees and trekking around to open days can also add up in travel costs.

9. Work damn hard at what you already do

There are far more applicants for graduate-entry medicine than there are places. I have no formal proof for this, just a hunch, but I suspect you are a far more enticing candidate if you’re doing well at what you currently do. It’s just a heuristic bias – a mental short-cut – we perceive those who are good at doing what they do as being more likely to be good at a new task. I have read far too many forum posts where applicants fail to understand why they are not being invited for interview when they meet the eligibility criteria for a particular course. The eligibility criteria should always be understood as the minimum requirement. You should aim to exceed these requirements wherever possible.

10. Enjoy it

I worked more 14+ hour days than I care to recall during the last year. What kept me going was the pure joy that I was challenging myself and doing something I really wanted to do. I’ve never felt so alive.

Good luck!

Echoes of exams (exams exams)

goingonabearhunt-trailwalker2012 — Tue, 09 Oct 2012 19:26:30 -0400

I’m caught in a glitch in the fabric of the space-time continuum – I’m sat at the same desk I sat at over seven years ago, learning things the 17 year old version of me knows. Meanwhile the rest of my peers merrily get on with house-buying and marriage – or at least drinking enough gin to ensure they certainly won’t be in a fit state to recall the Krebs cycle, or whether a positive biuret test is blue or purple (it’s purple). This is the joy of sitting entrance exams for graduate-entry medicine after having done a degree and a PhD. Apparently, I’m such a dinosaur, and sat my A-Levels so long ago, that Cambridge won’t even consider my A-Level qualifications unless I re-sit them (I politely declined and looked elsewhere). For my sins, I’ve chosen to apply to four medical schools with three different entrance tests. So, in August I sat the UKCAT, in September I sat the GAMSAT (the king of the entrance-exam jungle at 5.5 hours) and in November I shall sit the BMAT. Ignoring the cost of these exams (which will be the focus of another blog another time) this may not turn out to be such a bad strategy. The UKCAT was fine, and I have scored what I need. The GAMSAT was trickier, and if it doesn’t go to plan (currently waiting 6-8 weeks for the results) at least I have other options. But, the downside is that my spare time is filled with a lot of exam prep. I’m hoping that this Groundhog Day encounter with CGP revision guides is not what the General Medical Council means by lifelong learning. If only I could remember how the guy ends the Groundhog cycle, but as those of you who know me well will be fully aware, my memory for film endings is shockingly bad. I guess I’ll have to watch it again to find out.

'You'll never walk alone'

goingonabearhunt-trailwalker2012 — Mon, 16 Jul 2012 16:05:05 -0400

This weekend saw the culmination of 8 months of training; I took part in Oxfam’s Trailwalker Team Challenge. Teams of 4 have 30 hours in which to walk 100km, from Petersfield to Brighton along the South Down’s Way. To cut a long story short, at 80km, I had to retire because of a leg-injury. I may not have made it to the end, but I learnt two very important lessons along the way. Lessons which I think are integral to being a good doctor.

It goes without saying that the other three members of my team were absolute stars (and they did make it to the end, in a cracking 23 hours 56 minutes!) Without the camaraderie, ‘guess the intro’ whistling game, and the boys’ renditions of Disney tunes, I’m not sure any of us would have got close to 80km. But the ‘team’ stretched further than I’d ever anticipated and taught me that when you ask for help (something that doesn’t always come naturally to me), it arrives on a platter. On the day, we had two amazing support crews who met us at each check point that wasn’t closed due to water-logging. Earlier than that, there were the friends who accompanied me on freezing cold walks in January and February. Then there were all the wonderful people who had sponsored us in the weeks running up to the event. Plus dozens of people who text, called and tweeted us with words of encouragement and some pretty goddamn awful jokes along the way and into the night. One of the aspects of medicine that really appeals to me is its team-based nature, something I’ve witnessed from my work experience and hospital ward volunteering. Nothing beats the feeling of being part of a great team, and as I welled up in pride for my other three team members as they crossed the finish line, I knew for certain that the whole was greater than the sum of its parts.

But the strength to be found in a good team wasn’t the only lesson to be learnt. The crushing realisation that I had to call our support crew at 2.15am (thanks Mum and Dad!) to pick me up literally caused me to double over on my walking poles. I can’t describe the depths of my devastation. I was cross with myself and embarrassed to have failed. Still, I didn’t have time to feel sorry for myself. The team needed to feel motivated to continue for the next 20km and me moping wasn’t going to help. I encouraged them to eat and stretch while we waited for my lift, and I moved into support crew territory, assisting them at the next (last) check point. Waves of acceptance soon washed over me, and I was blessed by instant messages of support from those who learnt of my defeat. Resilience is crucial in the emotionally-charged world of medicine. Every doctor will come across cases where, despite their best efforts, a patient fails to recover. Cases where sweat, blood and tears, do not save a life. Learning when to accept defeat, and stop treating someone is paramount to the crux of being a doctor; not necessarily always curing patients (impossible in a mortal world), but reducing suffering. Sometimes the kindest thing to do is admit when you are beaten. My first lesson of the walk, asking for support from those around you, turned out to be the answer to dealing with the second important experience, trying your best but failing to succeed. My team, in the broadest sense of the word, have helped me take pride in the 80km I did complete.

I embarked on Trailwalker to provide an excuse to leave my desk at weekends, and as a challenge aimed to hone my team skills. Additionally, it turned out to be a lesson in dealing with disappointment and taking strength from knowing I’d pushed myself to my limits. After all, if you never reach the point of failing, have you really tried hard enough to discover your capabilities? In the words of T. S. Eliot, ‘Only those who will risk going too far can possibly find out how far one can go’.

Currently reading: Max Pemberton’s The Doctor Will See You Now

Not just the work experience girl

goingonabearhunt-trailwalker2012 — Tue, 03 Apr 2012 05:30:01 -0400

‘Ah you’re the sixth former’ pipes up a friendly doctor on the ward round. No, sadly not. I’m the 24-year old, soon to be 25-year old, with a PhD in Psychology (I hope – thesis and viva permitting). It’s a week ago, and I’m spending two days shadowing a friend who happens to be a doctor. I’m on work experience, about 10 years late.

The decision to apply for graduate-entry medicine is up there with The Big Ones in my life, and for the first time, I really get work experience. It has purpose. A far cry from a tick box or hoop to jump through, I am hungry for it. I want to know more and I want to be as sure as I can be that this is the right route for me. After all, when you’re facing a fork in the road, it’s generally a good idea to stop and check you’ve read the map correctly.

So, last week I spent two days of annual leave on a Care of the Elderly ward. I’ve seen a lot of hospital wards from the perspective of a relative over the past two years, so I wasn’t that worried about being faced with some poorly people. What I was, however, concerned about was whether I had the right shoes on (they were fine), whether my skirt was long enough (no one said otherwise), and whether I needed a cardigan (I didn’t, hospitals are painfully warm). Image matters a lot in health care, and I’d been sent a document on uniform policy a few weeks before my placement emphasising the importance of dressing to inspire confidence and dressing responsibly to minimise the spread of infection.

Speaking of infections, on arriving at the ward, we were told by one of the members of staff that a virus was spreading amongst the patients, and that the ward would have to be closed. For the next two days, no new patients were admitted to the ward, hands were washed and gelled more vigorously than ever, relatives visited at their own risk, and I became acutely aware that I did not want to be responsible for passing a bug to the patients who were currently virus-free. Thankfully, my own immune system didn’t seem fazed by the bug – a bout of D&V may well have put me off!

Ward round began at 8am and we were ‘post-take’ meaning that we had to visit all the new patients that had been transferred to the consultant’s care the day before. The patients were scattered in available beds on various wards around the hospital so this ward round included visiting an octogenarian on an early pregnancy ward! Most of the patients that we went to see had presented with a fall, but the underlying causes of the fall ranged from pneumonia to dementia. The doctors were rapid; charts were glanced at, x-rays and ECGs were flashed around, before new tests were ordered and impressions and management plans were recorded. Despite the pace, the doctors were kind to their patients, taking time to talk to them, explain what they thought was going on, and what the plan of action was. One thing was clear from the ward rounds I observed – the more senior you are, the less writing you do. I think I’ll be stocking up on biros.

The doctors that I followed were passionate about their work and keen to teach. I was not shadowing a teaching ward round (these are more knowledge-intensive, a 3^rd year medical student told me) but nonetheless, I listened to ‘crackles’ in the lungs of a patient with pneumonia, examined the lymph nodes of a patient with metastases, and was guided through the process of putting a patient onto the Liverpool Care Pathway (a palliative care programme), including a quick tutorial on the function of the drugs that are prescribed to ease the process of dying. I watched as the team took bloods, inserted cannulas, performed an ECG, and battled with a radiographer about conducting a chest x-ray on the ward.

The doctors faced a lot of uncertainty when making decisions. Should a patient be put back on diuretics? On the one hand, their legs were swollen with excess fluid retention, but their kidney function was less than optimal, something that the diuretics could worsen. Should a patient be given more oxygen? The patient’s oxygen levels had dropped too low, but their carbon-dioxide concentration was too high and was set to get even higher if more oxygen was provided. Best guesses were employed and the patients were monitored closely. In such situations, more senior staff members were consulted, and the clear chain of command gave me confidence in the system.

I was struck by the difference between being a relative, where every test ordered for your loved one is viewed with the upmost urgency, and being a health care professional, where tests are added to a long list of other tests needing to be done. Clearly, on this ward at least, patients do not deteriorate routinely as rapidly as I’d anticipated. Doctors see poorly patients every day, and it surprised me in the past when one doctor friend said to another doctor friend ‘How was your shift? Was anyone unwell?’ From the outside, they’re all unwell, they’re in a hospital. But you quickly realise there are degrees of unwell, something that can be missed as a relative new to the idea of failing health. In the case where a patient did become unwell, they were bumped straight to the forefront of the team’s attention.

One final reflection on this experience: one afternoon a relative asked me about a patient so I approached a member of the ward staff to ask for help and explained that I didn’t know what to tell the family because I was “just the work experience girl”. “Never say that!” she exclaimed. “If you’re just the work experience girl, that means I’m just the health care assistant”. It was a well-placed reprimand, a reminder of the importance of valuing all staff on the team, and I hope I will never think of a team member as ‘just the health care assistant’.

Currently reading: Atul Gawande’s Complications: A surgeon’s notes on an imperfect science

'Recalculating route'

goingonabearhunt-trailwalker2012 — Sun, 01 Apr 2012 13:55:42 -0400

Towards the end of 2011, I stared my future in the face and didn’t like what I saw. Two verses into Colin Hay’s ‘Waiting for my real life to begin’ and I’d made up my mind. I was going to say goodbye to a career in psychology (which I’ve been working towards for the past 6 years) and eagerly wave in a career in medicine. The journey to become a medical doctor is exceedingly long and I’ve already taken somewhat of a detour. I’ve been amazed and touched by the support of my family, friends, and colleagues who have taken my career decision and run with it. Some of these wonderful people have asked me for updates during the journey, so I’ve decided to start this blog so that we can share the blisters and the views along the route.