The emergency department is the key place where the general public interact with the hospital system. The "ED" or the "ER" as its called in North America, made George Clooney famous in the 1990s. It is also the pathway where the acutely unwell and the injured enter the hospital for treatment. As such, it is essentially in a state of constant pressure. There is rarely an end in sight, and essentially operates continuously spinning plates, assessing, treating, discharging and referring patients. Understandably, these are busy and high stress environments. There are however, the perfect place for medical students to learn. Emergency medicine is very much modern medicine in its purest form. There is a patient, a history, and exam, a work-up and a diagnosis (of sorts!). The emergency department is divided in sections, each which deals with a specific type of patient. 1- Resus (short for resuscitation)This is the most acute section of the emergency department. It is here where the sickest patients are placed, where the patients with multiple injuries arrive. It is in Resus where Cardio-Pulmonary Resuscitation (CPR) takes place, where chest drains are inserted and where fractures are reduced under sedation. While it is rare medical students will be engaged in direct care in Resus, it is an excellent opportunity to see how acutely unwell patients are managed systematically, following Advanced Cardiac Life Support (ACLS) principles in a cardiac arrest, or following Advanced Trauma Life Support (ATLS) in a trauma patient.2-MinorsThis is typically the minor injuries section of the department. Walking wounded patients with cuts and scrapes, finger/hand/wrist/elbow/shoulder injuries are washed, sutured, casted and put in slings. These units are often staffed by Advanced Nurse Practitioners (ANPs). This is excellent opportunity to learn about wound care, suturing, antibiotics, tetanus prophylaxis and casting. 3-MajorsThis is the main floor of the department, where patients who are too sick or too injured for minors attend and perhaps not sick to need to be in Resus. The opportunities to learn here are endless with a wide variety of patient types ranging from ectopic pregnancies to acute appendicitis and respiratory failure. 4-Doctors/Nurses StationTypically in a central "hub" of the department, usually in Majors or close to Resus. This is where doctors and nurses discuss patient cases and care, review investigations, write notes. It is where the decision making takes place in the emergency department and is a key learning environment. Just grab a seat (or a perch) and listen to the interactions between the staff. You'd be surprised what you pick up!How to get the most out of an emergency rotation-Introduce yourself to the nurses, ANPs, doctors, consultants and ask if there is anything you can help them with. You could either end up helping to move a patient or helping to take bloods or insert a urinary catheter. -Link up with one of the doctors and shadow them through the department. They can show you interesting signs, explain investigations and their clinical decision making. They might even let you take an initial history and exam and present to them!-See as many of the department sections as possible. There is so much variety, to get the most out it, spend some time doing a bit of everything. A good strategy would be to spend a day each in every section on a week long rotation.

A guide to the emergency department for medical students. Advice on making the most of your emergency rotations.

How to Succeed in Your Emergency Medicine Rotation as a Medical Student

Here are some of my top tips for FY1 junior doctors: General: ⭐ Always write a jobs list - you will do this naturally but find a way that's organised on paper ⭐ Take and give a good handover - short and sweet with the relevant information. Use SBAR - it actually helps! ⭐ Learn how to use all the systems in your trust ⭐ Document, document and document! Every relevant conversation with or regarding the patient should be written in their notes ⭐ Own up to your mistakes - we all make them! Specific On-call tips: ⭐ Use the A-E approach for all unwell patients! ⭐ Prioritise your jobs - attend to urgent jobs first ⭐ Ask yourself do you need to review the patient for the job that's being asked? Perfect example is when prescribing IV fluids! ⭐ You will always have a senior to ask for help so don't do things your not sure about Night-shift tips: ⭐ Have a nap before your shift begins ⭐ Have small but regular snacks to keep you going ⭐ If you get a (rare) chance to nap during the shift - take it! Tips post Covid: ⭐ Get fit tested if you will work around aerosol generated procedures. Covid is still a threat to many people, especially those with underlying health conditions ⭐ Do the risk assessments if relevant - specifically if from BAME background ⭐ It's still feels scary for everyone but take comfort knowing that we are past the most difficult times and that you are never alone Self-care tips: ⭐ Be YOURSELF ⭐ Don't be shy to ask for help. Medical school may have felt very competitive but it's completely different on the job. Your collegues will always help! ⭐ Use your spare time doing the things you love to do. The rota can be intense but it's good to do things outside of medicine ⭐ If you are struggling then raise it with the relevant people. Sadly mental health problems are very common in Medicine but don't suffer alone! ⭐ Have a good supportive network i.e. your family/friends/partner ⭐ Enjoy life as a doc - you worked hard to get here so enjoy using all your skills and knowledge doing what you love to do For my Muslim sisters and brothers: ⭐ Try to pray on time - locate the prayer room or ask the nurse in charge about spare rooms you can use ⭐ Always seek help from Allah and remember that your work itself is a form of worship ⭐ For more Muslim-related tips check out my Instagram @dr_tamz

Starting work as an FY1 doctor can be daunting. So here I share some of my top tips to hopefully make the journey a little easier.

Top tips for FY1 doctors 

Advice and tips for Obstetrics &amp; Gynaecology junior doctors: ⭐️ My most important advice comes first - don't be afraid to escalate/ask your seniors! Especially when you begin as it's likely that you will not know how to manage most pregnancy related problems ⭐️ With experience you will gain more confidence. Initially it can feel overwhelming, but slowly you will see similar cases over and over again so you will eventually know what to do. E.g. PV bleed (one of the most common presentations) ⭐️ Utilise the knowledge and skills from midwives. Here in the UK, Midwives have to complete a degree in order to qualify and often you will find that they know the answer to your question. On the other hand, don't forget that you are the doctor and if you are still not sure ask a senior ⭐️ SAFETY NET every patient you see! (O&amp;G has many risks and has the highest rate of complaints) ⭐️ Speculum exams get easier with experience. Don't feel shy to ask a midwife/doc to be a second pair of eyes. You need a chaperone when doing intimate examinations anyway so I would always ask them to have a look too. The more you do the easier it gets! ⭐️ This leads me to dignity. "My dignity is out the window" - I have heard this phrase SO many times and it's so disheartening. We should do our utmost to protect all our patients dignity. Ask them how they feel most comfortable, talk them through procedures such as intimate exams, and be mindful of how many people are staring at the other end who don't actually need to! ⭐️ If you enjoy surgery then there are plenty of opportunities to shadow and assist ⭐️ As the junior doctor you will always assist in caesarean sections. It can be physically exhausting (as there is a lot of pulling and pushing involved), but overall it's an enjoyable experience as you get to see the baby 😁⭐️ Every trust has their own policies and guidelines so make sure you utilise them I hope the above tips are useful for anyone starting a job in O&amp;G!

In this article I share some of my top tips for junior doctors who are going to start a job in Obstetrics & Gynaecology.

O&G Advice and Tips

Personal branding is perhaps one of the most important things to be conscious of in this day and age, where an increasing amount of attention is spent online and digitally.Your personal brand is the perception you intentionally create for yourself based on your values, ethics and accomplishments.A nice way to describe personal branding <blockquote>"Personal branding is the story people tell about you when you're not in the room.” - Aaron Orendorff - Editor in chief at Shopify Plus</blockquote> Therefore it's important to get clear and concise on who you are now &amp; what you want to be whilst you're showing up on your social media channels. Why is personal branding so important?Some of the worlds most famous people have a clear and public personal brand that has global recognition - think about how you perceive Elon Musk or Oprah Winfrey.Personal branding is the best way to show your uniqueness, specialties, and selling points. It allows you to benefit from high-volume exposure to opportunities.For example, the more customers know about you, the more likely they are to purchase from you. Tips on how to get started? <ol><li>Choose one platform to start, and begin to build your story there</li><li>Be consistent, show up, provide opportunities to connect and give your audience something to come back for</li><li>Make sure you have up-to-date and concise information on your social media profiles and Bios</li><li>Identify your niche or area of expertise (medical education, clinical entrepreneurship, Academia etc)</li><li>Share content regularly - Tweets, Stories, Posts or Reels</li><li>Stay positive</li><li>Engage your own audience and other creators/personalities online</li><li>Be consistent in your offering, ethos and ideas - avoid flipping back and forth</li><li>Avoid being everything to everyone</li><li>Be genuine and credible</li><li>Tell a story, build a narrative</li><li>Be open to failure</li></ol>

Personal branding is one of the most important things to be conscious of in this day and age, where an increasing amount of attention is spent online and digitally

How to Build a Personal Brand

Hemophilia is a genetic disease also termed as 'The Royal disease'Hemophilia is a&nbsp;genetically inherited&nbsp;blood-clotting disorder&nbsp;caused by the&nbsp;deficiency of clotting factors. It is characterized by the inability to properly form blood clots. Due to this, even a minor trauma can lead to profuse hemorrhage.The 3 types of Hemophilia are Hemophilia A(max%), Hemophilia B and Hemophilia C caused by the deficiency of clotting factors VIII, IX, and XI respectively.The affected gene is present in the X-chromosome. It can be passed along generations by hereditary transmission in an&nbsp;X-linked recessive pattern.Genotypically, males (XY) have one X and one Y chromosome. Whereas, females (XX) have two X chromosomes.&nbsp;Due to the recessive pattern of inheritance in hemophilia, when children inherit the affected X-chromosome,&nbsp;the affected male offspring will always express the disease&nbsp;whereas most females act as carriers of the disease. This is because&nbsp;the carrier females have another copy of X-chromosome that contains a normal gene aiding the formation of clotting factors. Whereas, males have only one copy of X-chromosome due to which they always express the disease if they inherit the affected gene.The&nbsp;treatment&nbsp;of Hemophilia is mainly by&nbsp;replacement therapy.The&nbsp;probability of genetic transmission&nbsp;can be better understood using&nbsp;Punnett squares.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fthe-royal-disease-of-the-royal-blood-decoded-8dvhy%2Fimages%2Fai-1.png?alt=media&amp;token=bdb36bd4-2da0-4c35-ad5f-c541846cd6b2">Can male off-springs of affected families be exempt from the disease?Yes, of course. One can understand this better by studying the probability of genetic transmission using Punnett squares. (Look at Scenario 1, 2 and 3)<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fthe-royal-disease-of-the-royal-blood-decoded-8dvhy%2Fimages%2Fai-2.png?alt=media&amp;token=1b9526d4-aaec-4c57-8572-468070c300fa">Also, keep in mind that an affected father can never pass the hemophilia gene to his son as he only passes the Y chromosome. Whereas, daughters of affected fathers always inherit a copy of the affected X chromosome. For this reason, the daughters of affected fathers always become carriers of hemophilia.Can female off-springs of affected families express the disease?Yes, that is possible. Find out more with the probable scenario shown in the Punnett square below.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fthe-royal-disease-of-the-royal-blood-decoded-8dvhy%2Fimages%2Fai-3.png?alt=media&amp;token=d613e2b4-7b2f-4147-aaa4-3e3478ac13f8">Can a female offspring be unaffected i.e., not even be a carrier?Yes. Look at scenario 1 to know the probability of a normal female offspring in an affected family.Can someone with turner syndrome develop hemophilia?Turner syndrome is a genetic disorder with a partial or complete monosomy of the X chromosome. The affected individual has XO genotype with female phenotype.A child affected by turner syndrome&nbsp;can develop&nbsp;hemophilia&nbsp;if&nbsp;the child inherits the affected copy of X chromosome from the affected father, affected mother or carrier mother.If&nbsp;the child inherits a copy of the normal gene from the unaffected mother, carrier mother or unaffected father, then the child with turner syndrome remains&nbsp;unaffected.Why is hemophilia called a royal disease?Queen Victoria, the Queen of England from 1837 to 1901, was a carrier of the hemophilia gene. She had nine children and as English royal family members married into royalty of other countries, the disease eventually passed on to the European royal families of Spain, Russia, Denmark, Austria and Germany. Therefore, hemophilia gained its title of ‘The Royal Disease’ because it&nbsp;spread through the royal families of Europe through Queen Victoria’s descendants.What subtype of Hemophilia did the royals have?Recent DNA studies show that the royal disease was&nbsp;Hemophilia BHow did Queen Victoria get affected by Hemophilia?The traditional explanation how hemophilia entered the royal family describes a&nbsp;spontaneous mutation&nbsp;in Victoria’s gene or the sperm in her father, Edward Augustus, the Duke of Kent.Does anyone in the current royal family have this disease?Check out this link for the pedigree chart containing an illustrated answer to this question.https://i.pinimg.com/originals/e2/9d/ec/e29dec213323be44c14ad966de090d8a.jpg

What is the royal disease?
Does it still exist in the royal family?
Read to find out!!

The Royal Disease Of The Royal Blood #Decoded

Is it bad to be checking your money on a daily basis? Actually, I think it’s essential. In a recent post, I wrote about the tasks I practice on a daily, weekly, and monthly basis, but I didn’t go into too much detail about the quick-check actions that I perform each day. And recently, I had a conversation with someone who asked me why I was doing these things every day.This person was worried that my actions were coming from a place of fear, and that this could show that I didn’t trust the universe, which in turn could block my flow of money and abundance. Respectfully, I disagree.&nbsp;Checking my money every day is not a fear-based practice but rather a quick, functional process to check my accounts and see what’s going on. These actions don’t need to involve any emotion, blame, or fear of what you might find. If anything, you’re looking after your money in the same way you would look after your loved ones. Checking in, making sure everything is in order. So, here’s a breakdown of the small tasks I do each day, to keep me on track with my finances.<h1>Daily Money Rituals</h1>The following practices are a great way of keeping everything tidy and ensure you’re not overspending, while the last two really help to keep you in line with your future goals.&nbsp;<h2>Money ritual 1: Checking Bank Accounts</h2>Every day (generally first thing) I make a cup of tea and take five minutes or so to check my bank balance, to make sure that all the outgoing transactions are as I expected. This is based on bills due, which I track on a weekly basis in my planner.I know what’s coming up for the week, and if there’s anything that doesn’t look right or I’m not sure about, it’s an instant flag. Usually, it’s a case of backtracking, which results in a recollection of a recent purchase. Once that’s done, I can be confident that everything is in order. If not, I can do something about it.There’s a safety element to this practice, too, as a few people in my community found recently when they did this with their credit cards statements. They began noticing little transactions that they hadn’t made and were then in a position to be able to put an immediate stop to the fraud and get their cards protected.&nbsp;Of course, I’m not saying you need to be constantly fearful of such occurrences, but it does pay to be aware. Another reason to regularly check your account is to spot any potential subscriptions you signed up for but forgot about it — especially if a payment is taken every four or six months, for example. If you’re no longer using the service, you can take steps to cancel it.&nbsp;<h2>Money ritual 2: Tracking Spending</h2>The next thing I do daily is to track my spending. I’m not perfect at this; sometimes I forget, because life is busy! But making an effort to do this every day does mean it’s more likely to be done than not. If I’m out and about, I’ll perhaps use the Notes function on my phone to keep a little note of what I’ve spent that day.&nbsp;When at home, I’ll use the dedicated section of my Healthy Money PlannerTM for that month to track all of my spending. It’s particularly useful for unplanned/unbudgeted spends as it means I’m able to capture any trends.&nbsp;<h2>Money ritual 3: Income Tracking</h2>When I receive either physical money or freebies, I track this as income in my planner, as an acknowledgement of wealth. I think sometimes we don’t realise when our lives are filled with abundance, and it’s important to recognise this.&nbsp;For example, our parents might buy us a little gift, or a friend might shout us a free lunch. All of these things are little acts of abundance which are happening in your life all the time. It’s nice to acknowledge that, and actually see our wealth and abundance in all its forms.<h2>Money ritual 4: Daily Affirmations</h2>I like to use affirmations on a daily basis, which involves writing them into my calendar with an alert so that they pop up as appointments at different times of the day. Which means each time one pops up I’m prompted to read it. By doing this, I receive a daily dose of feel-good positive statements, and I love reading them.&nbsp;The affirmation could be anything, like “Money is coming to me in unexpected ways,” or, “My bank account is always growing,” and “I’m getting better and better every day.” You can tell yourself these affirmations (and others) as well for a daily motivational boost.&nbsp;<h2>Money Ritual 5: Vision Board Check-In</h2>For some people, using a vision board may seem a bit “woo”, along with the affirmations, but I think it’s important to keep a focus on where you’re heading. Having a vision board allows you to keep in touch with your goals and dreams on a regular basis. I have some very specific things that I want my life to look like; what kind of house I want to live in etc., and as a result I like to check in with it daily.&nbsp;When I first began using a vision board, I used Pinterest, but it was a bit cumbersome to keep going into Pinterest every day. Plus, sometimes I’d forget. But somebody recently showed me a way to set up my iPhone, so that I can see my Pinterest board pictures flash up on a rotating basis.&nbsp;If you don’t have an iPhone or don’t have this function, there may be another way that you can do something similar, or you could perhaps change your wallpaper settings each week so that you have a different inspirational picture.<h2>Tools and Support to Help You</h2>It’s very easy to get caught up in the minutiae of everyday life. But actually, if you keep an eye on the future as well as the day to day, you have a clear vision of where you’re heading. You can see all the positive changes that you’re making, like getting out of debt, saving money, growing your investments. They’re all significant contributions to your bigger goals and your life vision. It will literally take just 5 to 10 minutes a day to do these things once they’re all set up, making the process really easy. Here are a couple of ideas to help you:&nbsp;<h2>Apps</h2>There are so many apps available now, such as Monzo, or Starling Bank, that give you a visual representation of your spending habits. For example, the Monzo app has a little green bar which shows you if you’re staying within budget. As soon as you start spending too quickly, it turns amber, then red if you’re running out of money. Apps have some really clever features nowadays to help you stay on track, and visually see where you are.&nbsp;You can also use apps like Nozbe and Insight Timer to put each money ritual into a list so you don’t forget to do them and tick them off every day!<h2>The Healthy Money Planner™</h2>I first launched the Healthy Money Planner™ in 2020, and I am over the moon with how it’s going and how it’s changing lives – not only through money management, but through planting trees too!&nbsp;For the price of 1 coffee every month for 12 months, everyone can afford to try this out and see how it can change their life too.&nbsp;You’re 10 times more likely to achieve a goal if you have a plan, and a further 3x more likely to achieve your goal if you have it written down. You can buy planners for cleaning and planners for Christmas – so why not your money too?If you’re interested in looking inside the planner, check out the “flip book” on this page. Using the planner is a great step in getting organised with your finances.<h2>Final thoughts</h2>So that’s it! I hope you found this useful. Big money changes do not have to be in big leaps – in fact, it’s much more realistic to do this in small steps. Daily money rituals are the foundation for your financial future – use my suggestions, and come up with some of your own. Future you will be so happy that you did!

Is it bad to be checking your money on a daily basis? Actually, I think it’s essential...

My 5-Step Daily Money Rituals

Studying can the difficult. We all know this. That being said, if you've managed to get into medical school whether by undergraduate or post-graduate means, you must have had some success with study. Clichés like "preaching to the choir" or "teaching grandparent to suck eggs" come to mind. We can still accumulate bad habits that may interfere with our performance. In this article I will cover some study and performance habits in general, and will cover specific study and learning techniques in the next chapter. PlanningAll effective study happens with some degree of planning and preparation. Studying in a haphazard manner, jumping at random from chapter to chapter or topic to topic is not going to yield good results. Studying at random in a variety of places with multitudes of distractions is also problematic. First and foremost, ask yourself these questions:<ul><li>What is the goal? </li><li>When is the exam? </li><li>How much time do you have? </li><li>What do you need to cover?</li></ul>The reason or goal for studying is key. What is your exam on? It it theory or practical? These are questions to ask when planning what to study. How much time do you have? This will determine if you need to stick to key or core principles or if you have time to go into the reeds on a topic. In terms of what topics to cover, the 80/20 principle, otherwise known as the Pareto Principle, is a good rule of thumb. This principle is attributed to Italian economist Vilfredo Pareto.It states that roughly 80% of results come from 20% of consequences. Applied to exams and academic modules, there is likely to be a smaller core set of information or concepts that cover the majority of results. This is certainly most relevant for clinical medical school tests such as short answer questions and OSCEs (Objective Structured Clinical Examinations). For each module or subject, identify what the key 20% of data is. If you are very familiar with this, it should yield good results, allowing you to fill in the finer points and data around those core fundamentals. For example, a cardiac examination OSCE, the a proportion of results will be for basics such as: hand-washing, introducing yourself, enquiring about pain. These should be hit on very quickly before every exam. Then move onto observation, auscultation, special tests well. This will likely yield most marks. The obscure findings (and now extremely rare) we read about in text books are going to be the final few marks. I have never seen a Janeway lesion myself. Some sort of timetable, whether split into 30 minute or 60 minute blocks with breaks incorporated is likely to result if optimal productivity. These smaller blocks should make up a broader schedule of work, again in context of how much time you have and what you need to cover. When planning and determining what is important and what is not (much like when applying the Pareto 80/20 principle), another useful tool is the Eisenhower Matrix. This is a way of prioritising tasks, or in the context of studying and coursework, assignments, topics and exercises. This enables you to maximise your time, and ensure you get important time-sensitive tasks completed on time. It involves putting tasks or topics into one of four headings, on a two-by-two table. Tasks are either Important or unimportant and urgent or not-urgent.&nbsp; If something is Important and Urgent, if should be a priority for you. If something is Important and Non-Urgent, it should be scheduled and noted. Anything Non-urgent and Non-important can be left. Anything Urgent but not important is a funny category. In business books they say this task should be delegated, but as a medical student you are unlikely to have a set of employees or subordinates to delegate study or coursework to. For this category, I would place it in the scheduled work pile too. Study SpaceThe place where you study can be as important to your success as what you study and how. Most universities have shared study spaces in libraries. Many university teaching hospitals also have these spaces. Truth be told, finding whatever space works best for you is the key. The key to the space, whether it is a study, a bedroom, a kitchen or the library, is to minimise barriers to effective study. Distractions can often be a problem: at home the TV or family/housemates, in the library it might be endless coffee runs and "study breaks" that take up the whole evening and end up in the pub. James Clear in his book Atomic Habits, talks about the four laws of good habits. These can be easily applied to study, and particularly to study spaces. If you set cues that are obvious, and make it easy with minimal friction (making it obvious and making it easy, laws one and three) you should have good success. NutritionStudents often have terrible, terrible diets. Late night burritos and kebabs, too much beer and coffee, canned tuna and beans-on-toast are all frequent student staples. It goes without saying that nutrition plays an important role when studying. Sticking to a balanced, healthy diet most of the time will not only reduce long-term risks of cognitive decline but also improve your cognitive performance in the short to medium term.Green, leafy foods are rich in iron and vitamins and low in fat and calories and are ideal to base most meals around. Fish is rich in omega-3 fatty acids have been shown to improve concentration levels and also reduce amyloid proteins in the brain, reducing long-term risks of Alzheimer's disease. Berries rich in flavonoids (strawberries, raspberries, blueberries etc) have a role in reducing neuro-inflammation and oxidative stress in the brain which aids brain health.Caffeine has the short term energy and concentration boosts we're all aware. A study in 2014 showed that caffeine administration improved short term memory recall in a placebo controlled trial Now that I've told you what the best brain foods are and the evidence behind them, continue drinking beer and eating midnight fast food. But don't say I didn't tell you! SleepSleep, it also goes without saying, is important. Anyone who has a smartwatch or fitness tracker that measures Heart Rate Variability (HRV) will see what poor sleep does to our levels of HRV. HRV is said to be a measure of the balance of our autonomic nervous system, between the sympathetic "fight or flight" system and the parasympathetic "rest and digest" system. The more in balance, the better able our bodies to cope with demands, such as the mental, emotional and physical demands of a stressful exam. As such, for optimal performance, good quality and quantity of regular sleep is essential. It is sleep which is fundamental for memory formation i.e. for you to retain what you're studying. Phases of Memory<ul><li>Acquisition: where memories are obtained</li><li>Consolidation: when memories become stable and ingrained</li><li>Recall: when memories are used</li></ul>Acquisition and Recall occur during wakefulness, but consolidation of memories typically occurs while sleeping. As such, for information being studied to become ingrained, quality sleep is essential. Being chronically tired to the point of fatigue or exhaustion means that we are less likely to perform well. References-Pareto, Vilfredo. Cours d'Économie Politique: Nouvelle édition par G.-H. Bousquet et G. Busino, Librairie Droz, Geneva, 1964-Clear, J. (2018). Atomic habits: tiny changes, remarkable results : an easy &amp; proven way to build good habits &amp; break bad ones. New York, New York, Avery, an imprint of Penguin Random House-https://www.health.harvard.edu/healthbeat/foods-linked-to-better-brainpower-Ioannis Bakoyiannis, Afrodite Daskalopoulou, Vasilios Pergialiotis, Despina Perrea. Phytochemicals and cognitive health: Are flavonoids doing the trick? Biomedicine &amp; Pharmacotherapy, Volume 109, 2019, Pages 1488-1497, ISSN 0753-3322, https://doi.org/10.1016/j.biopha.2018.10.086-Borota D, Murray E, Keceli G, et al. Post-study caffeine administration enhances memory consolidation in humans.&nbsp;Nat Neurosci. 2014;17(2):201-203. doi:10.1038/nn.3623-https://healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/learning-memory

A basic run down of the fundamentals of good study habits for medical students, for those new to medical school or for those who have perhaps lost their way. 

As we all know, medical school is hard enough. Get organised, get a plan and start here!

Study Habits for Medical Students: Preaching to the Choir

An emergency fund is really important to help you out if you lost your job or had an unexpected major life event to deal with. But how much should you have, and where should you keep it? As with anything to do with personal finance – it depends. It’s very specific to who you are and your circumstances. However, here’s a rough guide to give you something to think about.<h2>What Is Your Money Personality?</h2>Understanding this is really important when it comes to knowing how much you should have in your emergency fund. If your money personality type (such as the Accumulator) is someone who a) hates the idea of using credit cards and b) would freak out at the idea of losing your job, you would need more in your emergency fund than someone who is less concerned.Equally, if you have dependents, or if losing your current job meant you might struggle to find a new one, then a bigger emergency fund — perhaps 6-9 months’ worth of expenses — would make more sense to you.Essentially, you need to be honest with yourself. I want you not to feel stressed around money, but rather to have money freedom and no stress around your finances. How much would you need to have in the bank to feel comfortable?Some people may never feel comfortable, such as Rulers and Accumulators. It might be that no matter how much money you have in the bank, you still wouldn’t feel secure. In which case, you need to work on your mindset — because having too much money sitting dormant in an account is detrimental in itself.&nbsp;&nbsp;<h2>How Much Should You Have in Your Emergency Fund?</h2>At the very least, you should start with £1,000 to cover you for small, unexpected emergencies. After that, you should look to cover yourself for the number of months’ worth of living expenses (or income) that you feel comfortable with.For example, if you earn £2000 a month and your outgoings are £1500 a month, you could aim for 3 x that amount, so £4,500. Alternatively, you might be more comfortable with 3 or 4 multiples of your take-home pay. That way you’re covered not only for your bills but also to have money for leisure time, etc.<h2>Having Too Much in Your Emergency Fund Could Be a Problem</h2>The recommended multiples of your income or expenses varies. Dave Ramsey recommends you aim to save up to 3 – 6 months’ worth of expenses, whereas Suze Orman says 12 months. Personally, I think it can be overkill to store too much money in a savings account. Because with interest rates as low as they are right now, savers’ money is losing value thanks to inflation.It’s what I like to refer to as the “Freddo effect”. The Freddo chocolate bar now is not the same price as it was 10 years ago. I remember as a child, they were 5p. Now they’re 25p. It’s the same product but it costs more thanks to inflation, and the same goes for groceries and bills. Your grandparents would have been able to afford to buy a house for £10-£12K (and that would have been a stretch for them!), whereas today, you would expect to pay around half a million for the same property.&nbsp;&nbsp;If you have savings in an account with an interest rate of 0.5%, and inflation is rising at 2.0 – 3.0% a year, your money is not growing at the same rate, and is therefore losing value. You’re losing the difference between inflation and what you’re being paid in interest. £50,000 might seem like a lot right now, but in 20 years’ time, that money will not buy you the same as it would today.Ultimately, having a lot of money in an emergency fund might make you feel better, but having too much could be doing you a disservice due to that money losing value.<h2>Another Factor to Consider</h2>In the UK, your money is protected up to £85,000 by the Financial Services Compensation Scheme. If you have more than that, you need to make sure you’re spreading your money around because you are only covered per institution.So there are downsides to having lots of money sitting around in savings.<h2>Where Should You Keep Your Emergency Fund Money?</h2>Some people are tempted to invest a large sum of money, which I can understand as it makes more sense to grow it, than leaving it dormant to lose value. However, the whole point of an emergency fund is that you will need that money immediately. If it’s tied up in an investment, it might take a few days before you can get that money out. It could take a week — or more — especially if it’s tied up in property.So where should you keep it? Well, there are plenty of options, but I’d recommend you do some research online for the best savings accounts. Money Saving Expert is an excellent resource for this, as it’s always updated with the latest new offers.&nbsp;The best rates are often available to new customers, so if you are savvy enough, you could move your money around and grow it that way (to a certain extent). There can be limits on the amount of interest you might receive, and you need to be honest with yourself as to how likely you are to commit to seeking out the best deals on a regular basis.Premium bonds can be a good place to keep your money. They’re Government-backed, so are considered very safe because it is them who would have to pay you back your money. It sits in an account and gets entered into a prize draw where you can win anything from £25,000 up to £1,000,000, and it’s all tax-free.The more money you put in, the more chances you have of winning, though the maximum you can hold in bonds is £50,000. Most people won’t need that in their emergency fund, though, so it’s worth exploring.<h2>Is it a Good Idea to Use a Credit Card for an Emergency Fund?</h2>Using a credit card to cover an emergency is great if that’s all you use it for, and you pay the balance off in full, or have 0% credit card which you can commit to pay off during the offer term.&nbsp; The downside with using a credit card is that not all emergencies can be covered with one. Take American Express, for example. Not every shop accepts this as a form of payment, so if you are relying on this, then you can’t pay.Credit cards are good for protecting you when you make a purchase. For example, if you booked a holiday, or bought an expensive item, that protection can help to get your money back if there’s a problem as opposed to if you used a debit card, or cash. A credit card can also help you build your credit score if you’re paying it off in full every month, as this is documented favourably on your credit file.But realistically, I believe that having savings in a bank account is the best way forward. I’d much rather have money saved in the bank than use a credit card, because it gives me that extra level of security, and frees me from having stress around money.&nbsp;&nbsp;Hopefully that’s given you a good idea as to how much you need to save, and where you should put your money. If you have any more questions, please get in touch at info@femalemoneydoctor.com, or alternatively, come and join our Facebook group, where we chat about anything to do with money.Bye for now,<hr>If you liked this article, you can check out my website https://thefemalemoneydoctor.comThere are FREE resources covering: Investing, Savings, Budgeting and DebtAre you always worried about money? Perhaps wish it wasn't so hard? Maybe you think you should have more left aside for what you earn?I get you. I was the same, but I learnt what it takes to turn my money around, and I've now taken hundreds of women through the EXACT same process so they can improve their health and well-being through looking after their finances.<h4>I Offer A Location Independent Service</h4>I provide coaching to anywhere in the world using an online platform that is convenient for you.

It’s time for another reader question! 

How much should I have in my emergency fund?

This blog is dedicated to answering it…


How Much Should I Have in an Emergency Fund?

'Blind as a bat, Hot as a hare, Red as a beet,&nbsp;Mad as a hatter, Dry as a bone' -&nbsp;So goes the saying that describes a person poisoned with Atropine.Atropine is an anticholinergic drug which was first extracted from the plant Atropa belladona, hence the name.The nervous system includes the central, peripheral and autonomic system of nerves. The autonomic nervous system is composed of sympathetic and parasympathetic nerves. The parasympathetic nervous system mainly relaxes the body and inhibits or slows certain functions whereas the sympathetic nervous system has opposite actions.Acetylcholine, the chief neurotransmitter of the parasympathetic nervous system acts on Nicotinic and Muscarinic acetylcholine receptors. The actions of Acetylcholine varies depending on the receptor on which it acts, classified as its nicotinic and muscarinic actions.&nbsp;Atropine acts by blocking the muscarinic acetylcholine receptors, thereby preventing the muscarinic actions of acetylcholine. Therefore, it is classified as an anticholinergic (anti-acetylcholine) drug.Atropine poisoning can occur by ingestion of plant products that contain hyoscyamine, a component of atropine (or) by drug overdosage.&nbsp;The effects of atropine poisoning can be elucidated by first understanding the muscarinic effects of acetylcholine.&nbsp;The muscarinic effects of acetylcholine further depends on its receptor subtypes and the location of action. Given below is a list of muscarinic receptors, their location and response to the parasympathetic neurotransmitter acetylcholine.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fthe-toxic-analogy-8ghfdh%2Fimages%2Fai-1.png?alt=media&amp;token=39809415-dcc0-4e84-b7ea-5e3cafb4c502"><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fthe-toxic-analogy-8ghfdh%2Fimages%2Fai-2.png?alt=media&amp;token=09d98d16-4fcf-4537-a661-d17404d587ee">After learning the muscarinic effects of acetylcholine, one can easily analyze the effects of atropine, the drug which blocks the muscarinic receptors. When a person is intoxicated with atropine, the effects seen are quite opposite to the actions of acetylcholine.The effects of atropine poisoning are described using certain analogies and classic descriptions as follows:<ul><li>Blind as a bat ( Defective vision due to_Mydriasis&lt;dilated pupils&gt; &amp; Absent accommodation reflex)</li><li>Red as a beet (Vasodilation with skin hyperemia_flushed skin)</li><li>Hot as a hare (Hyperthermia_febrile)</li><li>Mad as a hatter&nbsp;(CNSexcitation_delirium, hallucinations,restlessness, irritability,disorientation)</li><li>Dry as a bone&nbsp;(Absent secretions_dry skin &amp; mucous membranes)</li></ul><ul><li>Full as a flask (Urinary retention_can't urinate)</li><li>Tacky (Tachycardic_increased heart rate)</li><li>Slurred and monotonous speech</li><li>Wool gathering (Phantom behaviors)</li><li>Automatic behaviors (Perseveration, disrobing, phantom behavior)</li><li>The hallucinations are described as Lilliputian hallucinations where people appear greatly reduced in size.</li></ul>Atropine poisoning is treated using the drug Physostigmine.&nbsp;Physostigmine is a reversible cholinesterase inhibitor. Cholinesterase is an enzyme that breaks down acetylcholine. Due to inhibition of cholinesterase, there is an increase in the amount of acetylcholine acting on the muscarinic receptors. Thereby, the effects of atropine can be greatly reduced.<h3>Remember that, the drug atropine itself is an antidote for a certain other poisoning, which is organophosphate poisoning. In yet another post, we will learn about the organophosphates.&nbsp;</h3>

Riddle Time: 'Blind as a bat, Hot as a hare, Red as a beet, Mad as a hatter, Dry as a bone'.
Read to know more!!


The Toxic Analogy

<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fangel-investing-money-and-happiness-dr-imran-mahmud-8vxtv3k%2Fimages%2Fai-2.png?alt=media&amp;token=7bce0dfe-ed5a-421b-b1ee-367f3ab92a6f">Dr Imran Mahmud studied Medicine at Oxford, before studying Public Health at Harvard on a Fulbright Scholarship. He then ranked first in the country entering the Ophthalmology training programme — promptly leaving and joining McKinsey. In 2018 he co-founded NYE Health, raising over £4M. He is now a startup advisor, angel investor, digital health consultant and content creator.<hr><h1>Interview Notes 🎙️</h1>We speak about leaving medicine, networking, angel investing and if the grass is really greener on the other side? The main reason I joined McKinsey was that more than any other company that I was aware of, McKinsey told this great story about transformation. You come as a doctor, you come as a scientist, you come as a lawyer and then they really develop you in your intellectual skills they teach you about, what it's actually like to solve business problems. You meet lots of clients, you're solving problems in different geographies, different domains and I was really hooked on that.<blockquote>I think at the heart of it, I was just really hungry to learn</blockquote>I spent three years at McKinsey 2015 to 2018, I left McKinsey and I co founded a telemedicine digital health company and essentially, the last three and a half years, more or less, I've been working at Nye, helping grow the company, helping with the products, helping with the fundraising, as a co founder, you just do a bit of everything. That was my role and about two months ago, I left Nye. Where does your experience sit about McKinsey? Let's get the bad stuff out the way first, you work really hard when you're working but you do have downtime. They call it being on the beach and when you're on the beach you're in between projects, so things are pretty chilled. But when you're working, you're working really hard, having said that in three years or so I never did an all nighter, I think I did one all nighter. I virtually never worked on the weekend apart from maybe one or two days, it's a trade off. you work hard Monday to Thursday, sometimes on Friday, and then you have your downtime.Some of that work is travel there were times where I'd wake up at four in the morning, catch a 7am flight to Chicago, land at like 10 or 11am, local time work until 11pm local time and then fly back on a Thursday, sleep overnight in the plane, turn up in London at 10am and have to do a full working day.But from a compensation point of view, I would say that don't go to McKinsey for the money, because I think it's hard work. In order to succeed there, if you're just motivated by the money, then first of all, you probably can get paid a lot more in other companies. McKinsey have this sense that they don't have to pay top of the market, because they've got a strong brand name.The key thing I would say is two things:The first - learning - all of that hard work leads to something, you're sharpening your sword as you're doing the work, you're making slides and you know we can poke fun at people that just make slides, but there's something in the art of communication and businesses. That's really what you're learning and you're also learning about ownership, delivering stuff to a really high standard, getting your stuff done on time, delivering complicated work, simplifying complex ideas. You do a lot in Excel, quantitative analysis, you might be doing some modeling. So you're learning, you're sort of in the kiln in the furnace, and you're learning in the process of doing the hard work.The second - People - McKenzie is full of very motivated, very talented people, there's a lot of very smart people, when you're working alongside the intellectual tempo and that kind of horsepower in those teams is extremely high. You form bonds with people, as a result, you build some great friendships you learn from people. Many of those friendships have continued since leaving the firm. Tell me a little bit more about your startup journey and Cofounding Nye Health? One of the best things about that process was starting the company with an old friend. I now having seen hundreds of companies, one of the greatest challenges is finding good co-founders. When I say good, I mean, a good fit.In terms of the actual business, we were doing telemedicine with the intent of building for the NHS first, we wanted to build telemedicine for the NHS. The first instance, we got a lot wrong, so although we were able to raise money reasonably easily in the first funding round, one thing we really struggled with was to get traction.I think that's normal a lot of people start somewhere, the first thing they put out is not quite the right thing. So we iterated through many, many different products, eventually, we found something that really worked. The great learning there is the thing that worked was like the simplest thing that we had ever built, it was like a 10% core out of the 100% of what we had conceived and built and the 10% is the thing that stuck.Things really picked up pace for us in the pandemic, we were growing 10 to 15% every week for 60 consecutive weeks. The company was doubling every five to six weeks, and its user base and its product usage. When you're building something that's growing that fast, literally exponentially, everything sort of breaks and falls apart, becomes not fit for purpose anymore at some point. Those intervals can happen quite close together, as you fix something all of a sudden it breaks again, because are now five times bigger than when you fix it before. When things stabilized we actually pivoted out of working with primary care and working more in the research space for a variety of reasons, partly what the competitors were doing, partly the challenge is commercializing products in the NHS, which is a real challenge. When we moved into the research space, we were working with clinical trials, and providing solutions that enable you to participate in a clinical trial from home, that's what the company is still doing at the moment.About two months ago, I stepped back from the company for a variety of reasons. I'm sort of taking some downtime and working on a few small projects, but also exploring a few different ideas to start a company. What advice do you have for networking?<blockquote> The first thing is that if you want to be interesting, do interesting things.</blockquote>The culture I try to embody or like propagate in my digital interactions, is more like win and help win type culture. The way I like to think of it is about just making friends. So I don't think that we're networking, I don't think that you're shooting up or shooting down. I think that we're becoming friends, I think that we're like chatting, we're getting to know each other, you're helping me because this is cheaper than therapy, I'm helping you because, you know, it's kind of interesting to be on the pod, and so on. So I think about it like that.I think maybe what I'm getting out there is about people's mindsets. The first thing I would say is just do interesting things that you are interested in. That starts to form the core of your basis for connecting with people. What are your thoughts on decision making? On the big decisions in my life, there have been a couple of things that have consistently helped. The first is seeing them as if they're reversible, recognizing that they're reversible. Most decisions in life are two way doors, you can wind back, after you've made the decision if things don't work out. Almost anything in the domain of careers, is like that. I think there are very few things that are one way in a career. Even leaving specialty training, leaving medicine, you can always go back unless you've done something terrible, which is why you've been asked to leave.People who are considering stuff, one way to think about it is like explore and exploit. So exploration is like just trying different things and then exploitation is a terrible word, but in the in the mental model, what it means is if you find, let's say you're tapping around, for oil, and you hit oil, then you start drilling, right?So at some point, you start exploiting what you found and I think that model is important. Because when you're exploring, you actually need to explore and tap around a lot, you need to make lots of changes, you need to maybe take a very winding route to find something that's a fit. But when you have found something that's a fit, then you do have to persist with it for some time.I think it's a judgment call, should I just keep persisting with this thing? or should I start exploring again, should I change it up again? I think you should be patient with the exploration, I think people should be willing to try more things. Especially if you think about careers now as a 40 to 50 year journey. It's really important to not have those 50 years defined by some decision you made as a 15 year old about your A levels, and then your university courses and so on. I think that's kind of illogical and a lot of people get trapped in that. What are the good and bad sides of transitioning away from medicine, is the grass greener? One thing to caveat, for me the transition has been by and large, very positive. I'm giving this recollection from that point of view. So there certainly will be people who have a rocky transition.The first place they land is not quite the right place for them. They may have doubts, etc. That kind of thing happens.My experience on this was, I haven't often looked back, there's certain parts of being a doctor that I miss. I think there's something about the professional community and camaraderie in medicine, or being around other health care workers, not just doctors, but nurses and everyone else in the hospital. That's quite special. I can really see that during COVID. That's been a great source of strength for many people in health care. That's something that people do and I think all too for good reasons envy, in a sense, it's a great thing to have. I don't mean envy in a negative sense here. I mean, people should aspire. It's good for people to aspire to that kind of thing, because it's a source of support.So I have looked back on it from time to time, but I have personally really, on the whole, although there have been some very challenging experiences, which I think actually far more challenging, in some ways than medicine less challenging in other ways. Mainly the sense of uncertainty about where you're going in life. When you walk off the beaten path and you're trying to patch together something that doesn't have such clear role models, you can feel lost, you can feel uncertain about the future, you can wonder where your income is going to come from, you can wonder how people will perceive your career, like what are your actual skills, I have no credentials beyond my public health degree after my medical school. I come from a paradigm where credentials are like your reason to have a seat at the table.Now I think if I'm working with somebody in a business setting, or any other setting, what are my credentials, when it comes down to it, which is much more scary, is it proof of your work? your podcasts, your audience, and your reach. So the actual work and what you're doing in the world and your ability, sort of command people's attention. That's a very scary place to be because it's much more uncertain how to make it out. In this world of entrepreneurship, content creation, solopreneurship, angel investing, startup contracting, startup founding is very amorphous. I think one thing I've really worked on the last six months, is reminding myself why I left medicine and instead of entertaining the doubt, that can creep into your mind from time to time. Instead, I try and double down on that intention.<blockquote>So the intention was to help people through content to build companies that have a positive impact in the world to back companies that do good things, etc.</blockquote>There's a few simple high level points I'll make, for anyone who's a medical doctor, or a clinically trained nurse, whose thinking about leaving healthcare, clinical practice, there are tremendous opportunities out there.I'll speak about doctors, but they apply to other professions. Healthcare, was at the center of the world's attention for the last 18 to 20 months. Our emergence from this pandemic, is because of innovation in healthcare and biotech, life sciences, etc. There's so much work to do beyond working as a clinician, in those industries, products, services, existing ones that are there today, companies that are hiring clinicians, or people that can do stuff in the digital realm, but have a clinical perspective. There's also so much more that needs to be created. So many more companies that need to be founded, there's so many more problems that need to be solved. I think there are tremendous opportunities, it may take a while.The best fullback that you can have in any of this are your hard skills. The reason why as a doctor you have job security is because you actually have skills and you have credentials and skills and ability to do something, you can be dropped in a hospital and you can be useful.If you can say that about your digital skills, then the same, you should have the same job security if not more, because you can work from anywhere, you can work for companies, not just in the UK, but anywhere in the world. You can work across sectors. What I mean by that are the kinds of digital skills that you can imagine anything from copywriting, to design to software development to anything else. So if you can learn those things as well, which is hard, will put you in even stronger position.I think that there's a huge amount of opportunity. I would advise people to learn useful skills that are needed in the world of work. You can see what people are hiring for, you can research on what skills are on the rise in their demand. Learn some of those skills, it's hard, but it can be done and you will have a very bright future. <hr> If you've enjoyed this, you can listen to the full episode on Apple, Google and Spotifyhttps://podcasts.apple.com/gb/podcast/073-to-be-interesting-be-interested-dr-imran-mahmud/id1500446262?i=1000546707248You can find me on Twitter @MustafaSultan and subscribe to my newsletter on www.musty.io

Dr Imran Mahmud is a startup advisor, angel investor, digital health consultant and content creator. Prev - Ophthalmologist (Ranked 1st), McKinsey and co-founded NYE Health in 2018, raising over £4M

To be Interesting, Be Interested - Dr Imran Mahmud

The first property that I purchased was a three bed, mid-terraced, victorian red brick house in Manchester, in 2013.&nbsp; I had only ever been to Manchester a handful of times in my life and was actually living in Glasgow at that time.&nbsp; This was bought deliberately as an investment property with the aim to rent to 3 students, as that was what I was familiar with following my own experience at University.&nbsp; At this time, I was still living in rented accommodation and although I had saved a deposit, I was not sure that I would still be living and working in Glasgow at that time. &nbsp; As such, an investment property in Manchester seemed reasonable and that was probably as much thought that was given to this decision!&nbsp; I managed to encourage my brother (who lived in Manchester) to conduct viewings of potential properties available on the open market on my behalf, and I viewed less than a handful of properties before negotiating on the property that was eventually agreed.&nbsp; The property had been recently refurbished, with a new kitchen, bathroom, and carpets.&nbsp; The asking price was £120,000 and we agreed a purchase price of £108,500 subject to a mortgage lender valuation of the property. &nbsp; When buying a property in England and Northern Ireland, it is the responsibility of the buyer to instruct appropriate surveys on the building to ensure its structural suitability.&nbsp; It is now commonplace for buy to let mortgage lenders to instruct their own property valuation to confirm security of their lending.&nbsp; Both the survey and valuation are subject to costs incurred by the buyer before the purchase is completed.&nbsp; Should these reports reveal any issues, there is the possibility to renegotiate the purchase price if necessary.&nbsp; As it was, the reports came back and advised that the whole front wall of the property required cavity wall ties to be installed and proof of works supplied to the mortgage lender on completion of the works.&nbsp; This issue was not going to restrict the purchase of the property at the agreed price.&nbsp; With hindsight, it may have been possible for a renegotiation in purchase price, but I didn't know that was a possibility at the time!&nbsp; In addition to this, there was a flat roof extension at the rear of the property, a common addition in the area, that contained the kitchen and bathroom.&nbsp; It was of course, needing to be replaced as this was likely going to be a problem in the next year or so.&nbsp; With all these issues aside, I still managed to purchase the property using an independent mortgage broker to obtain a suitable buy to let mortgage, that allowed for students to occupy the property.&nbsp; As this was the only asset that I would own, the lender insisted on a capital repayment mortgage product, and this was a fixed interest rate for 3 years.&nbsp; As this was a buy to let purchase, a 25% deposit was required.&nbsp; Whilst it is still possible to obtain a buy to let purchase prior to owning your own home, the Stamp Duty Land Tax (LLBT in Scotland) payable in 2020 has changed and once you buy a second property, regardless of the intended occupation, an Additional Dwelling Supplement (ADS) of 3% extra tax (4% in Scotland) is due on full price of the second property purchased.&nbsp; If this had been the case back in 2013, I may have considered it to be more practical to buy my own home first, prior to any investment properties to benefit from the initial reduction in tax on the purchase.&nbsp; It is worth noting that, should you decide to replace your own home and buy another, this is not subject to the ADS supplement, even if you own a buy to let investment or portfolio of properties. &nbsp; Once the property conveyancing was complete and I was the owner, I got to work making sure that the property was safe and secure, as well as being ready to let for the next academic year.&nbsp; I found quotes for the wall tie and flat roof repairs, and had new PVC doors and windows installed.&nbsp; Furnishings in each room were provided and I setup this entire house myself, commuting from Glasgow.&nbsp; I advertised it to local students when it was ready and secured tenants, using very little knowledge of the proper procedures.&nbsp; When I look back now, I think that this is a huge amount of time and effort to have spent,&nbsp; as well as risks to take, and it would have been possible to have spent less time (and money) in finding a local agent to project manage this process for me.&nbsp; But I didn’t, I have learnt this lesson the hard way so you don't have to.&nbsp; Thankfully, the students were reliable and because the house had been fully sorted prior to letting, there were very few issues and I self managed the property remotely for this first year.&nbsp; I subsequently found a local lettings agent familiar with the student rental market for the following years and have had regular student tenants each year with very minimal issues.&nbsp; I would expect to speak with the agent a couple of times each year on average and the rents have been reliably paid.&nbsp; If you are looking for a letting agent in Manchester, I have added their contact details (Tara Meeks) on my Recommendations page. My initial foray into being a landlord was bumpy to say the least and the lessons kept coming when I managed to incorrectly complete my HMRC self-assessment declaration of the rental income I had received.&nbsp; An apology, coupled with numerous calls to HMRC later, and I was fined just over £500 for the pleasure.&nbsp; Lesson learnt - I employed an accountant familiar with property related income and have piece of mind that I shouldn't receive any further fines.&nbsp; In fact, the accountant has subsequently saved a greater amount compared to their fees, so that has been a win, win! Despite the many mistakes and lessons learnt from buying and renting my first property, time is rather forgiving, and over the past 7 years, this property has subsequently been refinanced and all my initial investment has been repaid and the property continues to provide an additional profit every month the rent is paid.&nbsp; I think this is a useful example of how to improve on the buying and management process but also highlights the fact that property investment fundamentally requires years to create sustainable returns on investment.&nbsp; <hr> Thank you for taking the time to read this article.You can also check out my book - Buy to Let Property Investing: How I do it.(https://www.amazon.co.uk/Buy-Let-Property-Investing-How/dp/B095GFFL48/ref=sr_1_1?keywords=matthew%20wickham&amp;qid=1621663605&amp;sr=8-1)If you have any specific questions you can email info@wickhamproperty.co.uk

The first property that I purchased was a three bed, mid-terraced, victorian red brick house in Manchester, in 2013.  I had only ever been to Manchester a handful of times in my life and was actually living in Glasgow at that time...

Case Study: Lessons Learnt from my First B2L Property Investment

Pesticides are chemicals that are used to kill pests such as bacteria, insects, snails, rats and so on. Insecticides are a type of pesticide that specifically targets and kill insects.Organophosphates are the major components present in most insecticides. It acts by inhibiting acetylcholinesterase, the enzyme that breaks down acetylcholine. As excess acetylcholine is not cleared up from the site of release and action, there is overstimulation of the acetylcholine receptors. This leads to excess action of the acetylcholine molecule eventually leading to cholinergic crisis.Nerve agents used in chemical warfare contain a more potent and toxic form of Organophosphates.Acetylcholine is a neurotransmitter released from parasympathetic nerve endings. The actions of acetylcholine depends on their site of action and receptors. The acetylcholine receptors are classified as Nicotinic and Muscarinic receptors.&nbsp;The Nicotinic receptors are named so because the stimulation of these receptors by acetylcholine leads to effects similar to actions of nicotine.&nbsp;Muscarine is a toxin present in a specific type of poisonous mushrooms known as toadstools. The muscarinic receptors are named so because, in smooth muscles and glands, the stimulation of these receptors by muscarine leads to effects similar to stimulation by acetylcholine.Acetylcholine is the chief neurotransmitter released from parasympathetic nerve endings. Once released, it binds to specific receptors on the target organs. Upon binding, it stimulates the receptors leading to the receptor and location specific actions of acetylcholine.&nbsp;Acetylcholinesterase(AChE) is the molecule that helps break down acetylcholine(ACh), thus preventing overstimulation of acetylcholine receptors. Also, by cleaving the acetylcholine molecule, AChE aids its reuptake by the nerve cells.Organophosphates act by inhibiting the enzyme acetylcholinesterase. Due to this inhibition, acetylcholine released from nerve terminals is not broken down, therefore not reuptaken. The excess acetylcholine causes over stimulation of the acetylcholine receptors, both nicotinic and muscarinic. With prolonged untreated exposure, this can lead to cholinergic crisis.&nbsp;The effects of organophosphate poisoning can be understood by first studying the nicotinic and muscarinic effects of acetylcholine.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Ffor-the-insects-only-8ytdco%2Fimages%2Fai-1.png?alt=media&amp;token=143a6400-ba19-463b-bf2b-a34725f02310"><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Ffor-the-insects-only-8ytdco%2Fimages%2Fai-2.png?alt=media&amp;token=f080bfad-99ad-44cd-976e-2d4c14e44f2b"><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Ffor-the-insects-only-8ytdco%2Fimages%2Fai-3.png?alt=media&amp;token=1fa50636-3b31-4e0b-9db3-b3d24ceed9b3">In organophosphate(OP) poisoning, inhibition of AChE leads to accumulation of ACh and overstimulation of its receptors. The symptoms and signs of OP poisoning are due to excess action of Acetylcholine.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Ffor-the-insects-only-8ytdco%2Fimages%2Fai-4.png?alt=media&amp;token=f59d519f-2327-4a8b-bc43-94e1a0ed2d62">Treatment of&nbsp; OP poisoning:1. Immediate measures such as termination of exposure, personal protection of person attending the patient and decontamination of the affected patient.2. General supportive measures such as maintenance of a patent airway, including endobronchial aspiration; administration of oxygen; artificial respiration, if required;&nbsp; alleviation of persistent convulsions with diazepam; and treatment of shock.3. The muscarinic effects of OP poisoning can be countered using the anticholinergic drug, ATROPINE. It acts by blocking the muscarinic acetylcholine receptors as a competitive antagonist.&nbsp;Atropine in sufficient dosage effectively antagonizes the actions of acetylcholine at muscarinic receptor sites. In order to alleviate the CNS manifestations, atropine should be given in larger doses to cross the blood– brain barrier.4. The chief mechanism involved in OP poisoning is the inhibition of the enzyme acetylcholinesterase (AChE). The drug PRALIDOXIME, a cholinesterase reactivator, reactivates acetylcholinesterase, thus treating the primary mechanism of OP poisoning.

All over the world, there are unfortunate occurrences of intentional or accidental death due to poisoning. Various poisonous agents exist, one of them being the insecticides. Read to know more.

For the insects only!!

Contraceptive methods can be divided into hormonal and non-hormonal.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcontraceptive-methods-summary-for-medical-students-88o2nt%2Fimages%2Fai-1.png?alt=media&amp;token=1613abc8-77ea-4b9a-96c1-0e183af4ed7d">Let's start with the hormonal methods:<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcontraceptive-methods-summary-for-medical-students-88o2nt%2Fimages%2Fai-2.png?alt=media&amp;token=47d74d41-a48a-40e8-b52e-42c0ebe8c622"><h1>Combined Hormonal Contraception</h1><ul><li>Contains an oestrogen (e.g. ethinylestradiol) and a progestin (e.g. levonorgestrel)</li><li>Administration<ul><li>Oral: pill</li><li>Transdermal: patch</li><li>Intravaginal: vaginal ring</li></ul></li><li>Mechanism<ul><li>Inhibits FSH/LH, suppressing ovulation</li><li>Thickens cervical mucus, making it difficult for sperm to enter uterus</li><li>Decidualises (thins the lining of) the endometrium, making it difficult for implantation to occur</li></ul></li><li>Advantages<ul><li>Decreases risk of ovarian and endometrial cancer</li><li>Periods may be more regular</li></ul></li><li>Disadvantages<ul><li>Risk of VTE</li><li>Breast tenderness</li><li>Increased risk of breast and cervical cancer</li><li>Mood changes, depression</li><li>Headaches</li><li>Hypertension</li><li>Increased risk of myocardial infarction and stroke</li></ul></li><li>Contraindications<ul><li>&lt;6 weeks postpartum and breastfeeding</li><li>&lt;3 weeks postpartum with other risk factors for VTE</li><li>Current breast cancer</li><li>&gt;35 years of age and smoking &gt;15 cigarettes a day</li><li>Migraine with aura</li><li>History of VTE</li><li>History of cerebrovascular accident</li><li>Hypertension</li><li>Ischaemic heart disease, cardiomyopathy, atrial fibrillation</li><li>Major surgery with prolonged immobility</li><li>Severe liver cirrhosis, hepatocellular carcinoma</li></ul></li></ul><h2>Combined oral contraceptive pill:</h2><ul><li>Pill containing an oestrogen and a progestin. There are different types of pills and different regimens of taking them.</li><li>Rapid return of fertility after discontinuation</li><li>Predictable, lighter, less painful menses</li><li>Requires daily compliance</li></ul><h2>Combined contraceptive patch (Evra):</h2><ul><li>Combined oestrogen and progestin dermal patch</li><li>Weekly administration, therefore does not require daily motivation</li></ul><h2>Combined contraceptive ring (Nuvaring):</h2><ul><li>Combined oestrogen and progestin vaginal ring</li><li>3 weeks - continuous; 1 week - no ring</li><li>May increase vaginal discharge</li><li>Spotting (first 1-2 months)</li></ul><h1>Progestin-only Contraception</h1><ul><li>Contains only a progestin (e.g. levonorgestrel)</li><li>Administration<ul><li>Oral: pill</li><li>Subdermal implant: Nexplanon</li><li>Injection: Depo-Provera</li><li>Intrauterine: Mirena</li></ul></li><li>Mechanism<ul><li>Suppresses ovulation (but less than combined oral contraceptive pill)</li><li>Thickens cervical mucus</li><li>Decidualises endometrium</li><li>Reduced tubal motility</li></ul></li><li>Advantages<ul><li>Suitable for women in whom oestrogen's are contraindicated or who cannot tolerate side effects<ul><li>smokers</li><li>&gt;35 years of age</li><li>breastfeeding</li></ul></li></ul></li><li>Disadvantages<ul><li>Weight gain</li><li>Breast tenderness</li><li>Irregular periods</li><li>Mood changes, depression, changes in libido</li><li>Headaches</li><li>Nausea and vomiting</li></ul></li><li>Contraindications<ul><li>Breast cancer</li></ul></li></ul><h2>Progestin-only pill:</h2><ul><li>Taken continuously</li><li>Requires strict compliance with daily timings</li><li>Fewer contraindications and risks compared with the combined oral contraceptive pill</li><li>Suitable for women who cannot use oestrogen</li></ul><h2>Progestin implant (Implanon):</h2><ul><li>Flexible tube (2-3cm length) that releases progestin</li><li>Inserted subdermally under skin of upper arm under local anaesthesia</li><li>Advantages<ul><li>Effective for 3 years, therefore does not require daily motivation</li><li>Rapid return of fertility once removed</li></ul></li><li>Disadvantages<ul><li>Periods can be irregular</li><li>Weight gain</li><li>Tenderness, bruising and swelling at sight of implant on insertion</li></ul></li></ul><h2>Injectable progestin (Depo-Provera):</h2><ul><li>IM injection of medroxyprogesterone every 3 months</li><li>Advantages<ul><li>Effective for 3 months; therefore does not require daily motivation</li></ul></li><li>Disadvantages<ul><li>Irregular bleeding and weight gain</li><li>Decreases in BMD (reversible)</li><li>Delayed return of fertility after discontinuation</li></ul></li></ul><h2>Intrauterine system (Mirena):</h2><ul><li>Contains progestin that is slowly released into uterus, preventing implantation</li><li>Advantages<ul><li>Effective for 3-5 years</li><li>Fertility returns immediately after removal</li></ul></li><li>Disadvantages<ul><li>Infection</li><li>Uterine perforation</li><li>Irregular spotting (common in first 6 months)</li><li>Irregular periods</li><li>Abdominal pain</li></ul></li><li>Contraindications<ul><li>Pelvic inflammatory disease</li><li>Pelvic cancer</li><li>Pregnancy</li><li>Unexplained bleeding</li><li>Previous ectopic pregnancy</li><li>Previous tubal surgery</li></ul></li></ul>Now let's move on to the non-hormonal methods:<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcontraceptive-methods-summary-for-medical-students-88o2nt%2Fimages%2Fai-3.png?alt=media&amp;token=b45615e8-0e3b-4814-b00d-7f425a67a94a"><h1>Copper Intrauterine Device</h1><ul><li>Mechanism<ul><li>Contains copper which has a spermicidal effect</li></ul></li><li>Advantages<ul><li>Fertility returns immediately after removal</li></ul></li><li>Disadvantages<ul><li>Infection</li><li>Uterine perforation</li><li>Bleeding</li><li>Abdominal pain</li></ul></li><li>Contraindications<ul><li>Pelvic inflammatory disease</li><li>Pelvic cancer</li><li>Pregnancy</li><li>Unexplained bleeding</li><li>Previous ectopic pregnancy</li><li>Previous tubal surgery</li></ul></li></ul><h1>Barrier Methods</h1><ul><li>Types<ul><li>Male condom</li><li>Female condom</li><li>Diaphragm</li><li>Cervical cap</li></ul></li><li>Advantages<ul><li>Provides protection against STDs, especially the male condom which protects against HIV</li><li>Concomitant use of spermicide alters sperm membrane permeability, resulting in sperm death (the use of spermicides alone as contraception is not recommended)</li></ul></li><li>Disadvantages<ul><li>Effectiveness is dependent on correct use</li><li>Possible allergy to latex or spermicides</li><li>Diaphragm and cap must be fitted and checked by a trained professional</li></ul></li></ul><h1>Surgical Methods</h1><ul><li>Permanent and irreversible surgery that prevents pregnancy</li><li>Types<ul><li>Female sterilisation: tubal ligation, salpingectomy</li><li>Male sterilisation: vasectomy</li></ul></li></ul><h2>Tubal ligation:</h2><ul><li>Female sterilisation</li><li>Methods<ul><li>Performed by laparoscopy under general anaesthesia, with occlusion of the tubes using Filshie clips</li><li>Fallopian tubes can be tied or cut, or removed all together (salpingectomy)</li></ul></li></ul><h2>Vasectomy:</h2><ul><li>Male sterilisation</li><li>Vas deferens is ligated via bilateral incisions in the scrotum under local anaesthesia</li><li>2 azoospermic samples must be obtained at 3 and 4 months after the procedure to confirm success</li></ul>Thanks for reading!&nbsp;The following article was written and illustrated by myself – medblog.For more content, follow me on Instagram and TikTok @medblog_xoxo.For medical illustrations follow me @medart_xoxo

Contraception can be defined as the use of medicines, devices or surgery to prevent pregnancy. There are many different methods and in this article, we will cover all the basics you need to know as a medical student!

Contraceptive Methods: Summary for Medical Students

<h2>It is not a bone&nbsp;&amp;&nbsp;</h2><h2>It is not funny when it hurts.</h2><h2>The funny bone is a spot at the back of the elbow where the ulnar nerve rests against the humerus.</h2><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fisnt-it-funny-that-the-funny-bone-is-not-a-bone-8q597n%2Fimages%2Fai-2.png?alt=media&amp;token=ed492985-91f5-4230-b27f-feab24505326">The ulnar nerve runs from the brachial plexus of the axilla to the muscles of the hand.&nbsp;As the nerve runs down from the shoulder to the hand, it is&nbsp; protected by bones, muscles, and/or ligaments except in a specific spot behind the elbow.At the funny bone spot, the ulnar nerve is protected only by skin and fat, thus making it vulnerable to bumps/external compression.You may hit/compress your funny bone during activities such as resting your elbow on a table for a prolonged period, accidentally striking it against a wall and so on.As a result of this compression, there is pain, tingling, and numbness in the forearm and the fourth and fifth fingers<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fisnt-it-funny-that-the-funny-bone-is-not-a-bone-8q597n%2Fimages%2Fai-3.png?alt=media&amp;token=8f051d99-49f4-4e3b-9ce2-8a29e6088939">https://www.drgordongroh.com/orthopaedic-injuries-treatment/elbow/ulnar-nerve-entrapment-at-the-elbow/BUT WHY WAS IT NAMED THE FUNNY BONE?Well, there are two common thoughts on the origin of the name:1. The sound resemblance between the name of the upper arm bone 'humerus' that lies just above the funny bone spot and the word 'humorous'2. The odd sensation one gets when they hit the funny bone spotCLINICAL CORRELATION:Cubital Tunnel Syndrome:-Also known as Ulnar Nerve Entrapment syndrome-Recently, also termed 'Cell Phone Elbow'-Symptoms appear on flexing the elbow<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fisnt-it-funny-that-the-funny-bone-is-not-a-bone-8q597n%2Fimages%2Fai-4.png?alt=media&amp;token=f78f6758-32bd-4239-a0ec-86349704f971">Careful! It can hurt if you rest long 😉

Well, the funny bone is not actually a bone!!!
Read more to know the whats and whys of it...

Isn't it funny that the funny bone is not a bone!!

Typically, doctors are more scared for their first night shifts than for standard day shifts. I'll let you into my experience of working nights, and my top tips to take on board for yours. Night shifts are different to standard shifts - less staff, quieter &amp; darker wards, strange working hours, differing complaints. Let's discuss some thoughts:<ol><li>Your roleFind out what is expected of you on night shifts - are you expected to clerk new patients? Will you be doing all the ward jobs? If you are handed over a lot of jobs from the twilight team, don't start clerking new patients until you've completed jobs for the current patients! It will only overwhelm you (especially as it is likely that other senior doctors will hand you jobs as the night goes along, as will nurses). I would recommend not starting a new clerking until you're comfortable with your current workload.Get a piece of plain paper and make a jobs list - I split my paper up into sections titled 'Procedures', 'Prescribing', 'Patient Reviews', 'To Chase', and 'Other'. Put all jobs you're given over the course of the shift under the relevant heading - I find this structure helps with prioritisation and organisation.</li><li>DelegationThe nature of your work is different overnight. As it is likely you will be one of the only (if not the only) junior on your ward(s), there is less workforce to spread out the workload.You will get given a lot more practical jobs overnight - such as cannulas, bloods, blood cultures, catheters, etc.Find out who is on your team that evening - are there any nurses/assistants who can take bloods, do cannulas, or insert catheters? You can get very busy and will appreciate the help. Don't try and do everything yourself. Often, other staff may not offer that they can do these practical skills, so do not be afraid to enquire (otherwise you won't get). Obviously don't handover everything, but if you're finding that you've got a fair few procedures to do then there's no harm in asking around.</li><li>Patient ReviewsYou will likely get notified about 3 things - patients with high NEWS, patients who've fallen, or patients needing pain relief.Let's start with high NEWS - firstly, don't panic! Ask whoever is bringing this to your attention (likely a nurse, nursing assistant or HCA) more about the situation - under what parameters are they scoring? Is it new or ongoing? How is the patient feeling / how do they look? Have a quick look through the patient's notes if they are unfamiliar to you - what is their background &amp; what have they been admitted with? What medications are they on and what have they recently taken? What is the current ward round plan from the day team? Then head over to the patient and go through your A-to-E assessment, initiating management as you feel is appropriate. If you are worried/unsure, don't forget to escalate to an appropriate senior.Falls reviews are similar - ask the nurse if they witnessed the fall and the events surrounding it, and for the patient's vital signs, and where is the patient now (still on the floor or have they gotten back into their bed?). Again look through the patient's notes for their background and medications (any blood thinners?). Have a look at the falls proforma before you assess the patient (you can even take it with you to the patient bay) - it shows you what you need to document and therefore what you need to assess when you review the patient. It's basically getting a history of the events surrounding the fall, and a comprehensive top-to-toe assessment checking for any injuries and precipitating factors. Consider whether you need any imaging, and don't forget to escalate to a senior if you are concerned.Pain relief can be a difficult one - usually patients will ask for morphine or something similar, and in the middle of the night (especially if you have other things to do) it's tempting to give in and just prescribe an opiate to "make the problem go away". You may even get pressured by nurses to prescribe something (I've had someone tell me "it's not worth the effort" to look into it and to just prescribe a strong painkiller). Do not jump to assumptions - have a look at the patient's notes. What have they been admitted with, and what is their background? Have they had any analgesia whilst in hospital, and do they normally take any at home (are these prescribed)? Does their management plan from the day team need updating? Are there are other measures that can make the patient more comfortable e.g. positioning, pillows, etc? Work your way up the WHO analgesic ladder as appropriate.</li><li>DocumentationThis goes for any shift, regardless of time - if it's not documented, it didn't happen! Any patient reviews, falls reviews, management initiated, cannulas/catheters inserted, bloods chased, etc needs documenting in the notes for the day team to see. Remember to include names (e.g. names of seniors you contacted for help, chaperones who witnessed you perform a catheter, nurses who asked you to review a patient, etc).</li><li>Senior SupportFind out who are the seniors working with you that night - how do you contact them? Is there a registrar present in person on your ward, or are they somewhere else in the hospital and contactable by phone/bleep (and have you got their number)? Who is the on-call consultant if you can't get hold of the registrar?Usually there will be another junior member of staff on the ward with you, such as an SHO or a specialty trainee in the earlier years of their training. Always ask them for help if you want to query something/feel you are struggling - they should be able to help out. If it is beyond their realm of expertise, then they will direct you to the appropriate senior.DON'T BE AFRAID TO ASK FOR HELP! Personally, I would rather ask a senior about something that they might see as "simple" but be sure that that patient is safe and well looked after, than risk not appropriately managing a patient just because I was too scared to ask for help. As long as you have appropriately assessed a patient (i.e. taken a history &amp; performed an examination e.g. A-to-E or more focussed as appropriate to the situation) and put in any simple measures you're able to, then a senior should be happy to give you their input / take over the situation. Remember, there's a reason they are getting paid more than you...use their years of experience and let them take the responsibility!</li><li>Poor moodOur bodies are not accustomed to working through the middle of the night - so it is perfectly normally to feel more tired than usual. If you feel yourself becoming sluggish (and therefore potentially compromising patient care) or irritable, force yourself to take a break, no matter how busy your workload may be. Unless it is an emergency, everything can wait 20 minutes whilst you regroup for a coffee and some down time away from the ward environment. I cannot stress the importance of this - you might think you can just work through non-stop, but both yourself and your colleagues/patients will be grateful if you come back refreshed.If you find your jobs list is dwindling and you're keeping on top of things, great - take the time to chill out and head to the mess or a resting place to get some shut-eye if you're able to. However, make sure you are always contactable if needed. For example, on my rotation in AAU I don't carry a bleep and therefore I am not contactable this way, so I stay on the ward majority of my night shift and only leave for a short period of time for a food break. But, I know some of my F1 colleagues on surgery for example do carry bleeps and therefore if they are not too busy they spend more time in a resting area and can be contacted by their bleep if they are required for a job.</li><li>FoodSometimes people forget that even though it is nighttime, it is still a 10-12 hour shift and you will get hungry! Take enough food with you - not just snacks, but a proper meal. Imagine sitting in the staff room / doctors' mess, hungry, no food, and a closed canteen...I would also recommend batch cooking some meals and keeping them in the fridge/freezer for your week of nights - there is nothing worse than coming back home in the morning after work, starving, and being too tired to cook! Future you will thank you immensely for having a properly cooked meal already prepared and all you need to do is reheat, eat and head to bed.Alternatively, buy some ready meals and they'll come in handy if you're too tired/lazy to cook.</li><li>Sleep environmentLike I said before, we are not accustomed to working during the night and sleeping during the day - so make life easier for you! Get some earplugs to drown out the sound of your housemates, outside noises, doorbell ringing, etc. Grab an eyemask to block out the light if you struggle to sleep (or even invest in some black-out blinds if you fancy it). Try and sleep as much you can during the day - accept that on your week of nights, you won't be doing very much outside of sleeping and going to work - and that's alright!</li><li>Home timeAnd finally, remember that no matter how awful (or good) your night shifts are, they WILL come to an end! Morning will arrive, you can handover jobs, and you'll be done. Start prepping your handover list ~15 minutes before handover starts, so that it's succinct and ready to handover to the next team and you can head off home without any issues or missing anything.If you had any issues with staffing, patient concerns, or anything else don't forget to raise them - nothing can be improved if you don't raise concerns.Nights are honestly a good learning experience - they will make you more confident in assessing patients and making clinical decisions. And you should never feel 'on your own' - you should always have senior support readily available.</li></ol>I hope that was useful, and best of luck on your night shifts! See my other articles for more (hopefully helpful) advice &amp; tips.

Are you a FY1 on a medical rotation with night shifts coming up, or a fifth year medical student thinking ahead to foundation years? Nervous? Let me tell you what I learnt from my experiences on night shifts. 

Conquering your medical night shifts

This is the second installation of Anaestheasier's tips to get the most out of your anaesthetic taster sessions to build your anaesthesia portfolio and improve your chances at competitive anaesthesia core training interviews.In our previous article, ''Top Tips for a productive Taster Week in Anaesthesia", we discussed how to organise your taster week, how it would likely be organised, and some of the things you might expect to see.In this blog, we'll explore how a taster week will not only inform your career decisions, but how the time spent will pay further dividends when it comes to anaesthesia core training applications and anaesthesia interviews.The Maltese Foundation Programme write that taster weeks provide a ‘better understanding of what becoming and being an anaesthetist means’.In other words, it’s all well and good saying that you’ve had a 5 day taster in anaesthetics. Take it to the next level, like the Maltese, and demonstrate that you have reflected on not only the fun stuff and your love for propofol and coffee, but also the gritty stuff like training requirements, appraisals, exams, and importantly, what life looks like post-completion of training/CCT.&lt;aside&gt; 💡 How do we get the most out of a taster week in anaesthetics?&lt;/aside&gt;Getting the most from your anaesthetic taster weekWhen you’ve got your taster session organised, you might want to think about the reasons that are drawing you to anaesthesia in the first place.Your understanding and articulation of these reasons will become more shapely in time, but everyone knows that these reasons have to be top-drawer for your interview and thus every anaesthetics consultant you meet in your sessions will ask…<blockquote>So, why do you want to become an anaesthetist?</blockquote>In response, ‘I like coffee, bicycles and know my VO2max, have a Garmin strapped to every limb and dabble in sudoku’ is a very good start, but this week can provide opportunities to learn more about what the day to day really looks like, rather than compounding various stereotypes. After all, not every anaesthetist likes cycling and coffee (shock, horror!).. we think.The more you know about the career itself, from various people at different grades, the more you’ll be able to virtually slot yourself into their shoes that are taking steps in both one and thirty+ years in the future.Here are some groupings of themes of questions I like to ask, with an overlay from recent experiences and chats that I have had in theatres.What is life as an anaesthesia trainee really like?<ul><li>What do they do when they sit at the head of the patient on the other side of the 'blood-brain-barrier' surgical drape and surgeons? What do all of the beeps mean?</li><li>What about cool procedures and kit? E.g. I recently saw an interscalene nerve block. Give enough and you numb the arm’s brachial plexus and the patient will thank you. Give too much and you’ll cause Horner’s syndrome and/or a phrenic nerve palsy; the patient definitely won't thank you!</li><li>What does this drug do? ‘Apparently, to anaesthetise a big animal like a hippo, vets must use opioids (Carfentanil) so strong and lipid soluble that they need to cannulate themselves and have naloxone ready, because if the drug touches their skin or is accidentally inhaled they will become apnoeic…'</li><li>What does anaesthesia core training or ACCS training programs look like? What about the experiential side of training? How did they get to where they are? How did they adapt from being a dogsbody house officer to becoming a sanctioned drug dealer?<ul><li>Generally there is universal pride in the time and quality of teaching.</li><li>There's a feeling of being in a 'tribe' and having a purpose (of dedicated learning and skill acquisition, rather than just passing your exams!)</li><li>Relief at having no more ward rounds or administration to take up the ‘bandwidth’ of each given day. 100% of time can be spent in a close learning environment with a consultant anaesthesist, with patients, doing procedures or having protected study time.</li><li>Can you imagine a job where you feel fatigued at the end of a day because of the amount of learning that has been had!?</li></ul></li><li>Advice about courses or exam preparation – this is super important for your sanity in the future and also to answer ‘what will the hardest part of this training programme be for you’ when asked during any interviews.</li></ul>What is life as an anaesthesia consultant really like?<ul><li>What was their path to consultancy?<ul><li>People take many paths until they find the right one. I’ve met anaesthetists with first lives as orthopaedic surgeons, sound engineers, general medics and lawyers, who despite accrual of knowledge, experience and seniority in their fields have found themselves migrating to anaesthetics.</li></ul></li><li>Why do they like anaesthesia?<ul><li>Sometimes it’s due to the job plan, PAs per week, or salary.<ul><li>Work as a consultant is mapped onto the week as PAs, with one PA equalling a 5 hour session i.e a morning’s work. Anaesthesia is friendly to people who work part-time, job share, or split work with other specialties and commitments e.g. intensive care. The salary as a consultant, or even as a registrar, can be augmented with private practice work – but the amount of private work taken up varies between persons; thus, I conclude that anaesthetics is a very flexible specialty that can be tailored to fit many individuals.</li></ul></li></ul></li><li>How do they feel about their job roles and responsibilities?<ul><li>Some consultants love the focussed nature of their job – be a friendly and nice person to allay the fears of the patient and do the job safely, effectively and efficiently. Many say that they feel ‘free’ with their names above no beds in the hospital, with no retention of responsibility once they leave in the evening or for the weekend. Some find the anaesthetic part dull after a while, but recognise that a routine anaesthetic tempers high-stress commitments elsewhere.</li></ul></li><li>Are they working overtime? Do they feel that they are respected in their jobs? What are the problems facing working as an anaesthesia consultant?<ul><li>It’s highly recommended to explore the opinions of consultants with regards to the past, present and future political states of and working conditions within the NHS.</li></ul></li><li>What are the opportunities available to consultants to subspecialise – and why would one choose these subspecialties?<ul><li>Anaesthesia subspecialties include paediatrics, neuro, cardiothoracics etc, while, pain medicine, perioperative assessment, HEMs/retrieval/prehospital/wilderness medicine, intensive care medicine, the military, research and management all combine well with a CCT in anaesthesia.</li><li>Do you have a greater appreciation of the cerebral side of anaesthesia? Perhaps a parallel career in research is an appealing option. Prefer practical, hands-on RSIs and gung-ho central lines and like helicopters? Maybe consider working in prehospital medicine or a career with the military.</li></ul></li><li>Many anaesthetists genuinely love teaching and the company of trainees.<ul><li>One anaesthetist shared with me that having professional discussion with motivated and intelligent juniors is one of his favourite parts of the job. He enjoys teaching because by formulating his answers to complex or unexpected questions he has had to improve his knowledge, and his ability to communicate this knowledge - if this isn't a sign of a man with a 'growth mindset', I don't know what is!</li><li>Not many other specialties have as much time to teach, nor as much time of one-on-one senior-junior time.<ul><li>Did you know that if trainees did not join the lists of consultant anaesthetists, the International Crossword Protection group (ICP) estimates that the toll on the worldwide population of crosswords would endanger them to near-extinction by 2030?</li></ul></li></ul></li><li>There appears to be little in-fighting and few unhappy anaesthetic families.<ul><li>‘There is no other specialty where the staff are so collegiate – we all have fun and banter together, and we all know that we can call for help as soon as anything out of the ordinary happens’. As he finished saying this, a consultant colleague bumped through the door to ask whether he was having fun and had drunk enough tea - the third of such check-ups of the morning.</li></ul></li></ul>So, you've organised your taster experience in anaesthesia, put some tubes down and some lines in - after reading this blog, we hope that you'll appreciate the wider aspects of becoming and being an anaesthetist, and are informed to be able to ask your own questions to find your own answers!

How to get the most out of your experience in anaesthesia

Reflections from an Anaesthetics Taster Week

A power house is an installation where energy in the form of electrical power is generated for distribution.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fa-little-in-depth-power-house-in-a-living-cell-8oh0zgg%2Fimages%2Fai-1.png?alt=media&amp;token=0b99514d-a217-4bc3-b5ff-06ab2180890c">The cells in our body have energy producing powerhouses. Each cell contains not just one but many of these powerhouse organelles. The number and size of these organelles vary from cell to cell depending on the cell's functions. For instance, muscle cells need a lot of energy, and have 1000s of them per cell. Whereas each skin cell has just a few 100 of them. These powerhouse organelles go by the name 'mitochondria' Energy is released by the cell's powerhouse-mitochondria in the form of ATP (adenosine triphosphate). This energy (ATP) is extracted through the metabolism of food by a process called cellular respiration. The process of cellular respiration consists of four distinct stages, namely (1)Glycolysis (2)Pyruvate oxidation (3)Citric acid cycle, and (4)Oxidative phosphorylation i.e., the electron transport chain Of these 4 stages, glycolysis occurs in the cell cytoplasm whereas the other 3 stages happen in different areas of the mitochondria of the cell.&nbsp; In total, 38 molecules of ATP are produced during the whole process of cellular respiration. A majority of this ATP production, 36 to be specific, occurs in the mitochondria of the cell.&nbsp; Without the mitochondria, cells would be unable to extract energy (ATP) from the nutrients, and all cellular functions would cease. <h2>Structure of the mitochondria &amp;&nbsp;</h2><h2>Location of enzymes responsible for cellular respiration:</h2>The basic structure of the mitochondrion is composed mainly of two lipid bilayer–protein membranes: an outer membrane and an inner membrane.Many infoldings of the inner membrane form shelves onto which oxidative enzymes are attached.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fa-little-in-depth-power-house-in-a-living-cell-8oh0zgg%2Fimages%2Fai-4.png?alt=media&amp;token=bd0e044d-88b2-433b-8d93-8d630baea4fb"> In addition, the inner cavity of the mitochondrion is filled with a matrix that contains large quantities of dissolved enzymes that are necessary for extracting energy from nutrients.The enzymes in the matrix operate in association with the oxidative enzymes on the shelves to cause oxidation of the nutrients, thereby forming carbon dioxide and water and at the same time releasing energy in the form of ATP.&nbsp; <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fa-little-in-depth-power-house-in-a-living-cell-8oh0zgg%2Fimages%2Fai-2.png?alt=media&amp;token=8a30ea98-acf9-44ed-a50d-14d9dad20f1f"><h2>Interesting facts about the mitochondria:</h2><ul><li>Mitochondria are self-replicative, which means that one mitochondrion can form a second one, a third one, and so on, whenever there is a need in the cell for increased amounts of ATP.&nbsp;</li><li>The mitochondria contain DNA similar to that found in the cell nucleus. DNA is the basic chemical of the nucleus that controls replication of the cell. The DNA of the mitochondrion plays a similar role, controlling replication of the mitochondrion.</li><li>As zygote mitochondria are derived from the ovum, the&nbsp;inheritance of mitochondrial DNA is maternal. This maternal inheritance has been&nbsp;used as a tool to track evolutionary descent.&nbsp;</li><li>Mitochondria&nbsp;have an ineffective DNA repair system, and the mutation rate&nbsp;for mitochondrial DNA is over 10 times the rate for nuclear&nbsp;DNA. A large number of relatively rare diseases, mainly disorders causing defective energy production in&nbsp;tissues with high metabolic&nbsp;rates&nbsp;have now been traced to mutations in mitochondrial DNA&nbsp;.</li></ul><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fa-little-in-depth-power-house-in-a-living-cell-8oh0zgg%2Fimages%2Fai-3.png?alt=media&amp;token=fb4d1a3b-72ad-4eee-a659-56d53ec14580"><h2>More Fun Facts:</h2><ul><li>Mitochondria are present in all areas of each cell’s cytoplasm.</li></ul><ul><li>They are concentrated in those portions of the cell that are responsible for the major share of its energy metabolism.</li></ul><ul><li>They are variable in size and shape. Some are only a few hundred nanometers in diameter and globular in shape, whereas others are elongated—as large as 1 micrometer in diameter and 7 micrometers long; still others are branching and filamentous.</li></ul>

Mitochondria is the power house of the cell, so we learnt in school!!
Would you like to know more about this mighty organelle?
Click on the image to keep learning...

A Little In Depth: Power House Of A Living Cell 

For the majority of the people living in the UK, the ambition to own property is ingrained into the national culture.&nbsp; Over the past 10 years, house prices have (on average) out grown wage rises and, with interest rates at all time lows, the dream of owning property has become increasingly more difficult to achieve.&nbsp; However, there are potential options for everyone who has the desire to invest in bricks and mortar. &nbsp;The following is by no means an exhaustive list, but all are strategies that we have used successfully.&nbsp; After a collective 15+ years of investing in property, we would suggest that the actual amount of capital is not as restricting as one may initially think.&nbsp; As a general rule of thumb, to obtain a worthwhile return on a lower capital sum, more time and effort is usually required.&nbsp; For the purpose of this article, we will sub-categorise strategies by capital sum. How can I invest £5k in property? Knowledge is power, and investing a small amount into yourself, to increase your knowledge of property investment strategies is probably the best investment one can make.&nbsp; You will reduce the risk of making costly mistakes early on, or may even realise that you really do not want to be involved in property investment at all!&nbsp; There is a plethora of information available in books and podcasts (which are free).&nbsp; There are also training courses held throughout the UK but these can vary, so do what you can to find out how relevant they are to you. Crowdfunding - It is possible to invest smaller amounts into larger property projects through crowdfunding platforms, allowing you to own a small percentage of the overall development and profit.&nbsp; The return on investment (ROI) is very dependent on the individual project. Deal Packaging - Done legally, and with the appropriate knowledge, it is possible to find property deals and then sell them onto other investors.&nbsp; There are regulations to adhere to, but this strategy can allow one to build more capital for future investments. Rent 2 Rent (R2R)/Rent to Serviced Accommodation (R2SA) - Both these strategies allow for control of a property without having to buy the property.&nbsp; One can effectively take a long lease (3-5 years) on a property from a landlord and guarantee the rent and reduced hassle to the them. Then, by renting out the rooms individually (HMO) or by renting the property to guests at a nightly rate, it is possible to make your profit.&nbsp; This is possible to achieve with &lt; £5k capital but be prepared for hard work and the possibility of giving personal guarantees and buying all the furniture.&nbsp;These would be regarded more as a business than as true ‘investments’ , as they are very time and management intensive, however they have the potential to create significant returns (&gt;100% p.a.) when done effectively.&nbsp; How can I invest £25k in property? Simple Rental Purchase - In areas of Scotland and Northern England, it is possible to buy a small property outright for &lt;£25k.&nbsp; These types of properties are usually in less desirable areas and come with their own unique management problems as tenants will often be on benefits and one can expect longer void periods between tenants.&nbsp; However, due to the low purchase price, no mortgage lending is required.&nbsp; Remember to factor in Solicitor fees and additional LBTT (Land Buildings Transaction Tax) or Stamp duties (4% and 3% respectively).&nbsp; Expect a Gross ROI &gt; 12% p.a. Buy to Let - Purchasing a property to use as a vanilla buy to let is the basic strategy that most people are aware of.&nbsp; There are many mortgage products readily available, but expect a minimum 25% deposit plus taxes and fees.&nbsp; The main aim would be to buy at a discount and add value with a small refurbishment.&nbsp; This would then allow you to re-finance the property and recycle some or all of your initial investment.&nbsp; Expect a Gross ROI between 7-10% p.a. How can I invest £50k in property?With increasing amounts of capital, it is possible to employ some or all of the above strategies, and one could suggest it would be prudent to start small and risk less, before attempting the following strategies. &nbsp; Houses of Multiple Occupation (HMO) - This is a possible strategy for creating higher rental income from a single property by renting out rooms individually to multiple tenants.&nbsp; Ideally &gt;4 tenants sharing a single property.&nbsp; This strategy is more time intensive to manage the tenants as well as restrictions placed by lenders to stop first time landlords from purchasing such properties with an appropriate mortgage product.&nbsp; A higher initial investment is usual to cover the purchase costs and 25% deposit on a larger property, as well as furnishing it, ready for tenants who will usually expect this.&nbsp; Beware local council policies and Article 4 regions which can limit the number of HMO properties in certain areas.&nbsp; Expect a Gross ROI &gt;15% p.a. Serviced Accommodation (SA) - In addition to R2SA, you can also purchase a property with SA in mind.&nbsp; Expect a minimum deposit of 30% and higher interest rates when asking for a mortgage.&nbsp; These commercial products are currently available to operators with a minimum 2 years experience.&nbsp; Expect a Gross ROI &gt;20% p.a.<hr> Thank you for taking the time to read this article.You can also check out my book - Buy to Let Property Investing: How I do it.(https://www.amazon.co.uk/Buy-Let-Property-Investing-How/dp/B095GFFL48/ref=sr_1_1?keywords=matthew%20wickham&amp;qid=1621663605&amp;sr=8-1)If you have any specific questions you can email info@wickhamproperty.co.uk

For the majority of the people living in the UK, the ambition to own property is ingrained into the national culture...

How to Invest in Property for £5k, £25k and £50k

Cobblestones&nbsp;are naturally rounded stones (larger than a pebble and smaller than a boulder)&nbsp;with a characteristic rounded upper surface. These stones are used in paving streets or construction. The cobble stoned pavements are set in such a way that the cobble stones are irregularly placed between the surface of the road. <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fnuggets-of-knowledge-cobblestone-appearance-of-the-bowel-8axeig%2Fimages%2Fai-1.png?alt=media&amp;token=88a5ac40-b5f4-4ca4-8939-ab8a421aba30"> Cobblestone pavement Crohn's disease is characterized by cobblestone appearance of the intestinal mucosa involving mainly the&nbsp;terminal ileum and the colon. In Crohn's disease, similar to cobble stone pavements, the mucosal surface of intestine shows&nbsp;areas of mucosal island (cobblestone like)&nbsp;interspersed with&nbsp;fissures (like the road surface in-between cobble stones). Real images of Cobble stone appearance of the bowel in Crohn's disease: <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fnuggets-of-knowledge-cobblestone-appearance-of-the-bowel-8axeig%2Fimages%2Fai-3.png?alt=media&amp;token=2a8420b7-32b9-40e5-b533-15803bfe074f">Source: https://www.researchgate.net/figure/Cobblestone-appearance-of-mucosal-surface-in-Crohns-disease-of-the-large-intestine_fig5_17340103<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fnuggets-of-knowledge-cobblestone-appearance-of-the-bowel-8axeig%2Fimages%2Fai-2.png?alt=media&amp;token=eb1adea9-9ca1-457c-8d4e-b9c0de67cc5e">Source: https://radiopaedia.org/cases/crohn-disease-cobblestone-appearance-gross-pathology

Did you know? The intestinal mucosa in Crohn's disease is likened to that of cobblestone pavement.
Do you wonder why? Read to know more..


Nugget of Knowledge: Cobblestone Appearance Of The Bowel

In a very brief but consized description of how i got to france and working nowadays as an oncologist in less than 2 years. It has first started when i was in 3rd year residency in internal medicine in lebanon. I started to search for any opportunity to leave my country and pursue my studies in europe or elsewhere till the day i realised that france could be one of the easiest countries to work as a specialist and without even redoing your specialty. so, first let me explain the system in france or in other words what to do in order to come to france. In france they allow any foreigner to come and do 2 years in his specialty under the name of a fellowship agreement signed by the hospital in france and the hospital in the country of the doctor applying. He will be a fellow in france for 2 years under the name of " stagiaire associé" in french. at the end of each 6 months, he recieves a certificate confirming his training in the department wanted. So all you need is to choose the hospital and the department you want and you directly send an email to the chief of the department you want to train at. You will tell him that you want to come to train under his supervision as a fellow or " stagiaire associé" in french. After that he will contact the HR of the hospital and the will send you the contract to be signed by you and either your faculty of medicine or your mentor. The big question is how to find vacancies and posts in france. Well this is very easy , in frace there is a well known website called FHF, here is the link https://emploi.fhf.fr/offres-emploi.php?motsclefs=&amp;type=MED&amp;x=71&amp;y=20 . By using this website you can search for the vacancies. Another way is to directly search on google by writing either the name of the hospital and the department wanted or by writing simply " list of hospitals in france". Believe me its not that hard to find a job by this way. What to do when you are accepted ?well as i mentioned before, this way gives you 2 years of training in france even if you dont know any single word in french. You dont need to have even a langauge proof to get the job. So after being accepted, You have to know that there is an equivalence exam in france for each specialty that is done once per year for all foreigners. This exam is very important to stay in france more than 2 years and later on get inscribed in the french order of physicians. This exam is like a concours, in other words there is certain number of seats. Its a short assay questions and mcq style questions for general medicine. Its not very hard, they ask you basic questions related to the specialty you are applying to. But the trick is that you should keep in mind that your answers must be very detailed considering that the one who will correct your exam sheet is not related to medicine. In this site you can get more information about this exam and the procedure of applying online. https://www.cng.sante.fr/In the next article, i will explain how to prepare for this exam and get it ! Thank you please share my article if you find it interesting and informative.

Being a doctor graduated from a forgein country and especially the MENA east region is something not really easy for someone who wants to start his career in europe and mainly in france. 
In this article i will summarize my journey from lebanon to france.

How to start your career in france as a foreign docotor 

There's a lot to consider when making the transition from purely (100%) clinical medicine to other roles in health tech or other fields. It’s often useful to start something like this on a part-time basis and see how you get on before going 100% into a health tech role. But obviously you can do this too if you are 100% sure!Having a portfolio of different experiences is great because it keeps you feeling in control of your career, motivated and passionate about what you do- while also bringing some work-life balance. ⚖️Below are some of my tips and strategies I used when I first began my transition from full-time doctor to part-time doctor with health-tech roles!<ol><li>Think of your strengths and skills:&nbsp;What do you actually like to do? What aspects of medicine do you enjoy the most? Are you a good team communicator, content creation, medical writing? There are&nbsp;SO&nbsp;many skills that start-ups and companies in health tech are looking for. Look at the skills you already have and really promote these to get experience under your belt. Getting your foot in the door for the first role can be the hardest, but once you have one role it is a lot easier to land the next exciting role! 💪</li></ol> ⭐️Some key skills include research, content creation, good communication, teamwork, medical education, and leadership, to name a few. These are skills that are transferrable ⭐️<ol start="2"><li>Talk to someone/get a mentor:&nbsp;Asking the people who have paved the way before you is always super helpful and something I would highly recommend. These kinds of roles in health tech (clinical advisor/medical advisor) are relatively new and so there isn't a lot of information out there. So, if you see someone who's doing something that sounds interesting to you, reach out to them, and ask for advice! In my next post I will show you&nbsp;some of the templates I use&nbsp;for approaching or 'cold calling' people and companies! (When I say ‘cold call’ I mean messaging or emailing someone who you don’t know previously, for example through LinkedIn)&nbsp;☎️</li><li>Don't give up:&nbsp;It will take some time for you to land your first role. Don't be disheartened by this. It's best to approach quite a few companies and see what response you get. Some people won't reply at all, this is OK and often is just because they're busy and it's nothing personal. Others will reply and say they currently don't need you but it's always good to keep that communication open. One of the people I went to advice for advised me that your first role may be unpaid, and this is OK just to get that experience first. 💰</li><li>Set clear boundaries:&nbsp;For your first role this may be on a freelance basis and no contract will be signed. Effectively the work you do will be voluntary. It is highly important to set clear boundaries when doing this kind of work and ensure you set a realistic time aside that you can devote (for free). For example, working 1-2 hours a week or every fortnight might be realistic. Don't get bogged down working hours and hours for a company that isn't paying or rewarding you in some way. They will be making value of the value that you bring to them. ✋</li></ol>So, in a nutshell, remember no matter what stage you are at (medical student/junior doctor), you always can bring value to these companies. 🤩 You have medical knowledge and can write articles and quizzes and give great insights. It's important to remember your strengths, have clear boundaries and persist. 📚 It might not be easy to get that first gig, but after getting over that first step hopefully the next one will come along easier. Working in health tech as an advisor is a great role that is very different from clinical medicine but it is so rewarding for several reasons including engaging with colleagues from different backgrounds, developing new skills and reaching a larger patient population.I’ll be writing more about my experience in the next few articles, so don’t forget to follow me so you don’t miss my next article on templates to use to approach potential mentors and health tech companies. 🔜

Have you felt burnt out from demanding rotas or hospital life? 🔥 Have you wondered if there is a way to explore new areas in your career without leaving medicine completely? 🤔 You're not alone!

That's what happened me in early 2022. Here are my tips! ⬇️

4 Tips to Go From Clinical Medicine to Health Tech (Medical Advisor)

Cretinism is caused by extreme hypothyroidism (decrease in thyroid hormones) during fetal life, infancy, or childhood.&nbsp;This condition is characterized by failure of body growth and mental retardation.&nbsp;STUDY THE CONCEPT BEHIND FACTS What is the reason?&nbsp;The reasons include conditions that lead to decrease in thyroid hormone levels. 1.&nbsp;Congenital lack of a thyroid gland (congenital cretinism) OR2.&nbsp;Failure of the thyroid gland to produce thyroid hormone&nbsp;&nbsp; &nbsp; because of a&nbsp;genetic defect of the gland,&nbsp;&nbsp; &nbsp; or iodine lack in the diet (endemic cretinism)&nbsp; &nbsp; or&nbsp;fetal hypopituitary hypothyroidism3. Maternal antithyroid antibodies that cross the placenta (affecting thyroid hormone secretion in the fetus) How severe can endemic cretinism be?The severity of endemic cretinism varies greatly, depending on the amount of iodine in the diet, and whole populaces of an endemic geographic iodine-deficient soil area have been known to have cretinoid tendencies.Can a neonate with cretinism look normal?<ul><li>A neonate without a thyroid gland may have normal appearance and function because it was supplied with some (but usually not enough) thyroid hormone by the mother while in utero.</li><li>T4 crosses the placenta, and unless the mother is hypothyroid, growth and development are normal until birth.&nbsp;</li><li>A few weeks after birth, however, the neonate’s movements become sluggish and both physical and mental growth begin to be greatly retarded.&nbsp;</li></ul> What if the mother is also hypothyroid?When the mother is hypothyroid as well, as in the case of iodine deficiency, the child shows features of cretinism at birth. Also, the mental deficiency is more severe and less responsive to treatment after birth. Can treatment reverse both the physical and mental effects of cretinism?Treatment of the neonate with cretinism at any time with adequate iodine or thyroxine usually causes normal return of physical growth, but unless the cretinism is treated within a few weeks after birth, mental growth remains permanently retarded.&nbsp;Why is early treatment of cretinism vital to the child's mental development?<ul><li>Unless the cretinism is treated within a few weeks after birth, mental growth remains permanently retarded. This results from retardation of the growth, branching, and myelination of the neuronal cells of the central nervous system at this critical time (mainly the first year of life) in the normal development of the mental powers.</li><li>If treatment is started at birth, the prognosis for normal growth and development is good, and mental retardation can generally be avoided; for this reason, screening tests for congenital hypothyroidism are becoming routine.</li></ul>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;https://peerr.io/quiz/cretinism What is the reason behind the potbelly appearance seen in cretinism?<ul><li>Skeletal growth in the child with cretinism is characteristically more inhibited than is soft tissue growth. This is because thyroid hormone is essential for skeletal growth whereas growth hormone is sufficient for soft tissue growth.</li><li>&nbsp;As a result of this disproportionate rate of growth, the soft tissues are likely to enlarge excessively, giving the child with cretinism an obese, stocky, and short appearance.</li></ul> The stunted skeleton combined with a normal soft tissue growth&nbsp;in the abdomen&nbsp;gives it&nbsp; the appearance of a pot belly. Cause and effect of a protruded large tongueOccasionally the tongue becomes so large in relation to the skeletal growth that it obstructs swallowing and breathing, inducing a characteristic guttural breathing that sometimes chokes the child.Solve a quiz to test your knowledge!!&nbsp;https://peerr.io/quiz/cretinism

Cretinism is caused by extreme hypothyroidism during fetal life, infancy, or childhood. 
Read more to study the facts and concepts of cretinism.

A Little Reasoning: Cretinism

If you’re wondering what an anaesthetist actually does to drift a patient off to sleep for an operation, then please join us for a gentle wander through a standard, low-stress elective operation. Remember that anaesthetics is a craft, much like carpentry or cooking, with many different ways of achieving a good result and a happy patient, so the following is just one example of how to anaesthetise someone, rather than an all-encompassing definitive guide.After the team briefing with the surgeons and theatre staff, in which the patient and their case are discussed and the surgical and anaesthetic plans agreed upon, the patient is ‘sent for’, meaning the ward is informed that the patient can now be brought up to theatres for their operation. The surgeons disappear and the anaesthetic team get their equipment and drugs ready.<h2>Drugs</h2>There are generally two categories of drugs to draw up and get ready for an elective procedure; those for induction of anaesthesia, and emergency drugs, which are kept on hand to deal with any urgent problems during the procedure.The basic recipe for a general anaesthetic is as follows<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fwhat-is-a-standard-anaesthetic-8d88s2%2Fimages%2Fai-1.png?alt=media&amp;token=42db387e-d8ef-455e-b99d-7b1ddfd45d1e"><h4>An induction agent</h4>Also known as a sedative, this induces a profoundly deep sleep, rendering the patient unaware of their surroundings and the procedure. Typically we will use propofol, or ketamine if we’re concerned about the patient’s blood pressure being too low. I like to give a little bit of lidocaine local anaesthetic into the cannula as well, to numb the vein before the propofol is injected, because propofol can sting as it is very irritant to the inside of the vein.<h4>A strong, fast-acting opioid painkiller</h4>This reduces the body’s stress response to the physical process of intubation, and also provides pain relief for the beginning of the operation. Frequently fentanyl or alfentanil are used as a bolus injection, or remifentanil as an infusion, because it is so short acting that a bolus would wear off too quickly.<h4>A muscle relaxant</h4>Neuromuscular blocking agents, or muscle relaxants, are used to paralyse the vocal cords, and allow the endotracheal (breathing) tube to be inserted into the trachea without the patient coughing and going into laryngospasm. The agent of choice was previously either atracurium or suxamethonium, but now more commonly rocuronium is used.<h4>Antiemetics</h4>These are given to offset the sickness caused by some of the drugs and the effects of the surgery itself. Ondansetron and dexamethasone are classic examples, but others such as cyclizine and droperidol can also be used, depending on the anaesthetist’s preference.<h4>Long acting pain relief</h4>Usually morphine, given at the beginning of the operation as it takes 20-40 mins to have peak effect. Other pain relief options include paracetamol, NSAIDS such as diclofenac, and clonidine and magnesium also can be used.<h4>Antibiotics</h4>Not all operations require antibiotics, but anything involving the intestines or orthopaedic implants such as a hip or knee replacement will need at least one dose of antibiotic, which is usually given just after induction of anaesthesia.<h2>Emergency Drugs</h2><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fwhat-is-a-standard-anaesthetic-8d88s2%2Fimages%2Fai-2.png?alt=media&amp;token=a8164a51-3719-4b94-ae64-d7789d124f70">The emergency drugs are essentially rescue therapies for if the unexpected happens during an operation, for example if the patient’s blood pressure or heart rate drop dangerously low as a result of the anaesthetic or the surgery itself.As with all things anaesthetics, the choice of drugs depends again on personal choice but I usually have ephedrine, metaraminol, atropine and glycopyrrolate at the ready. As well as being useful to have immediately available, they’re also source of psychological comfort to have at your side when venturing into the murky waters of unconsciousness!<hr><h2>The arrival of the patient</h2>As the patient arrives, the anaesthetic team introduce themselves and run through a sign-in checklist to confirm that the correct patient has turned up expecting the right procedure. If they’re having limb surgery, it is confirmed with the patient which side they’re expecting the operation, left or right, and that there is a visible mark on the correct limb, drawn by the surgeon. They’re then brought into theatre. Before anything else happens, three bits of monitoring are applied:<ul><li>Pulse oximeter</li><li>Blood pressure cuff</li><li>ECG or electrocardiogram</li></ul>These three things provide continous essential information throughout the operation about how the patient is feeling, how well their vital organs are working and how deeply asleep they are. One of the skills required of the anaesthetist is being able to interpret what the numbers mean in any given scenario, and what they need to do about it.Is the blood pressure low because the heart isn’t pumping properly or is it because the anaesthetic drugs have made all of the blood vessels relax?Is the oxygen level actually low or is it electronic interference from the surgeon’s cauterising forceps?High airway pressures, low blood pressure, high heart rate and low oxygen suggests anaphylaxis until proven otherwise<h2>Induction of anaesthesia</h2>I like to draw comparisons between anaesthesia and flying a plane. The generally more interesting bits are during take-off and landing (induction and emergence from anaesthesia), and ideally there are only minor adjustments to be made during the surgery in between.Induction of anaesthesia is like take-off. After inserting a cannula into a vein in the hand or arm, the patient is given pure oxygen to breathe through a mask, to replace all the air (which is mostly nitrogen) in their lungs with oxygen. This acts as a reservoir of oxygen for the body to use throughout the period of time when they are not breathing during the intubation. It is an important safety net in case anything unexpected happens and we are unable to move gas in and out of the patient’s lungs – such as in the case of an unexpectedly difficult intubation.To give you an idea of the importance of this pre-oxygenation – a patient breathing room air will drop to critically low oxygen levels within a minute and a half, while a patient with lungs full of oxygen can last up to fifteen minutes.Once the lungs are full of oxygen, the induction drugs are injected into the cannula and the patient goes to sleep. Once asleep, the muscle relaxant is injected and a timer started. The patient rapidly stops breathing, as their muscles become paralysed, and therefore starts using up the reservoir of oxygen sitting in their lungs. After about ninety seconds the patient’s vocal cords will be adequately relaxed to allow intubation, so the mask is removed and the laryngoscope is used to insert an endotracheal tube into the patient’s trachea.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fwhat-is-a-standard-anaesthetic-8d88s2%2Fimages%2Fai-3.png?alt=media&amp;token=9271bc1d-562a-4c74-aa41-5f3f60858f2a"><hr><h2>The operation</h2>The aim of the game for the anaesthetist during the operation is smooth sailing, with a nice steady blood pressure, oxygen level and heart rate. Many surgical operations involve particularly painful or physiologically stressful parts that the body can react to even in the patient isn’t aware of it, which need careful navigation to avoid upsetting the body’s delicate balance and causing unnecessary spikes in blood pressure or heart rate.The patient needs to be kept adequately asleep with enough pain relief on board to reduce the stress of the surgery itself. In the same way that a person who is asleep might unconsciously move their hand to swat away the fly that just landed on their nose, a patient under general anaesthesia won’t be aware of what is happening, however their body will still show a stress response to a painful stimulus if they’re not given enough pain relief.For a simple, lower risk operation this often doesn’t involve actively doing much at all, which is how anaesthetists have become famous for their crossword and sudoku habits, however their job is to remain vigilant to change, and to ensure that they spot anything going wrong and to deal with it before it becomes an issue. It’s very rewarding to hear the surgeon exclaim ‘they’re much more stable than I expected’ from the other side of the drape, unaware that it’s because you’ve been quietly correcting every possible physiological derangement before it became clinically apparent.<h2>Extubation</h2>As the surgeon ties the final few sutures, it’s time to get ready for landing, or extubation. The easy bit is switching off the anaesthesia, because the patient does all the work of waking up by breathing out the anaesthetic gas or metabolising and excreting the anaesthetic drugs, depending on what you’ve been using to keep them asleep. The tricky bit is keeping them safe as they ascend through the planes of anaesthesia, some of which can be rather turbulent to say the least.The ‘safe zones’ are either wide awake, or deeply asleep, because in each of these situations either you or the patient has complete control over their breathing.However much like a plane descending through stormy clouds, the patient must rise through a dangerous middle zone of being semi-anaesthetised, where they can become agitated if not managed correctly, and in the worst case can either go into bronchospasm or stop breathing entirely. Clearly, this could be disastrous if the patient’s oxygen level were to drop to a dangerously low level, so we do our best to avoid these problems in the first place.The key is ensuring you’ve suctioned out any saliva and secretions that might irritate the vocal cords when the tube comes out, reversed the muscle paralysis to ensure they have the muscle power to breathe effectively, and allow them to transition through this bumpy period relatively undisturbed.Given that extubation carries the same, if not more, risk than intubation, the patient must also be pre-oxygenated with 100% oxygen, to buy time if anything goes wrong.Then, once they are awake enough to protect their own airway and breathe for themselves, the tube is taken out. The patient can then be taken round to recovery, and the anaesthetist can get ready for the next case!

If you are a medical student, junior doctor or anaesthesia enthusiast from another healthcare background, and are interested to know what a 'normal' anaesthetic case looks like, then join us for a rundown of a simple, elective case.

What is a ‘standard anaesthetic?’

Its a messy business all this doctoring. If you're reading this, you have likely moved past the point where writing coherent and competent notes is a massive undertaking. Hopefully you've learned how handover works. If you're struggling with either of these, perhaps you would like to read my articles on handover and clinical note-taking. But anyway. Lets get back to the shoulders. You're about to start your first week of nights in ED. You are likely to see a few of these. Shoulder reductions are a frequent presentation to emergency departments. Typically as a result of trauma, they can occur in the younger athlete, involved in a rugby tackle. They can also occur as a result of a trivial fall in an older patient. The mechanism for an anterior dislocation is usually as a result of a force acting on an abducted shoulder, with external rotation. The key is to get this reduced, to minimise pain but also reduce risk of potential neuro-vascular sequelae.Step 1: DocumentationDocument clinical findings: particularly pulse of affected limb, and status of all the nerves: radial, median, ulnar, musculocutaneous, axillary. These may be altered pre-reduction. The most commonly affected is some altered sensation to the "regimental" patch-typically from an axillary neuropraxia. Step 2: Preparation and Planning-where will you do it? Ideally Resuscitation Bay-what sedation will you use? Whatever is appropriate for the patient-what technique will you use?-who is the proceduralist?-who will assist?-do you have a sling to apply after?Proper Planning Prevents Poor PerformanceStep 3: TechniquesStimson's Technique:-patient lies prone-affected arm hanging over side of bed, a weight can be attached-gradually relaxation allows humeral head to slip back into placeHippocratic technique:-supine-longitudinal traction of arm with counter-traction against the axilla*Risk: brachial plexus injury, axillary nerve injuryKocher method:-supine-elbow flexed and tractioned-arm is externally rotated-adducted across chest-internally rotated*Risk: humerus fractureNo one technique is perfect for reducing shoulder dislocations. Often a series of attempts is required, occasionally a full general anaesthetic with muscle relaxation is required. A technique trick is the cross body sheet seen in the thumbnail picture: this gives an assistant the ability to apply counter traction more easily. Be sure to escalate these patients as soon as possible to senior colleagues if needed. References:-Christofi T, Kallis DA, Raptis M, Rowland and Ryan J. Management of Shoulder Dislocations. Trauma 2007; 9: 39-46-McRae R. Pocketbook of Orthopaedics and Fractures 2nd Edition. Churchill Livingstone Elsevier 2006: 276-280-Cunningham NJ. Technique for Reduction of Anteroinferior Shoulder Dislocation. Emergency Medicine Australasia 2005; 17: 463 - 471-Kocher T. Eine neue. Reductionsmethode fur Schultetrverrenkung. Berliner Klin Wehnschr 1870; 7: 101-105

A fully referenced how to guide for shoulder reductions. Techniques, technique-specific complications and technique pearls included. 

Anterior Shoulder Dislocations: A Reduction How-To Guide

Dear Friends, It has been a little over one year as a doctor now and there are several lessons I’ve taken away and reflections I’ve made over the past 12 months. Here are a few of them that apply to all walks of life. Don’t Ask, Don’t GetIt’s very simple. If you don’t ask for help or advice, you won’t receive it. Generally, humans are not great at reading minds and signals. So, if you’re in a tricky situation and need support — ask for it and 9 out of 10 times you’ll receive it. Work-Life Balance FallacyTrue work-life balance doesn’t really exist in the realms of traditional careers. It certainly doesn’t within medicine — the hours are crazy and at times the workload is intense. But as a bigger concept, I think there is no such balance. You have predominantly work periods. You have predominantly life periods. There is seldom an equal balance between the two. Perhaps, you could in theory strive to get closer to an equilibrium, but this requires deviation from traditional careers. Even a 9-5 doesn’t cut it. Maybe a 10-2 would, but that requires you to carve out something pretty niche and high yielding. Share Your ConcernsIt’s important to pay attention to your body and mind. Work can become stressful on busy days and around busy periods (like winter months in the hospital or around project deadlines in the corporate world). These are the days when a moment of reflection and debriefing can help.I try to chat to my colleagues at the end of a rough shift or chat to my fiancée and kind of just get some things off my chest. I always swear by the mentality of a problem shared, a problem halved and so debriefing and opening up helps me overcome stressful days faster. Make Fun PlansOften when assessing motivation and mental wellbeing, it’s clear that people are generally more motivated and happier when there is something to look forwards to. This is why I make fun plans.I try to look ahead in my work schedule and make plans for days and weekends off. There’s a delicate balance to this — you want to ensure you give yourself some time for general house chores and life admin. Every second off work filled with motives can quickly become a chore in itself. Have Passion ProjectsThis is a sticky one for me. I tried to keep up my passion projects (like this newsletter and YouTube) over the past year but failed quite badly. I think my main priority going forwards is to allocate some of my free time to progress on my passion projects.There are many wins to be taken from having something on the side. It can act as a stress reliever, mind cleanser, or even a cheeky money-making machine (sadly this is not the case for me due to be an internal struggle with consistency). Work Smart, Not HardThis is common sense but it pains me when I see my colleagues working very hard and finishing hours late every shift. I have found having systems (to-do lists, colour-coding, box techniques, etc.) and prioritisation methods allows me to be most productive at work.If we can batch similar tasks, then we should be more efficient. I’ve also learnt to leverage the team available. For example, efficiently dividing up jobs for patients following ward-round between the team means we all work equally and end up finishing on time (mostly). --------------------------------------------------------------------------------------------------- Quote of the week:The key lesson in all these ideas is to always be experimenting. Try new things and see what happens. ($100 Startup) Recommendation of the week:App 💻 - NumiThis is a ridiculously cool calculator for mac (sorry windows). It converts common text into calculations. So, you could type something like ‘add 6 months to today’ or ‘1000 GBP in USD’ and it will do just that. Also if you’re a Mac user, it neatly sits in the menu bar making it ultra convenient.

It has been a little over one year as a doctor now and there are several lessons I’ve taken away and reflections I’ve made over the past 12 months. 

Here are a few of them that apply to all walks of life.

One Year As A Doctor

<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Five-never-worked-harder-joe-stringer-octopus-ventures-8d73p6%2Fimages%2Fai-1.png?alt=media&amp;token=9ad54532-3714-4bd6-84a2-a1bc733d2c79">Joe Stringer is a Partner at Octopus Ventures, one of the largest European Venture Capital firms with £1.8 billion under management.He was Partner at Ernst &amp; Young for 10 years, before leaving his cushy position to launch his own venture fund TenX Health. He then led Google Health in the UK before becoming Partner at Octopus Ventures.<hr><h1>Interview Notes 🎙️</h1>There is a negative perception in healthcare of 'consultants' that they come in, they charge a lot of money, and nothing really gets done, or there's no tangible improvement. Do you think that's a fair assessment? You can't generalize, so in any industry, there are great outfits, and there are less great ones and invariably, it's the less great ones that give the industry a bad name.You could point to a lot of projects, thankfully, none that I can think looking back that I've been directly involved with, but you could point to a lot of projects where you would seriously question the outcome and the value for money.Let's take some of the recent coverage, say around COVID, I was really pleased with how the consulting industry properly stepped up and it's what the press and the public, either don't want to hear or never hear. Which is actually, when you need an army of people that will work 20 hour day is with ambition, agility, yeah, massive amounts of intellect and experience in different functional areas, to get the hospitals up and running to get a test and TRACE program up and running. It's not just about the consultants, but they had a difference and they made it happen quick, I was really pleased with that.I've had some projects where the client either has no intention of doing anything with the recommendations, or actually, you're brought in to be the bad cop. So it's never a sort of good project, bad project but I think the challenge in consultancy is accepting the right kind of projects and being as selective as possible around the kinds of projects where you can really add value. To make significant returns in investing, you need to be right when other people are wrong. If you're doing the exact same thing as every other investor, there's probably not a lot of room for you to make great returns, if that is true, then within healthcare, can I ask you about your thesis in particular, any unusual beliefs you might have about the future of health care? I think you're broadly right, you've got to have an opinion, that doesn't have to be polar opposite of the crowd. But actually, you've got to have conviction, which is always the word that you hear investors using. So you got to have conviction around your thesis around the growth opportunities.So much depends on the expectations of your investors, are they expecting a 10% return? lower risk, nice sort of steady businesses, in which case that drives you down a certain thesis? Or do they want the game changers, the category defining businesses, the the sort of 20 to 50x returns?One of VCs biggest challenge is crowd mentality that herd mentality, where you see a lot of the same funds associated with a lot of the businesses that end up sort of chasing smaller addressable market. A lot of cap tables, which are often an extension of a startups brand is the list of investors, the quality of investors, they've been able to attract, what I always love is seeing real breadth and depth of insight in the sector, as well as brilliant generalist investors. <blockquote>So I'll be less impressed with seeing some big brand US VC on a cap table than I would a brilliant Angel here in the UK, who has a network that can accelerate the growth of that business tenfold. So yeah, we I do try and take a counter view. But so much depends on the investment thesis.</blockquote> In terms of thesis, there are three main areas that we as a team and I sort of look for: <ol><li>Personalization - Businesses that support the personalization of diagnosis or treatment</li><li>Fundamental decoupling of physical capacity - whether it's buildings or people from the point of diagnosis or treatment. Telehealth providers we're the first wave of that.</li><li>Removing friction from the supply chain - one of our most recent investments is a business called automata. They're literally hardware robotic arms to tackle the last bastion of inefficiency in healthcare, which is labs. Think of lab technicians with a pipette, doing repeated actions, very often prone to error, you know, 1000s, if not millions of times, this is a super low cost roboticplatform that essentially allows allows lab managers to turn the lights off, and they can run 24/7.</li></ol> One area that is really taking off is digital therapeutics, businesses like Big Health and Quit Genius where they've developed such sophisticated technology, but they are now a genuine alternative to drugs, tackling, you know, whether it's insomnia or anxiety, or in the case of quit genius, you know, severe addiction, smoking, drinking and opioids. We prefer to look across that spectrum and the ones that are a lot closer to genuine alternatives to treatment. So if we take those kinds of businesses, they cover personalization and decoupling, because you don't have to physically be in front of a therapist for for mental health treatment. I want to ask you a little bit about decision making? <blockquote>As a team, we've actually got a bit of a phrase within our team - fences are criminal. So you can never ever be on the fence. So you score any business out of 10 and it's either a six or a nine, and to back it, it's got to be a nine - Indecision is the enemy of of any investor.</blockquote>It's amazing how when you look at so many decks, when you meet so many founders, the consistent threads of quality, just jump out at you, whether it's the quality of the team, their ability to hustle and to create commercial traction without throwing, you know, 10 million at the product. It's those kinds of traits that that you look for, which isn't rare in any investor.One thing we do as a team is provide helpful feedback where we have a business and we made that decision not to invest, whether it's a not now decision, or we're unlikely to invest at any point, but also signpost you where they might need to work on the team, where they might need to work on the proposition, look at their geographical sort of go to market strategy.<blockquote>So we we try and be helpful, you know, there's nothing worse than a sort of an unhelpful, no, for a founder. We always endeavor if we have met a business and taking an hour out of their diary, to make at least one or two, meaningful introductions on the back of it, even if we're not going to invest as well.</blockquote> What have you learned about leadership in your career?<blockquote>I think some of the best leaders I've known are the most human, most grounded, most authentic. It's the ones where the teams will run through brick walls for a cause, not for a leader. But it's the leader that is able to set that cause. I can probably count on one hand, the number of leaders I've followed, where I have been prepared to run through those brick walls.</blockquote> What have you learned about maintaining relationships? One wise person, advised me 10 years ago, to have a 10 x 10. You don't have to over engineer this there are great tools out there.<blockquote>I'd always say pay for LinkedIn premium, because it's always worth it.</blockquote>From a sort of CRM perspective, I have a simple spreadsheet, 10 columns, different sub sectors, whether it's investing, healthcare, UK healthcare, US healthcare, insurance, different sub sectors, across columns, and allow yourself 10 rows, and in each cell, you have a name, I tend to try and go through that on a quarterly basis.It's just a good nudge, Oh, I haven't caught up with so and so for 18 months, or I need to update so and so on X, Y, Z. I think that allows you to keep that breath. Otherwise, you're in danger of just being really focused on your niche and having a really amazing deep network in one niche, but then it makes it bloody hard to transition from one subject to another. So that would be my sort of practical advice and tip.Practical tip, don't ask for random coffees and catch up, have a reason, doesn't have to be a transaction, but just just have some kind of purpose around a conversation. What have you learned about building relationships? I'm a massive believer in sort of paying it forward and helping others out and I've seen firsthand in the last few years, that the sort of benefit that's had, where I've helped a lot of other people out, and now starting to see some incredible support coming out from those people that I might have helped sort of 5-10 years ago. So always put yourself in their shoes, think about what they want to achieve, go the extra mile to help them.A general career advice point, if you're interviewing my 12, and 9 year old children, what would be the first thing that dad would say,<blockquote>It's just grit and determination, it's that hard work element, you can't get anywhere without that hard work. That doesn't mean to say working stupid hours for the sake of working stupid hours. You got to be prepared to put that shift in and really push it if you want to have a sort of meaningful impact.</blockquote> Are there any things you do to avoid wasting time?I use one app called superhuman, which is brilliant for email triage and auto responses. I think a lot of people try and revert to tools but very often it's your choice about which meeting you take, that is the biggest driver of efficiency and productivity.Just to be clear, I've been through periods in my life where I've pushed it too far, not got enough sleep, I'm not one of these people that sees it as a badge of pride for getting four hours sleep, I think that's nonsense and physically, you're going to do yourself a lot of harm.<hr> If you've enjoyed this, you can listen to the full episode on Apple, Google and Spotifyhttps://podcasts.apple.com/gb/podcast/097-ive-never-worked-harder-joe-stringer-octopus-ventures/id1500446262?i=1000574543927You can find me on Twitter @MustafaSultan and subscribe to my newsletter on www.musty.io

Joe Stringer is a Partner at Octopus Ventures, in this episode we talk about his thesis on the future of health, the importance of hard work, grit and resilience, as well as building and managing relationships, in particular, trying not to be too British.

I've Never Worked Harder — Joe Stringer (Octopus Ventures)

CONTENT:Study guides:Familiarise yourself by looking over the study guides in advance so that you can be prepared. Make a list of everything so you have an easier way to access it than the study guides.Time management:Plan out your time and see how you can cover everything with enough time before the exam. I personally set a goal of having all of my core conditions completed by January.Try to learn as much as you can of your special senses content before this placement. I found summary tables to be quicker than making notes!Quesmed and Passmed will be your best friend! Do as many questions as you can and make Anki cards/notes based on the things you get wrong.Use a tracker:This is a really good way to track your progress from making notes/flashcards to completing questions on this content in particular. There is a lot to cover, it is easy to miss things so this is a great way to stay on track.PLACEMENTStudy guides: Familiarise yourself so you know what to expect for each placementDOPs: Be aware of what DOPs you need to cover for each placement. I made a spreadsheet so I could tick them off. At the beginning of each placement, I would make a plan of which DOPs I needed to complete and how I could achieve this in the first 2 weeks or so.Core Conditions: Be aware of which conditions you are likely to see/be asked about on each rotation, this can be a good way to organise how to learn your conditions and plan your revision. Listen to a ZtF podcast on your commute! Special senses: Try to learn as much as you can of your special senses content before this placement, you only get 5 days on each of dermatology, ENT and ophthalmology so it is good to have a good knowledge base to make the most of it!Pharmacology: Try to get involved with the nurses when they do the drugs rounds, be aware of the common types of medications you are likely to encounter on each placement. This can make your formularies much easier to make!OSCE PREPThe best things that helped me with my OSCE prep were GeekyQuiz, Quesmed OSCE section and the OSCEStop revision guide!Find a study buddy and make sure to do practise the following at least once a week, and make it a non-negotiable - this will give you enough time to cover everything before the exam and will guarantee you are ready.Comms Skills: Improve your history taking by talking to as many patients as you can! Make the most of your time on the wardsClinical Skills/Examinations: Practise, practise, practise! Do as much as you can on placement, finding a good junior doctor to follow and ask to supervise you at first whilst you first get used to things is a great way to gain confidence. Make the most of the clinical skills facilities at LGI and SJUH - book them early as by the end of the year it is impossible to get a spot! I would make a habit of going on Fridays when I didn't have anything else timetabled.Counselling Scenarios: Be aware of the types of scenarios you can be expected to counsel a patient on. This is normally things like medications and their side effects, counselling on a condition such as asthma or diabetes, or even explaining how to use an asthma inhaler! You can find good examples of how to do any of these in the resources I listed above.MAKING TIME FOR YOURSELFhe tricky thing about 3rd year is how much you have to do on top of placement! But if you use your time well, you can still have lots of free time!Try to do some revision in the morning on your commute, and also on the way home! Whether this be listening to a Zero to Finals episode or doing some Anki flashcards, it is a great way to reduce the amount you have to do once you get home!If you have free time on placement/there is nothing to do, either use the time to do some exam Qs or do some OSCE practise with the rest of the people in your placement group. There are days where you will be able to leave early, so you can use this time to get some work done too.If you plan your time well, there is definitely chance to still enjoy yourself and have your weekends.

How to do well in 3rd year medicine at Leeds!

How to Succeed in 3rd Year (LEEDS)

What colour are your eyes?Is it black, grey, amber, red, hazel, green or blue?Genetics is the major determinant of a person's eye color.Chromosome 15 present in a cell's nucleus contains two main genes namely OCA2 &amp; HERC2 that determine the amount and quality of melanin pigment in the iris of the eyes.Melanin pigmentation of the front layers of the iris imparts the color to the center of the eyes.Iris is the structure that surrounds the pupil of the eyes.More the melanin, darker the color and vice versa. For instance, black eyes have more melanin.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcolors-to-see-as-i-look-in-your-eyes-8inrec%2Fimages%2Fai-2.png?alt=media&amp;token=87d73d64-ea87-4c1f-99bd-0d2ce950a27f">Heterochromia iridisHetero means differentChromia means pigmentation or coloringHeterochromia iridis&nbsp;is a rare condition characterized by a difference in color between the iris of one eye and the iris of the other eye.&nbsp;Sometimes, the difference in color is observed between parts of the same eye.&nbsp;&nbsp;<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcolors-to-see-as-i-look-in-your-eyes-8inrec%2Fimages%2Fai-1.png?alt=media&amp;token=a46e7d18-3e21-4063-86b6-8a20b3e24928">

What color are your eyes?
Is it black, grey, amber, red, hazel, green or blue?
What determines the wide array of differences?
Maybe I can answer the last question for you..

Colors to see as I look in your eyes!!

<h2>Crystals in joint fluids</h2>Gout and CPPD are two of the major causes of acute monoarthritis (acute inflammation of one joint). CPPD (Calcium pyrophosphate dihydrate crystal deposition disease) is also termed as pseudogout due to certain similarities with gout seen during acute presentation. It is necessary to differentiate between gout and pseudogout as their presentation varies.Read further to learn their similarities and differencesSimilarities of gout and pseudogout: - causes of acute monoarthritis (acute inflammation of one joint) - characterized by intra-articular crystal deposition - the crystal deposits can be observed by visualizing the joint fluid space under polarized light microscopy - acute episodes of intense pain, redness and visible swelling of the joints involved - acute episodes triggered by illness, trauma or surgery - systemic symptoms such as fever maybe present but is not usual.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcrystals-like-needles-when-i-looked-in-the-microscope-8psc6z%2Fimages%2Fai-4.png?alt=media&amp;token=15994d8e-0acc-44ba-85a7-e8da2d69995c">- For this purpose, joint fluid is aspirated from the joint space and viewed using polarized light microsopy.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcrystals-like-needles-when-i-looked-in-the-microscope-8psc6z%2Fimages%2Fai-3.png?alt=media&amp;token=db64deaf-8193-42f3-aec7-d40f9d392ddb">The above image shows needle-shaped crystals in gout seen on polarized light microscopic view of the joint fluid<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcrystals-like-needles-when-i-looked-in-the-microscope-8psc6z%2Fimages%2Fai-2.png?alt=media&amp;token=582c5079-1f2a-4ecd-843a-d430451d2018">The above image shows rhomboid-shaped crystals in pseudogout/CPPD seen on polarized light microscopic view of the joint fluid<ul><li>Gout and pseudogout/CPPD can be differentiated and a definitive diagnosis can be made using polarized light microscopy.</li><li>The image below depicts the difference between the microscopic images of gout and pseudogout/CPPD.</li></ul><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcrystals-like-needles-when-i-looked-in-the-microscope-8psc6z%2Fimages%2Fai-1.png?alt=media&amp;token=d0176219-9c49-4e44-8ff8-cf45e0147a67">

Here you see the image of ice crystals from natural snow that are shaped like needles.

In certain arthritis, when fluid from the joint space is examined under polarized light microscopy, similar needle shaped crystals can be viewed.

Crystals like needles when I looked in the microscope!!!

A scruffy looking man walks into the department, into the doctor’s area. He must’ve sneaked in when another patient was being called. He comes up to a colleague and says “I’m in so much pain I need help.” The doctor asks, “Who is looking after you?”, he replies “Nobody, I’m in the waiting area.” “Okay I’ll prescribe you some analgesia and then you’ll need to go back to wait to be seen.” “No doctor I can’t go back this is too much pain.” He starts becoming more aggressive. I come over to the assess the situation and assist my colleague. “Is everything alright here?” “Doctor I’m in so much pain I’ve dislocated my shoulder.” “I understand you’re in pain but you have to wait like everyone else. We’ve given you the strongest pain killers, but you’ll have to go back to the waiting area.” He refuses. The floor coordinator says “Why don’t you ask the consultant if he can be bumped up so you can pop it back in and send him on his way?” I go to the consultant and he tells me to take him into resus and prepare propafol, fentanyl and ondansetron (anti-sickness). I asked the nurse if she can assist in the preparation of the drugs, she says she can’t she’s busy. Another nurse points out where the drugs and syringes are. For the first time in my career I begin preparing drugs for sedation. It’s 3am, I am tired, hungry and my hands are quite literally shaking. I open the ondansetron vile (anti-sickness), the lid shatters and I cut my finger. I hold the cut closed and hope it seals and start drawing up the drugs with a new set of gloves. I go out to confirm the dosages with the consultant. All correct. I can still hear the patient moaning from the cubicle. He is fidgeting, agitated and complaining. He then informs me of how much he had to drink and proceeds to ask if he is allowed to have a beer to help the pain. I, of course, staunchly refuse and tell him I’m about to stab him with a needle into his blood vessel to give him drugs to help with the pain. First cannula, patient moves, cannula failed. The consultant comes, expecting everything to be ready, and sees I have failed the cannula. He asks me to pass him a fresh cannula and to hold the patients arm down. I do so and in 30 seconds we have a fully functioning cannula in situ which bloods taken from it and flushed. The consultant asks if the drugs are prepped. A registrar comes in and reminds us (and teaches me) that we can’t start giving the sedation drugs until appropriate monitoring is in place. We connect the monitor and the consultant instructs me to give the fentanyl (pain killer), ondansetron (anti-sickness) and propafol (sedation) - in that order.I expect the patient to drift off to sleep. He doesn’t. In a minute or so the registrar grabs one side of the patient and I find myself providing counter-traction. The patient looks at the registrar angrily and shouts “You’re hurting me what are you doing?! You’re trying to rip my arm out!!” He begins resisting, tensing his muscles and fighting back. The registrar tries again. He’s completely tensing his arm now. We let go. The consultant comes to see whether the dislocation has been reduced. He feels the shoulder, it’s back in place. Alhamdulillah. Job done. We put him in a collar and cuff and repeat the shoulder x-ray to make sure it’s in place. The patient, now completely sober from the sedation and any alcohol he had drunk beforehand (the pain probably sobered him up really quick), begins thanking us, apologising for his previous behaviour when he entered the department and praising us at how amazing we are at our jobs. He’s like a completely different person now. “Hats off to ya doctor, you guys are miracle workers. The pain – it’s completely gone.”I asked the patient a few questions and quickly realised he had absolutely no recollection of the events of the last 10 minutes. The last thing he recalls is up injecting him through his cannula. He was awake, but it was as if the last 10 minutes didn’t happen.Reflections:1.&nbsp;The patient came in, in his version of reality, was in a sort of trance that we call sedation, and then came back to reality after a short period of time. This got me thinking. Adam AS was in his home of Jannah (heaven). He came down to this earth for a short period of time, which compared to eternity is literally a blink of an eye, then returned back to the heavens. How must he have felt knowing that this wasn’t his true home? Is it normal that we feel out of place living in this world? We aren’t from here, so when we feel like this world is a prison and is so restrictive and horrible, is it because this isn’t where we belong?2. This life is the 10 minutes of delusion. Everything around us is the illusion and the reality is to come. Allah created our souls in the world that is now unseen to us, we come here for our short 60 or 70 years - for some, sedation wears off quicker than others, just like some live longer than others – and then we return back to the true life that is forever. How much focus do we give to this short stint we have here compared to how much we give to where we will remain forever?3. Just like the patient suffered during the sedation period with the pain of reducing the dislocation, we may struggle and suffer for a period in this life. It’s not supposed to be easy or comfortable. A lot of people try to find ultimate happiness in this life, but this world wasn’t made for that. This world was meant to be stressful and a struggle and ultimately a test. But just as the patient fought us and struggled against, it led to the pain being entirely removed and him completely forgetting about it afterwards. This is similar to the narrations that mention about a person who suffered so much in this world and he is dipped in Jannah for just a second and he will say he didn’t struggle for a single moment in the worldly life.Ultimately this life is not our permanent abode and we should always remember that whatever we do in our lives we will find the outcome of in the next life. The seeds we sow today become the crops we harvest tomorrow. Make sure your garden is worth harvesting.Follow me on Instagram @storyofamuslimmedic and Twitter @muslimdrstories

Read about the first time I assisted in reducing a dislocated shoulder at 3am on a night shift and what I took away from giving someone propafol for the first time. 

Sedation and the Illusion of Life - Story of a Muslim Medic

<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fstring-of-pearls-appearance-8l4isv%2Fimages%2Fai-2.png?alt=media&amp;token=0dfd48c4-7654-40a1-92b1-078c4bb80848">Necklace beaded with a string of pearls_An appearance in&nbsp;small bowel obstruction<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fstring-of-pearls-appearance-8l4isv%2Fimages%2Fai-1.png?alt=media&amp;token=c10a4b9c-a9d1-4390-a0eb-8fc73bccd817">The linear arrangement of air bubbles gives an appearance similar to string of pearls&nbsp;(or beads) on abdominal radiographs of patients with small bowel obstruction.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fstring-of-pearls-appearance-8l4isv%2Fimages%2Fai-3.png?alt=media&amp;token=7c465cd0-787c-4d43-a698-2b29e50fc956">The observed rows of air bubbles represent gas trapped between the valvulae conniventes, the folds of mucosa present in the small intestine.The gases get trapped as they are unable to pass beyond the obstruction in the small bowel.The below image shows the gross and radiographic appearances of the folds, namely the valvulae conniventes of the small intestine.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fstring-of-pearls-appearance-8l4isv%2Fimages%2Fai-4.png?alt=media&amp;token=10b7b77d-950a-406b-bfa8-13aa10cfad85">

What would you say if a radiographic image of the abdomen shows areas similar to this?

String of pearls in the radiograph

So you're in your final year of university, or you've just started foundation year 1? It's a daunting time and everyone feels out of their depth. I'll get straight to it - here are some things I would recommend you familiarise yourself with to make the transition from medical school to foundation doctor as smooth as possible. I would recommend taking a notebook with you with a list of these things (plus any other questions you may have) and noting down the answers, so you don't forget.<ol><li>DocumentationDoes your hospital use paper notes or electronic notes? Do you have login access to all of the necessary systems (including referral systems)? If the notes are paper notes, where are they kept? For example in my hospital, we use electronic notes but there is a physical folder which holds things like ECGs and blood gases etc.</li><li>Prescribing &amp; Intranet guidelinesDoes your hospital use paper kardexes or electronic prescribing? Do you know how to access the trust guidelines on the intranet - it will save you a lot of time (and you don't have to ask seniors for simple things) if you know where to look when you are prescribing meds for a patient, or if a nurse comes up to you and asks you to see a patient because they are hyperglycaemic for example, and you want to know what treatment the hospital guidelines advise for various scenarios.Even if your hospital uses eMeds, there are usually paper forms for certain prescriptions, such as blood transfusions. I would recommend locating where these paper forms are kept so you can access them when you need, and know how to fill them out.</li><li>Key-codes, Toilets, Changing rooms &amp; Doctors' MessWhere are the closest changing rooms and toilets to your ward? SO important to know; you don't want to arrive at work when you're running late and not know where to get changed into scrubs! Also, make sure to ask where to actually collect your scrubs. Write down all the important key-codes on a note in your phone/notebook - e.g. access codes for the changing rooms, utility/storage rooms on the ward, doctors' mess, etc. Also find out where the doctors' mess is - it's good to take your breaks away from the ward and it's a nice place to see the familiar faces of other foundation doctors who may be taking their break at the same time.</li><li>Absence reporting policyAlthough it might seem trivial in your day-to-day life, the last thing you want to be doing when you are unwell is trying to dig out phone numbers and email addresses of people to contact when you are ill and can't go to work and you just want to curl up and sleep (trust me, I'm speaking from experience). Ensure from day 1 that you have the contact details of the appropriate person(s) to call, as you never know when you might need to call in sick.</li><li>EquipmentWhere is all the important equipment kept on your ward? Such as venepuncture/ABG/cannulation equipment, catheter packs, etc. You'll need these in your everyday practice so make sure you know where these are kept (and if it's in a locked room, ensure that you've noted down the door code).</li><li>ABG machine &amp; loginDo you have a login to run blood gases on an ABG machine, and do you know where your closest machine is? Not all wards have one, and the last thing you'll want to be doing when you need to run a blood gas is running around different wards trying to find the machine (especially if it is an emergency situation like a cardiac arrest).</li><li>BleepsHow do you actually bleep or contact someone in your hospital? Every hospital will have a slightly different system - at our hospital, we have to type into the phone '55' plus the bleep number plus half of the telephone number (it's very odd) so it's worth asking at the start and noting it down on your phone or notebook. I would highly recommend downloading the 'Induction' app on your phone - it is an extremely useful app that once you register for and input your hospital, it allows you to search for all of the extensions and bleep numbers for your hospital.</li><li>ReferralsHow do referrals to other specialties work in your hospital? Chances are it's different for every specialty (useful, right). It's worth knowing for the main ones, such as cardiology, respiratory, gastro, neurology, etc. In our hospital, some referrals are done via the main computer system (ICE), some are done via phone call, and some are on a different website altogether.</li><li>Ordering investigationsAre you aware on how to order investigations such as blood tests and scans? Blood tests are easy to order, however for scans &amp; endoscopy you need to include more clinical information within your request. Some hospitals use electronic requests, and for some you might need to call Radiology and order it over the phone, or even go to Radiology in person with a paper form. Whatever form it is, you'll need to provide adequate reasons for why this patient needs this particular scan - and if it not sufficient, your request could be rejected. On ward rounds, consultants may not necessarily tell you why a scan is needed and just ask you to order it, but remember you'll be the person requesting it - so if you're not 100% sure, just ask them the rationale behind that investigation. It's good for your own learning and also means you won't have to call the consultant later on in the day asking them to clarify why they want a particular scan ordered (they'd prefer you to just ask in the moment).</li><li>PDPs &amp; PortfolioWhen you start FY1, you'll create a PDP (personal development plan) with help from your supervisor. It's worth thinking about this early on and keeping in mind your goals for the year, as it will allow you to seek out opportunities during your shifts, and get SLEs (supervised learning events) for them i.e. some feedback for your portfolio. It is good to keep on top of your portfolio and input things throughout the year rather than all at the end. Keep an eye out for interesting cases &amp; procedures, challenging discussions, etc that you can reflect on and add to your portfolio throughout the year - you'll need an adequate portfolio to pass ARCP at the end of the year (and they can see when you've uploaded your evidence; you won't pass if it's all added at the end of the year!). Remember - as a foundation doctor you are not just service provision, you are there to learn and be trained - seek out opportunities to take part in various procedures and activities that will enrich your knowledge. If you find that your work is becoming repetitive and/or you are unable to find the time to take part in learning activities, speak to your Educational Supervisor.</li><li>WellbeingAnd finally, wellbeing is crucial to this job. Although it can be interesting, it is also taxing and it is important to take care of yourself in whatever way suits you best - taking time for yourself for your hobbies, going to the gym or playing sports/instruments, socialising with friends/family, etc - try and find something that you enjoy doing during your time off. Likewise, it is okay to use your time off to do nothing and order takeaway and watch TV - use it how you like to maintain positive mental health! Know who to contact if you find you are struggling at work - such as your Educational supervisor, Guardian of Safe Working Hours, Wellbeing team, or Medical Education team.</li></ol>Although it is easier said than done, try not to be overwhelmed - if you're proactive, you'll pick all of this up when you start. Use your shadowing period well to find out as much as you can about daily life in your new hospital. Usually the best people to speak to are the current F1s &amp; F2s on your ward, as they will have recently gone through what you are going through and will be able to give you an accurate low-down. Enjoy your new job (and the paychecks that come with it!). And remember - if you don't know something, don't be afraid to ask! You're a newly qualified doctor starting (what is usually) your first job - no one will expect you to know everything and will appreciate you asking questions rather than being unsafe/unsure.Best of luck!See my other articles for more (hopefully helpful) advice &amp; tips.

Are you a fifth year medical student or newly qualified FY1 doctor wanting to know some handy tips to make your first year as a doctor easier? As an FY1 myself, I've provided some hot tips for things to know/find out when you start in your new hospital.

The FY1 Perspective - Top Tips for your new job

The Biceps muscle (Biceps Brachii) has long been shown to signify strength.Popeye is a famous 90's cartoon character known for his show of strength.Biceps brachii is one of the main muscles of the upper arm which acts on both the shoulder joint and the elbow joint.&nbsp;<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcomics-in-medicinepopeye-muscle-8w6ucc%2Fimages%2Fai-2.png?alt=media&amp;token=13fb0d42-fe9c-41fd-8fde-be2614d279e5">It derives its name (Bi-ceps) from the fact that it consists of two parts (heads).Tendon is a structure that attaches muscle to the boneFrom the below image, you can learn that the biceps muscle is attached to the bone in 3 areas:1. Proximally, via the long head tendon2. Proximally, via the short head tendon3. Distally, via the distal bicep tendon<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcomics-in-medicinepopeye-muscle-8w6ucc%2Fimages%2Fai-3.png?alt=media&amp;token=f017bc48-8557-49d5-afb1-564364d01610">Popeye muscle is a characteristic bulge in the upper arm that occurs as result of:1. Bilateral proximal tendon rupture &amp;/or2. Distal biceps tendon ruptureIn proximal tendon rupture, the muscle moves down towards the upper arm whereas in distal tendon rupture, the muscle retracts up toward the upper arm.&nbsp;<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcomics-in-medicinepopeye-muscle-8w6ucc%2Fimages%2Fai-1.png?alt=media&amp;token=969dee21-29b0-4023-b1ab-d129e43a19ba">In both situations, the result is a characteristic bulge seen at the middle of the upper arm known as POPEYE MUSCLE.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcomics-in-medicinepopeye-muscle-8w6ucc%2Fimages%2Fai-4.png?alt=media&amp;token=95c7a1e4-840b-4d6e-972a-df913fcbbb35">

You might know Popeye as a famous 90's cartoon character known for his show of strength.
Well, what is Popeye muscle?! Read to know more..


Comics in Medicine_Popeye Muscle

As the start date for DCT posts is fast approaching and I thought I’d share a few little gems I’ve picked up during my first year of DCT - some tips were kindly passed down from me from DCTs above and others I learnt the hard way!So, here it is, 10 top tips that I swear by.. <ol><li>Be organised with a diary</li></ol>Physical or electronic - there’s always lots of important dates to remember (study days, mandatory training etc) and so to save double booking use a diary to keep organised&nbsp;<ol start="2"><li>Book annual leave early</li></ol>Sometimes there is a limit to how many DCTs can be off at the same time so book early to avoid disappointment! <ol start="3"><li>Look after your well-being</li></ol>My maxfacs days were long hours and often very busy and so many of us were guilty of not eating / drinking enough through the day. Make sure to look after yourself first and encourage others to do the same&nbsp;🧡<ol start="4"><li>Keep a logbook</li></ol>Not only is this great for your own portfolio / CV it also comes in handy when your electronic portfolio is checked at around the mid point and end of the year as this is part of the requirements to pass. You can easily upload this when needed saving you a lot of work!&nbsp;<ol start="5"><li>Embrace and enjoy the journey</li></ol>DCT is a great learning curve, you really learn a lot about yourself, your strengths and things you can improve. Socialise, make the most of it and enjoy the experience!<ol start="6"><li>Stay on top of your ePortfoilo</li></ol>By updating it a little weekly this helps reduce the workload when the assessment day is approaching! (Believe me, you’ll thank me later&nbsp;☺️)&nbsp;<ol start="7"><li>Get involved in teaching</li></ol>Skills in teaching are invaluable and help build your communication skills. Evidence of teaching is required in many specialities so it’s great to be able to tick this off early.<ol start="8"><li>Get stuck in</li></ol>You’ll be surrounded by registrars, specialists and consultants. By showing your eager to get involved and learn they’ll love to give you opportunities to do so. The highlight of maxfacs for me was fixing a broken mandible from start to finish, myself! Of course the consultant was guiding me every step of the way&nbsp;👩🏽‍⚕️<ol start="9"><li>Use the team - audits and research</li></ol>Get involved in research / an audit during DCT1 as leaving it until DCT2/3 can cause things to become very busy during those years! Get at least one under your belt&nbsp;✔️<ol start="10"><li>Make friends - you’re all in this together</li></ol>It can be quite daunting starting DCT but there are lots of others feeling the exact same. Talk, help each other and make friends. This helps with your well being, networking and making sure you never miss out on anything!&nbsp;And that's it! They are my golden nuggets of advice but above all, be proud, you yourself managed to secure this job, go you and best of luck&nbsp;🌟

10 super tips to help you get the most out of your DCT year as well as allowing it to go as smoothly as possible :) 

Dental Core Training (DCT) - Top Tips!

<blockquote>“Success is a journey, not a destination. The doing is often more important than the outcome.” — Arthur Ashe</blockquote><h2>A Story</h2>Imagine someone telling you that there is an amazing prize waiting for you at the top of a mountain. It takes 7 hours to get to the top but it’ll be worth it. You decide to take the trek to the top of the mountain and on the way, you meet amazing people, try amazing food, and discover new activities like paragliding and rock climbing that you never thought you’d be doing, but loved nonetheless.Throughout the whole journey, you cannot wait to see what prize is waiting for you at the top of the mountain. After hours of trekking and many new experiences along that way, you get to the top, and the prize was a rock. A boring old, round, palm-sized rock.Would you be happy? No, of course not. But does that take away from all the new experiences you had, and loved, along the way?No matter what the ‘prize’ at the end was, the journey was the same. And that’s life. You make what you will of the journey, not the destination.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fwhy-the-journey-matters-more-than-the-destination-8zejoe%2Fimages%2Fai-1.png?alt=media&amp;token=50d75707-cda9-4550-bb13-83d3ac6d3446"><h2>The Facts</h2>A Harvard study found that we spend almost 50% of our time thinking about the past and future, instead of focusing on the present, which leads to increased unhappiness.<blockquote>“The journey is what brings us happiness, not the destination. — Dan Millman</blockquote>Nowadays, there are countless self-help books and articles talking about teaching people how to improve their ‘destination’ and goals, rather than the journey which will ultimately build their character for success.So, it turns out that you might not even need to reach your goal to be successful. By setting out to achieve a goal, you’re forming new habits and creating a purpose for your life. And no one can take those lessons away.Successful people are adaptable and that adaptable nature comes from the journey, not the destination.Have a great week!AbdullahCheck out my Blog &amp; FREE eBook with lifestyle tips talking about my journey from rejection in medical school to now getting within the top 10% in the UK. - abdullahnadeem.co.uk

“Success is a journey, not a destination. The doing is often more important than the outcome.” — Arthur Ashe

Why The Journey Matters More Than The Destination

The hexagonal&nbsp;honeycomb made by bees&nbsp;to contain their larvae and store honey and pollen has long been admired as one of nature's architectural marvel.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fhoneycomb-in-medicine-8372dy%2Fimages%2Fai-3.png?alt=media&amp;token=55fe3ab5-2cdb-4b85-ae72-b2c976a65126">Picture of honeycombsNote that the surface of honeycombs have a characteristic texture that looks like gaps or air spaces separated by thick segments. In fibrosis of the lungs, the lung tissue becomes damaged and scarred. The fibrotic lungs exhibit a similar appearance with variable sized cystic air spaces separated by thick fibrotic walls as depicted in the image below.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fhoneycomb-in-medicine-8372dy%2Fimages%2Fai-1.png?alt=media&amp;token=16046a6f-4008-4e56-8824-3099a36cb080">https://www.flickr.com/photos/pulmonary_pathology/13436105903 This gross appearance can also be visualized radiographically by CT imaging of the lungs as seen in the below image.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fhoneycomb-in-medicine-8372dy%2Fimages%2Fai-2.png?alt=media&amp;token=9dd3b2d0-98b9-4125-9942-6eaf66423496">https://in.pinterest.com/pin/379428337355530820/ Note:-The walls of the air spaces are&nbsp;lined by bronchiolar epithelium and the spaces are often filled with mucin and inflammatory cells.&nbsp;Suggested references:radiopaedia.org_honeycombing lungsuspharmacist.com_causes of pulmonary fibrosis

Medical professionals across centuries have introduced interesting ways to learn medicine including the use of eponyms. Read to find out how one of nature’s wonders, the structure of a honeycomb is used to describe a pulmonary pathology!!

Honeycomb in Medicine

Well done! After all the studying, all the effort and strain, all those all-nighters and cram sessions you are a bona fide doctor! This is an tremendous achievement and you should be very proud. This new title to your name ("Dr So&amp;So") comes with a few responsibilities. Patients are now relying on your knowledge, competence and the skills you are rapidly acquiring in the workplace. All of this is of no surprise to you. But there comes a time when you will need to go home and live your life. Sleep, dinner, exercise and something called a personal life are necessary (I know its crazy isn't it that doctors are allowed a life!). The European Working Time Directive (EWTD) brought shift work more the forefront of doctors workflow, resulting in fewer working hours, with larger teams of doctors covering different shifts during the day. So what to do when you go home but there are still patients, sick in the hospital? The Clinical Handover is the answer.Clinical HandoverThe expressed transfer of responsibility from one clinician to another clinician for a patient or patients. Essentially it involves communicating the goals and tasks of care for patients as you leave the workplace and another clinician or team of clinicians arrives. Why Handover?With shorter working hours to maximise doctor performance and reduce burnout, handover is essential for the safe operating of a hospital. Everything from priorities for sick patients to mundane (but very important) tasks like unfinished discharge summaries must be communicated. How Do You Perform Safe Clinical Handover?The Royal College of Surgeons in England have an excellent document on evidence based handover. Handover meetings are typically organised at the start of a shift, to enable clinicians to familiarise themselves with patients they will be caring for.The key components of effective formal handover are:1-The handover is a two-way process to provide and receive information, and gives an opportunity to ask questions. 2-Sickest patients are discussed first3-Clinical staff should make each other aware of relevant issues. 4-Handovers must be focused and structured – one speaker at a time. 5-Checklists might help in the management of common conditions. 6-Distraction free: no bleeps, dect-phones or phones.7-Handover arrangements should be reviewed as part of the clinical governance strategy to ensure they are appropriateReferences and Credits:-Royal College of Surgeons of England. Safe handover: Guidance from the Working Time Directive working party. London. RCSEng. March 2007-British Medical Association. Safe handover: safe patients. Guidance on clinical handover for clinicians and managers. London: BMA; August 2004. Image credit in thumbnail: https://www.ceotodaymagazine.com/2019/03/when-is-it-time-to-hand-over-the-baton/

An easy and understandable article on clinical handover for doctors. 

What is it?

Why do we do it?

How is it done? 

Evidence Based Clinical Handover for Doctors: The Whats, The Whys and The Hows

A famous 1900's daily American comic strip, Little Orphan Annie illustrated its lead character as a girl with red hair, red dress, and vacant circles for eyes.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcomics-in-medicinethe-orphan-annie-8rys98l%2Fimages%2Fai-4.png?alt=media&amp;token=8b67cb86-7f4c-41cb-b8be-3d77728616bf">Note the vacant eyesPapillary Carcinoma of the thyroid gland(PCT) is characterised by 2 distinct features on light microscopy, namely Orphan Annie eye nuclei and Psammoma bodies.In PCT,the cells of the thyroid gland i.e., the thyrocytes are large and show an abnormal nucleus and cytoplasm with several mitoses.&nbsp;The thyrocytes have characteristic "Orphan Annie eye nuclei"&nbsp;as explained in the figure below.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcomics-in-medicinethe-orphan-annie-8rys98l%2Fimages%2Fai-1.png?alt=media&amp;token=d691d29b-3e5c-422c-bffc-0ca1ada31eeb">The hand drawn illustration of Orphan Annie-eye nuclei reveals large nuclei cleared out in the center with powdery chromatin marginated to the periphery along with few open- and close-faced nuclei. 1=Orphan Annie-eye nuclei, 2=open-faced nuclei, 3=closed-faced nucleiThese are so named because they have a “cleared-out” appearance, similar to Little Orphan Annie’s eyes. This optically clear or empty appearance is also described as 'ground glass appearance'Features of Orphan Annie-eye nuclei in histopathology include:<ul><li>Large nuclei with singular membranes&nbsp;</li><li>Nuclei with finely dispersed chromatin, which imparts an optically clear or empty appearance</li><li>Nuclear grooves(Invaginations of the&nbsp;nuclear&nbsp;envelope bilayer, which constitute a characteristic feature of papillary thyroid carcinoma)</li><li>Nuclei that are often seen overlapping each other</li></ul><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcomics-in-medicinethe-orphan-annie-8rys98l%2Fimages%2Fai-2.png?alt=media&amp;token=1050cd0a-81ee-4793-b67d-9a9753a696db">Photomicrograph showing numerous Orphan Annie-eye nuclei with few hyperchromatic and vesicular nuclei. &nbsp;1=Orphan Annie-eye nuclei, 2=open-faced nuclei, 3=closed-faced nuclei Also note the overlapping cells and other histological features.Interestingly, papillary thyroid cancer is also characterized by psammoma bodies (derived from the Greek&nbsp;psammos, or sand): in the comic strip, Annie’s dog is named Sandy.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fcomics-in-medicinethe-orphan-annie-8rys98l%2Fimages%2Fai-3.png?alt=media&amp;token=531cce04-0b56-44ce-8659-c674cc6c7819">Suggested references: Robbins Basic Pathology textbook_click for pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830218/

A famous 1900's daily American comic strip, Little Orphan Annie illustrated its lead character as a girl with red hair, red dress, and vacant circles for eyes. How is she related to medicine?! Read to find out!!

Comics in Medicine_The Orphan Annie

Being a dentist can be a daunting thought, especially when you’re just starting out and becoming familiar with the dental world. Progressing from Dental student, to Foundation Dentist, to an Associate and further can seem like very big steps in relatively short spaces of time. Regardless of which level of dentist you may be, timekeeping is an essential element of the profession and enables one to operate more efficiently, reducing daily stress and achieving an overall more satisfactory experience for your patients.Below are some hopefully helpful tips which I’ve learnt (and still learning!) through my own experiences to keep you organised with your time on a day-to-day basis.&nbsp;1)&nbsp;&nbsp;&nbsp;&nbsp; Morning Mindset-&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Leave enough time to arrive to work in the morning. You’ll feel far less stressed and can have time for a warm beverage to get you going for the day ahead. There’s nothing more stressful than arriving late and starting the day already behind! (This sometimes happens though and can’t always be helped, so see ‘communications’ below for tips on how to manage this)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; -&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Arriving early also gives you a chance to look through your diary for the day and know what to expect. You can then mentally prepare for the longer treatments and plan for possible overrunning. You can also check any returned lab-work required for that day, making sure firstly that it has arrived and that it is satisfactory, allowing you to communicate with the lab if required ahead of time rather than during the appointment.&nbsp;2)&nbsp;&nbsp;&nbsp;&nbsp; Diary planning-&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Book in enough time to complete your appointments fully and properly. When starting out, give yourself extra time for treatments especially those which you may find trickier. You can always shorten the timings later when you become more confident, but it is always better to consider quality over quantity and to practice safely.&nbsp;<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Ftimekeeping-in-dentistry-8k3w5e%2Fimages%2Fai-1.png?alt=media&amp;token=aa698bad-d6ea-4aa2-98ff-a6c4f376869b">-&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Try to form a ‘Smart Diary’ whereby there are specified sections for examinations, treatments, emergencies, private work etc (see diagram as an example). This helps you to ensure an even balance of work throughout the day, and to organise your daily workflow better, so that you don’t tire from too many treatments back-to-back or become demotivated by check-up after check-up.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 3)&nbsp;&nbsp;&nbsp;&nbsp; Communication-&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Make sure your team are aware of the treatments for the day so that they can be best prepared ahead of time, thus reducing the need to interrupt the appointment to look for equipment/materials. For example, if a patient is booked for a ‘Root Canal Treatment’, it is helpful to inform the nurse of which tooth it will be for; whether this is the first or second visit; which material you want to restore with after the RCT; how many radiographs you’re likely to take etc, so that everything can be readied in advance and your nurse knows what to expect in the session. This goes for all treatments. If you’re lucky, an experienced nurse may already check these details for you beforehand, but it is still a good habit to run through the day list with them to make sure you’re both on the same page for each patient.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; -&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; If running late to work, don’t panic. Make sure to call your nurse/receptionist so that they can inform the patient and if necessary, move appointments around to keep everything running smoothly for when you do arrive.&nbsp;&nbsp;&nbsp; -&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Similarly, if running late during an appointment, a simple act such as asking your nurse to explain the delay to the next patient and inform them of the estimated waiting time goes a very long way in reducing patient frustration and relieving your stress in the process.-&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; If you have any tricky cases/appointments coming up, use the time beforehand to discuss the case with other colleagues and clarify any concerns or uncertainties you might have. This way, you can begin that treatment with more confidence and with a plan of action if things require a different approach, rather than panicking on the spot. For example, if a root is left behind during an extraction, if you have discussed this case beforehand you may have predicted this outcome and planned the best way to overcome the obstacle rather than feeling panicked in the moment. Not only do you appear more professional and in control to the patient, but you also are likely to be safer in your approach to such cases.&nbsp;4)&nbsp;&nbsp;&nbsp;&nbsp; Making use of free time-&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; There are times when you may find yourself with some free time during the day, certainly early in the Dental Foundation year, or when patients cancel/fail to attend appointments. This can be a fantastic opportunity for clinical practice on models and extracted teeth. Try creating and restoring cavities which you find tricky, or becoming more proficient with different crown preparations, or simply practicing restorative techniques e.g., carving amalgams. This will help you become more proficient with these treatments and reduce time needed for your appointments whilst maintaining quality of work.&nbsp;Time management is a skill that you will work on constantly as a dentist, especially as you increase your knowledge and skills and undertake more complex treatments. There is a fine balance that is needed between working efficiently and safely, whilst maintaining the quality of your work, and this comes with experience and practice. Implementing the tips mentioned above can hopefully go a long way to helping you achieve this balance and make dentistry a far more enjoyable experience.&nbsp;&nbsp;

Here are some simple tips which can be used on a day to day basis, whichever level of dentistry you're currently at, to help you with keeping organised with time in this busy profession!

How to Manage Time as a Dentist

CV writing is rarely, if ever, a skill covered in medical training. In the UK especially, employment as a doctor post medical school is pretty much a given after filling in a few forms and making sure that you’ve passed your finals: No CV or interview needed. But whilst there are thousands of resources available on the internet and beyond that can teach us how to put together the most effective, dazzling document of your accomplishments you can imagine, it’s important to take not of what NOT to do with that precious CV of yours should you be looking to scope out jobs beyond a traditional training programme.&nbsp;&nbsp;Below are some of our top tips on what to avoid when putting together your own precious CV:&nbsp;1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Not matching the job advert skills requests&nbsp;Sound obvious? Sending out a generic, one-size-fits-all CV to prospective employers that doesn’t reflect the skills they’re interested in (or any reference to the job description at all) is not only lazy, but will be a sure-fire way to ensure your resume heads straight to the “Reject” pile. It’s incredibly easy to tweak your CV to include a few keywords that match the job you’re applying for – so read the job description carefully, and integrate&nbsp;their&nbsp;wording where you can to demonstrate that you’re a great match for the role.&nbsp;&nbsp;2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Not providing examples of your skillset&nbsp;&nbsp;Whilst soft skills are undoubtedly important for employers when hiring new candidates, they want to read evidence of those skills in&nbsp;action: In which case, it’s crucial to highlight not only your technical competencies, but to demonstrate how you applied them – for instance, how many people you managed as a student society president, and what outcomes you achieved, such as hosting a conference for “x” amount of people. This is a practical, slick way to demonstrate your value in a single sentence, and how the company you’re applying to can benefit from this too.&nbsp;&nbsp;3.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Not detailing your responsibilities&nbsp;“Responsible for” is a phrase often batted meaninglessly around in the job sector market. Employers don’t get much of an idea of what you’re capable of if you’re skimming over what those responsibilities actually are, especially without context – talk about a research job you did, or an event you organised, or an audit you performed and what this specifically involved. Detail exactly what you were responsible for, when, and what the outcomes were, but be concise – this is where the value add lies.&nbsp;&nbsp;4.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Not explaining your accomplishments&nbsp;You’re fresh out of medical school with a bunch of awards and honours – so what? What do these awards actually reflect; did you better the life of the university? Did you win a national competition for surgical skills? Did your research get a top-notch recognition at a conference? How well did you outperform your peers (no pun intended)? Be explicit, and show how these accomplishments differentiate you from others.&nbsp;&nbsp;5.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Excluding volunteer work&nbsp;&nbsp;Unpaid work – especially at an early career stage – is very important to demonstrate, and also shows your dedication to a role that is often underpinned by collaboration, community and selflessness – excellent qualities all round that employers love to see.&nbsp;&nbsp;6.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Including irrelevant hobbies&nbsp;It’s also important to recognise when you&nbsp;shouldn’t&nbsp;include something – and unnecessary hobbies take up space on your limited CV pages. Most employers have inherent biases, and though they want to see you are human, it’s not necessary to dedicate more than a line or two to something that you’re interested in outside of work. Better still, if your hobby links back to something you’ve accomplished or achieved, emphasise that (e.g. ran a marathon in support of a charity you volunteer for) rather than something arguably irrelevant (e.g. your love of reading fiction).&nbsp;7.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Not putting the most vital information at the top. &nbsp;&nbsp;Recruiters don’t have a lot of time to read your CV – most will skim over your life to date in 30 seconds or less. In which case, make the most important information the first bit that they’ll actually read – put your qualifications, accomplishments, skills and most recent (chronological) work experience in order from the top-down, and less relevant information (hobbies, for example) at the end.8.&nbsp;&nbsp;&nbsp;Not getting to the pointIn the same metaphorical vein with point (7), overachievers, beware - nobody wants to read a 6-page CV (unless, maybe, you’re applying for an academic job that specifically demands one. In which case, kudos). Keep your CV neat, readable, specific and short - 2 pages should be more than enough to cover what’s needed.&nbsp;

Things NOT to do when it comes to writing your CV...

Common CV mistakes NOT to make

Those who are going through – or have gone through – medical training anywhere in the world will know how time- and resource-consuming it is, and the sunk fallacy cost can be a huge deterrent from pursuing other career options. But if you are considering a break from a traditional clinical training path, it can be enormously rewarding and even complementary to either a long-term career in medicine, or one that can lead you to work a different industry altogether. Surgical and medical doctors acquire a huge set of soft and hard skills at every stage of their training, and which are readily transferrable to a range of other disciplines, so don’t be discouraged!&nbsp;&nbsp;Below are some tips and recommendations we at Peerr wanted to share around non-traditional job roles for medics to better inform your decision-making process.&nbsp;&nbsp;First of all, questions to ask yourself:&nbsp;&nbsp;1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;What are your strengths?&nbsp;A cliched, classic interview question for some, but it is hugely important to consider what strengths you have that differentiate you from other medics and non-medics alike when looking at a competitive job market, and provides you with a so-called “unfair advantage”. Do you have any experience of coding or programming, for instance, that you can either build on or could lead you straight into a tech job? What about any extra degrees that might lead you into a research career in academia or pharma? This is a useful starting point to underline where your best career “fit” may be.&nbsp;&nbsp;2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;What are your passions?&nbsp;Having said that, it’s arguably of equal importance to consider what you&nbsp;enjoy&nbsp;doing – you may be particularly good at communication, marketing or coding, but it might not necessarily what rocks your world. Think about what you want to do, and see if there’s a match – for instance, do you enjoy getting outdoors, or travelling? Expedition medicine may be the one for you in that case, and many taster or short trainee courses exist that can allow you to assess whether you enjoy it or not (see WEM, for example). What about writing, or journalism? Medical writing and copyrighting may also play to your passions and medical training strengths: It’s also easy enough to get started as a freelancer whilst still working as a medic by pitching to various organisations such as the BMJ Opinion, who accept open submissions on a rolling basis.&nbsp;&nbsp;3.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;What can you build on?&nbsp;Depending on what arenas you wish to pursue, it’s always helpful to work on&nbsp;building both a strong academic record and a portfolio of relevant experiences to differentiate yourself from others applying for the same roles. Volunteer work and internships are also options here, and it’s important to remember that it’s never too late to change course and try something new. Reflect on what experiences you have that will be relevant or transferrable to where your interests and strengths lie. Identify if any courses you can sign up to (or even a higher education degree) would enhance your skillset and build on what you already know to better position yourself for your desired career.&nbsp;&nbsp;4.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;What are you doing to network?&nbsp;If you only have only takeaway from this article, it should be this - don’t be afraid to reach out to connect with others (I’m a huge advocate of LinkedIn for this) – generally, the worst-case scenario is a rejection, which you can also seek feedback on, or being ghosted, in which case, you can simply move on to the next point of contact. Message people (politely!) via email, social media or in person (think conferences and work events) to convey concisely and clearly what it is that you want – are you asking them for advice; to review a job application; to provide recommendations; to share their experiences?. Think also about what you can also offer them (if anything) – what’s in it for them to respond to you, other than goodwill?&nbsp;&nbsp;And lastly for this article, a few quick-fire pointers to remember:&nbsp;1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Don’t be afraid to make the leap&nbsp;One of the major advantages of a medical career is that it can always act as a fallback – as long as you maintain your professional requirements, taking a career break and returning to training is never impossible.&nbsp;&nbsp;2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Don’t be afraid if it doesn’t work out the first time&nbsp;&nbsp;Don’t fear failure – it can be incredibly disheartening, but it is also not the “be all and end all”. It is absolutely crucial to learn how to dust yourself off and start again if something doesn’t work out the way you expected it to, and to learn from any failures along the way in your alternative career journey. Where possible, always seek feedback and input on what may have gone wrong (for instance, an interview that didn’t go to plan, or some pointers for your CV), and build on this for next time.&nbsp;&nbsp;3.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Don’t feel you have to do everything at once&nbsp;Another major advantage of medical training is that you don’t have to completely abandon it in pursuit of another career – you can learn a skill or take up a part-time educational course in evenings, weekends and during PTO, for example, rather than completely trading in one career for another.&nbsp;

A quick-fire guide to getting started (and questions to ask yourself!) for those of you with medical degrees wondering what else lies out there in the world of employment...

Alternative careers in medicine – getting started

TikTok is an abusive, technological marvel in so many ways.Its User Interface (UI) removes the clock at the top of your screen, similar to casinos, so you don’t realise how long you’ve spent. It prevents you from skipping to particular parts of the video/ going back if you miss something - thereby, forcing you to watch the entire thing again.But its crowning glory is its algorithm.<h1>📱 The Algorithm</h1>Everyone knows how (scarily) good TikTok is at keeping you scrolling through endless videos. Its algorithm crunches through terabytes of data to keep you on the platform.Its power is of no surprise when we consider the fact they're backed by the authoritarian and invasive Chinese government, who lack respect for any notion of “individual privacy” or “human rights”. If you’ve ever downloaded the app, or even watched a TikTok online, your data already belongs to them.Through this wealth of data, it infers even more user characteristics such as your ethnicity, religious beliefs, and sexual orientation. If you can find groups in this data, you can target content to boost watch time.For example, young, white, privileged, atheist Millennials, who visit Starbucks often, may spend more time on the app (watching more ads) when shown puppy videos at 11 pm, whilst they’re in bed.Profit is maximised by showing the right people the right content at the right time.But there’s too much data to be understood by humans.<h1>📊 Classification Algorithms</h1>TikTok identifies groups using classification machine learning algorithms.The actual implementation is complex, but the core idea is understandable.For example, when deciding which videos to show me, the algorithm considers variables like my <code>age</code> and my time spent watching videos tagged as <code>coding</code>. It compares this with similar users and places me in the Group <code>‘Nerd’</code>. I get shown maths videos interspersed with science videos because Nerd Group users spend longer when shown this combination of content.They just need to sort through all the data to find the right groups.<img src="https://www.anchit.me/content/images/2022/03/image.png" alt=""><h1>💻 K-Means Algorithm</h1>An actual example that does this is called the ‘K-Means’ algorithm.Let’s imagine we just use two variables to find different groups:<ul><li><code>user_age</code> on the X-axis</li><li><code>time_spent_watching_coding_videos</code> on the Y-axis</li></ul>We can already see 2 distinct groups: at the top-right and bottom-left:<img src="https://www.anchit.me/content/images/2022/03/image-1.png" alt="">But the algorithm can’t see these groups: instead, it uses ✨maths✨ to explicitly find groups in data.<h2>🕶 Some maths</h2>It needs training to identify the groups <code>Nerd</code> and <code>Not_Nerd</code>. Because we want to find 2 groups, it randomly places 2 ‘centroids’.The computer calculates the distance between each point and centroid - assigning each point a particular Group, depending on its closest centroid. Through an iterative loop (shown in the gif below), the algorithm then finds the mean of each cluster and moves the centroid closer to the centre of each group. The process stops when the variance of each group is roughly the same.<img src="https://www.anchit.me/content/images/2022/03/clsuer.gif" alt="">In Python, this can be programmed in 3 lines:<img src="https://www.anchit.me/content/images/2022/03/carbon.png" alt=""><h1>⚖ The Power of Algorithms</h1>This works fine for 2 variables.However, TikTok uses millions of variables per user. It’s hard to visualise identifying these groups because they exist in the millionth dimension, but it’s very easy for algorithms to do so using maths.<img src="https://www.anchit.me/content/images/2022/03/flea_col.gif" alt="">TikTok wastes this power on profit (and probably pro-CCP propaganda) but the possibilities are endless: you could predict general health status from Deliveroo data or suicidality from Tweeting habits.You could do great good by targeting help.Or you could selectively increase insurance prices and bar people from applying to your company.What would you do?

Everyone knows about TikTok's algorithm.

How does it know exactly which cat video to show at the perfect time?

This article covers one example of a machine learning algorithm used in recommendation engines!



How does TikTok's algorithm work (sort of)?

Maneuvering the many seen and unforeseen challenges that come with this journey of obtaining a medical degree is both mentally and physically exhausting. I wish I’d had someone to get some insight on what to expect so here are some of my tips and advice for getting through your first semester of medical school! Get to know resources available to you - Becoming familiar with the resources provided to you by your institution before you actually need them is essential. For example, my school provided learning strategists that we could book appointments with to maneuver the transition between studying for undergraduate versus medical courses. Other resources such as counseling/therapy can be an immense help when and if you start to feel the mental toll medical school can take. As you’ll come to experience, life does not stop while you progress through your studies and learning healthy coping strategies will help you get through difficult times.&nbsp; Find your people - If you're moving to a new city, state, or country for medical school this will be even more important. Finding your family away from home may take some trial and error but it will help make medical school less lonely and daunting. Finding the right people for you is important because unfortunately you may find that your friends and family back home will not fully understand why you are so stressed. Having others in the same struggle, who you study well with, and support you will help make this experience a happy time. Keep in mind, you want to have people who you study well with i.e. don’t spend your entire study session talking. But that doesn’t mean you can’t be friends with those students, they can serve as your people who keep you sane when you need a study break! Be flexible - The transition from undergraduate (and even graduate level) courses can be difficult and it will take some time to find what works for you in terms of how to study in medical school. Being malleable in your approach to studying and trying new study tactics will be paramount to your success. Sometimes you will have to change your study habits and technique from module to module or term to term. Be patient with yourself and remember to be flexible during this transition to find what works with you throughout.&nbsp; Set realistic goals and expectations - As I’m sure you’ve heard time and again, the amount of information you are fed in medical school is like trying to drink from a firehose; it is probably the most accurate depiction I’ve come across. This is why it is important to set realistic daily goals for yourself. There is always going to be an infinite amount of things to do but you won’t always be able to get them done. You’ll find yourself adding things to your to-do list and before you know it, it looks like a grocery receipt! That’s why being realistic with your to-do list will help keep you sane and productive. Prioritize the tasks that are time sensitive and leave the others for the weekend.&nbsp; Remember to take a break - This is a marathon, not a sprint. The days of pulling all-nighters are over. Prioritize getting sleep. If you’re tired and falling asleep while trying to do practice questions, review a lecture, etc. chances are you are not going to remember what you’re doing and will have to redo all this work. When you feel tired, stop and take a break. You will feel guilty about it but I guarantee you will feel worse about having to spend extra time re-doing material you didn’t fully grasp the first time. One of the things I like to do is take Friday evenings off. Fridays after lecture I treat myself to eating out and spend the evening watching Netflix, facetiming friends/family, or napping. This way I start the weekend feeling refreshed and ready to attack my to-do list.

A few little things you can do to start your medical school journey and ease your transition from pre-med to  med! 

Tips for Starting (and Surviving) Medical School

I recently appeared as a guest on “The Healthtech Podcast,” where I talked about the fact that every job that I’ve gotten since medical school has come to me via social media because of my visibility online. Whether you want to attract more patients to your private practice, network with like-minded medical professionals, or grow your reputation within the health care industry, personal branding can be a great strategy to help you achieve your career goals. What personal branding is and why you should do itPersonal branding is how you share who you are to the world. Your personal brand is made up of your voice, personality, interests, what you’re good at and passionate about, and how you communicate that to the public.Building a personal brand provides many opportunities for career advancement. Through social media, you can connect with fellow medical experts and thought leaders you may never have had the chance to meet in real life. I’ve gotten to know so many other doctors through Instagram who, like me, have branched out to other fields, and I’ve made lots of friends in the process!Becoming visible online lets the world know that you’re open to building connections, and you’re more likely to attract interesting job opportunities. Thanks to blogging, I was contacted to become a content reviewer for BabyCentre. Since leaving clinical practice, I’ve been offered jobs and collaboration opportunities through Instagram. I’m also often contacted to comment on women’s health topics and have been quoted in Glamour, Marie Claire, Cosmopolitan, and HuffPost, in addition to many British newspapers. It’s a snowball effect — the more visible you become, the more opportunities you’ll attract.If you’re interested in finding or becoming a mentor, social media is a great place to do that. Someone recently reached out to me via LinkedIn to become her mentor as she makes the transition into the world of healthtech, and it’s been really rewarding to share my experience with her!When creating your personal brand, be very mindful of the fact that everything you do and post online may affect your reputation. The truth is, we all look people up online and check how they present themselves on social media. So it’s important to be conscious of what you’re putting out there — people will use that to form an impression of you. A word of caution about sharing medical information when building your personal brandI first started building my personal brand while working as a general practitioner (GP) within the UK’s National Health Service. As a doctor, I naturally centered my posts around medical topics at the beginning. But as time went on, I realized that talking about medical topics can be rather tricky, and risky too. It’s difficult to make your posts applicable to everyone who sees them. You also need to be careful when speaking about your personal health choices because people could perceive them as personal advice.For instance, if you’re a doctor and talk about a vitamin you take regularly, one of your followers may start taking it too, even if they have different health circumstances, and it could potentially be harmful. As a doctor, it’s important to be aware of the fact that people view you as an authority figure and will follow what you say. A single post has the potential to impact a lot of people.It’s certainly possible to post medical information safely, and many people do it well. You just have to be careful to balance the potential risks. The General Medical Council in the UK is planning new guidelines stating that doctors who share “misleading” information on social media could face regulatory action, according to a recent article published in The Guardian.Another thing to be aware of is that people will likely reach out to you for medical advice on occasion, and you need to think about how you wish to respond. Giving personal medical advice via social media is never a great idea, and, personally, I don’t give out generic medical advice to individuals either. <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fhow-to-build-a-personal-brand-a-guide-for-medical-professionals-8lwe2t%2Fimages%2Fai-1.png?alt=media&amp;token=ed1b7b94-f241-4ef7-aebd-620494d79a1c"> If you’re a practicing doctor and post about health topics, it’s crucial to maintain complete confidentiality and respect your patients’ privacy. When I was a GP, I was acutely aware of everything I shared on social media. I felt really anxious talking about patients’ medical conditions in case they saw it and realized I was talking about them, even if it was totally anonymous and nonspecific. So I never posted anything related to a patient that I saw that day.Another thing to be mindful of when building your personal brand as a doctor is how much you share about your personal life online. Once I realized the risks of posting about medical topics and patients, I began posting more about my daily life. I got high engagement but started to feel uncomfortable sharing so much about my kids. Patients would come in and say that they knew where I was over the weekend or talked about things I said I liked or disliked. I realized that, for me, it was not the best idea to put my whole life out there as a clinician. If this is something you want to do, it goes without saying that you should be aware that patients can see everything you post. Before sharing something, ask yourself: Do you want your patients to see that?Now, I see social media as a place to share my personal portfolio, mostly with bits from work and the occasional bit of home life. And I don’t share the same things everywhere. For instance, I use LinkedIn for networking, sharing my thoughts, and job opportunities to help others, while Instagram is centered around lifestyle. How to build a personal brand step by step <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fhow-to-build-a-personal-brand-a-guide-for-medical-professionals-8lwe2t%2Fimages%2Fai-2.png?alt=media&amp;token=dca6035d-56fa-46a9-9d14-6e7c01a830a1"> 1.&nbsp;Understand that it will add to your workloadBefore you start creating a personal brand online, you need to make peace with the fact that it’s a lot of work. You’ll likely be posting in the early morning or late evening. Because of that, it’s helpful to actually enjoy doing it. And remember that with the extra work come more opportunities and connections, so it does pay off! 2. Experiment with platforms and choose the one you like bestFeel free to try different social networks. If one doesn’t feel like a good fit for you, you can always delete your profile later. I experimented with each platform and picked the ones I liked best.<ul><li>Twitter has many doctors, so it’s easy to connect with peers, and the short format makes it faster to create content.</li><li>LinkedIn is a must for networking!</li><li>Instagram is a good place to show off your personality.</li><li>TikTok and Snapchat have a steep learning curve and a younger target group, so it can be challenging to toe the line between professionalism and being entertaining.</li><li>Websites are great if there are topics that you want to share a lot about. You can do so with your own blog.</li></ul>Don’t feel like you have to be everywhere! Personally, I chose to stick with LinkedIn and Instagram. I also recently started creating TikTok videos for Flo to reach some of our younger users. 3. Be yourselfThe most important aspect of personal branding is to stay true to who you are. Some say that you should show people what you want them to see, who you want them to think you are. This may apply in some cases, but I strongly believe that personal branding is much easier and more enjoyable when what you’re sharing aligns with your personality and values. If you have to constantly edit yourself to fit the image you want to portray or what you think people will like more, it adds more work and is unauthentic. Eventually, people will see through it.This point also applies to your profile photo — just be yourself! Don’t obsess about looking professional. My LinkedIn banner photo is my kids pulling silly faces, as this shows off a huge part of who I am. 4. Find the content formats that work for youSome people think that to build a personal brand, you have to show your face on social media all the time. I disagree. If you aren’t into taking lots of selfies and sharing photos of yourself, you don’t have to. You can also get your point across through text posts, screenshots of articles, and comments on other people’s posts. Making your opinion known is more important than showing your face, and that’s also what potential employers care about more! 5. Don’t obsess over your post consistency, likes, or followsIt’s really easy to get wrapped up in these things when building a personal brand on social media. But if you’re not able to keep up with a certain consistency of posts, that’s OK. Don’t worry too much about the algorithm or your like and follower count. These aren’t always a marker of success! You don’t need millions of followers to build a strong network and attract interesting opportunities. I certainly didn’t. 6. Audit yourselfIt’s a good idea to look yourself up a couple times per year and scan your profiles. Ask yourself, “Does this represent me and the image I want to put out there?” Review your bios and refresh them with new information if necessary. 7. Follow thought leaders and experts in the fields you’re interested inOnly follow people you actually like, want to see regularly on your feed, and want to hear what they have to say. Avoid overly affiliating yourself with any one person. 8. Don’t just post for the sake of itTake a moment to consider why you’re sharing something before hitting publish. There have been times when I realized I was just posting for myself and not engaging with other people’s content. Remember that social media is a give and take. The whole point of it is to have interactions with others. Engaging with people is the thing that actually benefits you in the end. People can tell when someone is just posting to show themselves off. So each time you’re about to post something, ask yourself why. We’re always looking for more medical experts to collaborate with at Flo, we’ve found many of our 100+ medical advisors thanks to their visibility online! If you’re interested in chatting about personal branding or working for Flo, my door is always open!

Article by Dr. Claudia Pastides, medical advisor at Flo Health Inc.

How to build a personal brand: A Guide for medical professionals

Ever since I transitioned from working as a GP to a full-time job in HealthTech, I often get asked if I miss seeing patients. While I absolutely do, my job at Flo has opened the door for me to become the medical professional I’ve always wanted to be (but didn’t know it). If you are a doctor and entertaining the idea of getting into HealthTech, here is my story and a guide to how to make that shift. The role of a medical advisor in HealthTechThere are a variety of roles for a doctor in HealthTech. For instance, in my case, the role of a medical advisor is to make sure that all the content we publish, whether it’s an article, video, or social media post, is medically credible, trustworthy, and as safe as possible for our users. A medical advisor steps in whenever there needs to be another doctor’s eye to look over something and takes part in the content development process from start to finish.Medical advisors are a crucial part of HealthTech companies. Doctors can put themselves in the shoes of users who consume the content and anticipate different situations or where something might be misinterpreted. Nowadays, there is so much health information readily available online and through mobile apps, but without qualified medical experts working together with these companies to ensure the accuracy and credibility of the content, it could end up being harmful for people.Working in tech, you have the potential to make an impact on a large scale. One of my favorite parts of being a physician was promoting public health by educating my patients and practicing preventive medicine. At Flo, when you work on an article about disease prevention, that piece of content has the potential to reach 200 million users around the globe! So it’s still fulfilling because you’re making a difference and helping people, just in a different way. How to make the switch from clinical practice to tech: The guide and formulaWhat is unique for HealthTech is that here you can actually put your other passions and interests into practice, even those not so obviously related to medicine. HealthTech can provide the opportunity to combine those hobbies with your main medical specialization.But where should you start as a doctor if you want to become a part of a HealthTech tribe? While there’s no obvious career pathway to get you there, I’ve summarized the things I’ve learnt and done along the way in a multi-step guide: <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fhow-to-go-from-being-a-practicing-physician-to-a-medical-advisor-in-healthtech-8y6dqe%2Fimages%2Fai-1.png?alt=media&amp;token=9d64470e-4b8e-442f-b5dc-f850c124a1f1"> 1. Specify the area of your medical expertiseYour medical specialization is your core skill and the greatest value for HealthTech — make it stand out in your CV. 2. Add a unique ingredient — define your passionsThere might be something you are doing as your hobby or some unique skill that you never thought could be of use in your medical practice. Maybe you’re curious about marketing or good at storytelling. Or maybe you love analyzing data. Whatever it is, be sure you highlight it — this extra ingredient could be exactly what a HealthTech company is looking for in a medical advisor role.In my case, before transitioning full-time into tech, I was blogging and creating social media content and putting together and marketing medical courses and conferences in addition to my clinical work. I’ve always been passionate about writing and marketing, and that was something that was missing for me in my work as a doctor. 3. Explore the opportunitiesNow it’s time to check what’s out there on the market. You might need to be aware of the latest technological progress and trends. I would advise using different health apps as a user (a “patient,” if you will), reading more articles online, etc., and, of course, simply checking the “careers” pages of different HealthTech companies and exploring the descriptions of relevant roles. You might be surprised how unique those roles are. By doing this, you’ll be able to understand where you match, or what additional skills you might need to develop to match these roles. 4. Learn additional skillsOnce you’ve explored the market, you might find you need to level up or add some new skills to your professional background — for example, go to some marketing workshops or take some online courses. If you wanted, you could also familiarize yourself with tech platforms and tools that are commonly used, such as Google Docs, Slack, Jira, Miro, Zoom … the list is probably endless! We use a wide variety of tech platforms compared to what’s used in clinical medicine, and although you might not have access to these, you can have a look on YouTube and get a feel for them. 5. Polish your profileThe digital age requires digital solutions. Make your profile visible on professional web platforms like LinkedIn, and make sure your social media accounts on Twitter, Facebook, Instagram, etc., give off the right impression. 6. Network and reach outIn addition to simply applying for available roles, there are plenty of HealthTech meetups, events, and hubs to attend that could open a lot of doors for your career in tech. If there are none in your area (often the case due to the pandemic), check out online options. These events are a great tool to meet new people and develop a strong professional network.I especially enjoy networking on LinkedIn and following people like Dr. James Somauroo, who has a great HealthTech podcast and regularly posts updates about the industry. Often, by following people working in HealthTech, you’ll discover more and more people to follow. I encourage exploring different HealthTech podcasts such as healthpodcastnetwork.com. There are more of us out there than it seems! This guide could also be simplified in a formula:Your medical specialization + Your unique passions and skills (hobbies) + Market needs = Your new role in HealthTech <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fhow-to-go-from-being-a-practicing-physician-to-a-medical-advisor-in-healthtech-8y6dqe%2Fimages%2Fai-2.png?alt=media&amp;token=2d39fc3c-db5c-4c91-a7ec-8ca5635aef6e"> So the formula can look like this: define particular passions and skills you have, some of which you might not be able to express in your GP position, and look for a role in tech that matches it.Because there are a variety of unique roles for a doctor in tech, this combo of passions and skills can be exactly what both you and the tech market are looking for. So in my case, it was my medical knowledge as a GP plus my passion and skill for writing and marketing as a unique ingredient that was exactly what Flo was looking for in a medical advisor.However, the role description for a medical advisor is not limited to just this one example. You might be a better match for the role of a senior medical advisor: For this, you might need to be a good presenter and a strategic thinker. Or you might match the role of a medical advisor who works on chatbots, so in that case, you’d need to understand how data analytics work. The options are limitless and constantly evolving.And because those roles are evolving together with technologies, let’s now go over what other qualities you might need to work in HealthTech. What else a medical advisor needs when working in tech Working quickly and being flexibleDoctors have to work quickly because time with each patient is limited, but you follow guidelines, and processes take a long time to change. In tech, things are in constant motion, and you need to move fast to keep up and continue progressing. At Flo, you have to learn to fit into sprints, stick to tight deadlines, and adapt to changing circumstances. Creative thinkingIn HealthTech, you have to get used to thinking outside the box. Not just to come up with a constant string of fresh content ideas, but also to figure out how to make that content relevant to as many users as possible. Outside of my content role, I frequently take part in brainstorming sessions for exciting new app features and ways to improve the user experience. Doctors need to stick to procedures and standards, and there’s not always a lot of room for creative thinking. Being a team playerWhen I was a GP, I worked mainly alone in my exam room with my patients, reaching out to other specialists and team members when needed. In HealthTech, you’re part of a big team that consistently needs to work together. There is very little that you can do in isolation. It is all a team effort. You also have to adapt to a different structure and style of teamwork, and learning to regularly receive and give feedback is a big part of that. Using different softwareWorking in the content side of HealthTech, you’ll likely need to become familiar with many different software programs to manage daily tasks. It’s a very different workflow from the one in general practice, where you have just one computer system, and that’s it. Remote workingWhile for many of us, remote working became a normal part of life during the pandemic, health care is mostly still face to face. You need to learn how to work from home and manage your time well while doing so. Advice for doctors thinking about working in HealthTechNowadays, thanks to HealthTech, there are so many opportunities available for doctors that weren’t there before, and the industry continues to grow daily. Moreover, your own interests and skills may be just the thing that a HealthTech company needs. There’s this thinking that doctors should follow one straight path of education, training, and then seeing patients until you retire. And if you don’t do that, you’ve either failed or aren’t good enough.My advice for physicians thinking about transitioning into tech is to remember that your medical education is valuable. Your skills and knowledge are incredibly useful outside of one-to-one patient consultations, and you can make a positive impact on many people’s lives by working in HealthTech. If this has inspired you to check out HealthTech— you can discover what opportunities are available at https://flo.health/careers

If you are a doctor and entertaining the idea of getting into HealthTech, here is my story and a guide to how to make that shift.

How To Go from Being a Practicing Physician to a Medical Advisor in HealthTech

<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fis-the-grass-greener-on-the-other-side-dr-cynthia-tan-anaesthetic-resident-non-us-img-83ktxyk%2Fimages%2Fai-1.png?alt=media&amp;token=12a49217-496a-433e-9ab7-d5e60b4318e2"> Dr Tan graduated from Warwick Medical School in 2018, and worked as an FY1 in the NHS before moving to the US as an anaesthetic resident.<hr><h1>Interview Notes 🎙️</h1>How did you find the transition from an undergraduate degree to studying medicine?I had colleagues who were accountants, engineers, lawyers before medical school who then decided to go into graduate med. I feel like medicine is a commitment, when you choose to do medicine, you really have to put yourself out there as someone who continually studies daily, or whatever works for people.So I think it's a change in how you study and also the content that you're studying. For me, I guess, coming from a science background, I kind of had a bit of basic understanding but for a lot of my colleagues, I know, they really struggled.So for people who are going to graduate medicine, I would say, don't feel afraid, don't be deterred by the fact that you've done something different before going, because a lot of people do choose to go to grad med having done something completely different. Tell us about the highlights of your time at medical school?There was definitely some really daunting memories of sitting exams and thinking I failed that exam.I definitely made great friends from med school who are now lifelong friends. That's definitely a huge highlight and I think for a lot of us students going through med school and realizing, wow, I am capable of doing that.I can go through that training and all of what is expected from me and being able to graduate and become a doctor. I think that's definitely a huge highlight, because, five, six years ago, I would never have thought that this is where I would be. Tell us the thought process and how you sat the USMLE while in medical school?I still don't know how I managed to do that and I think that's definitely one of my proudest and biggest achievements, because I was in my second year at Warwick, which meant, it was like a clinical place.So that year was an exam year, I had to sit my Warwick exams, and then I was prepping for my USMLE I still don't know why I chose to do that. I was just like, oh, the timeline worked out well, so that's what I'm going to do.<blockquote>But it was very, very stressful because the USMLE content is very different to what I feel med school in the UK which is very clinical driven whilst the USMLE is very basic sciences driven. So I was studying for two different things at same time, stressed out like crazy, I remember breaking out, I was constantly doubting my ability to be able to do what I was doing.</blockquote><blockquote>So it was very, very difficult and whenever people in the UK asked me this, what they should do, I always tell them to just make sure they plan things out better than I did, because I kind of just tried to do two exams the same time, whereas I would recommend that people do one after the other or, if you can do the USMLE before your clinical exams that will give you a better foundation. </blockquote>Did you always want to eventually go to American to practice medicine?Two big reasons, it was something I've always thought about when I was an undergrad, I've always admired how innovative scientists and research is in the US, I've always thought it would be a great place to go for training.Throughout med school, I considered it but it wasn't something that was on my mind until I was in my second year of med school. Just because I knew how many extra exams and steps I had to do to get to the US. Personal reason was also that my husband's American. Do you need to be matched in order to work in America?Matching is a whole process in the US, when you apply for residency you submit your applications in September, and between October to February you get interviews from whatever schools you apply to.One week in March, on a Monday you find out whether or not you've matched but you don't know where.Between Tuesday and Friday that's for people who haven't matched and go into second, third and fourth rounds of matching processes.Friday is like the official match day where you find out where you've matched, what program you matched and where you're going to be for at least three to six years of your life.Is Anaesthetics something you have always been interested in?Anesthesia is definitely something I've always been interested in, starting in med school, when I did a mission elective trip in Nepal, where I worked with an anesthesiologist who was amazing. He showed me the skills of the trade but also we had like a power outage in the middle of the surgery, and they were just so calm, and they continued to do surgery, I kept the patient ventilated, and I was like, Oh, my gosh, people are amazing, they're so calm.Throughout med school, whenever I was on my clinical rotations, whether it was like surgery the anesthesiologist always were the one that taught me and I felt really under their wings and they let us do procedures.My undergrad had a lot of physiology and pharmacology as well. So it just kind of all tied in together to things that I was personally interested in and what I enjoyed. The lifestyle of anesthesiologist was also pretty good. What happened between graduating from medical school to going to the US?My plan was always to do f1 because I wanted to be GMC qualified and registered, should I decide in the future, I want to come back to the UK, I will have my GMC registration. I originally had thought, maybe I'll do F2 as well, because I had some good rotations. But at the same time, I was trying to get over to the US as quickly as possible. Because at that point, my husband and I were in a long distance relationship for nearly five years.It was kind of weighing things that like, should I stay in the UK or should I come over, but coming over to the US meant that I was not going to be working for nearly two years. So I actually took two years off between f1 and starting residency, which was a very difficult time for me because I wasn't sure like how it was going to look like in my application. I was worried that I'll be de-skilled clinically. I ended up taking a master's in public health and then set my exams June 2021 and started residency in July 2021. What is the difference between working as a doctor in the UK vs US, is the grass greener?I think that really depends on people's personal preferences and choices and priorities. I'm now in my intern year, which my f1 equivalent and I can say that it's very difficult. My work hours are double what I did in the UK, here it is 82 to 85 hours on average.I take 24 to 28 hour calls very often. Nights for example, I did one whole month of nights in September where I worked 26 out of 30 nights. So work wise, it's a lot harder here, you're going to be pushed to your limits of exhaustion. Weekends here, especially on medicine you work six days a week. So work hours were very difficult and I think I definitely took it for granted when I was in the UK, because I was working half the hours.I'm involved in a lot more clinical decision than I was as an f1 Back in the UK. So I just feel like education is a much bigger emphasis in the US than it was in the UK. One big difference here compared to the UK is the the years of training, for example, to become a cardiologist, it's five years here and in the UK it's 10 years and to become an anesthesiologist is four years here and in the UK, 8 to 10 years, depending on what pathway you choose. So, you work double the hours, but you finish it half the time.So it's, do you want to put in all your hard work now? And then enjoy it quicker? Or do you want to just spread it out over 10 years? it definitely comes down to individual practices. Advice for people making the transition to the US?One thing a lot of people are afraid of moving over is starting in a new country and not knowing anyone. I definitely struggled with a lot when I first moved over. So do not be afraid to do simple things like going for a walk in your local parks, even joining apps where you see local events to get to know more people in my area as I integrate into a new country. Everyone who's thinking about transitioning to a new country need to keep in mind it can get very isolating as you don't know anyone.I think it's important to remember coming with experience (F1/F2), or even just finishing med school in the UK, you have done so much and your clinical experience is amazing.<blockquote>I've always heard from the consultant especially attendings here that they're always impressed by UK grads, because of how much we're able to do... So, don't underestimate how much you know, when you come here as a doctor.</blockquote>I rotate in different rotations every month for example, I started my year with one month of ICU, and then I went to medicine where I did a whole month of nights, then a different medical rotation, then ICU again, and then a month of general surgery, and now on my month of burns ICU. Then after I have another month of surgery and in my last four months, anaesthesia related.You go in to work usually six days a week, on average, you get four days a week off a month. Days start anytime between 5am and 7am, depending on the patient. On general surgical rotations, I will be in by 5- 5.30am because rounds are by 6am.Your days start very early 5am or the latest I started 7am and depending on whether or not you're on call. If you're just doing a normal day, it can end anytime between 4pm and if you are on-call anytime between 6pm to 8pm. So you're working, between 12 to 13/14 hours a day. If you enjoyed this, you can listen to the full episode on Apple Podcasts, Google and Spotifyhttps://open.spotify.com/episode/4gg8YsorpzNc6XenwExHjr?si=609e8e7905b745fd

In this episode anaesthetic resident Dr Tan shares her journey from studying medicine in the UK to moving over to the US and becoming a resident! Hear her story as she delves into sitting the USMLE, the barriers and obstacles she faced.

Is the Grass Greener in America As a Doctor (IMG)? - Dr Cynthia Tan (Anaesthetic Resident non-US IMG)

<h2>15 Side Hustles you can start while at University</h2> Side hustles are a great way to make some supplemental income while studying at university, there is 💰 everywhere, you just need to figure out how to get yours hand on it! <ol><li>TikTok Content CreationTikTok is absolutely killing it right now, with so many viral trends the opportunity and reach is incredible, you can be creating content for both businesses and influencers. One way is to repurpose existing content like podcasts as a new channel over on TikTok. </li><li>Graphic DesignerThis one is for the creatives, all you need to do is a quick search on Twitter for people or businesses looking for help with graphic or design work...there are 1,000s of tweets searching for designers and they are willing to pay a decent amount. </li><li>Marketing AgencyThis involves offering a variety of services which help businesses make money and can span from email marketing, creating thumbnails, to managing Facebook, TikTok or Instagram Ads. The agency part involves using leverage, meaning you find clients as well as people that can deliver those services, designers etc and wrap it all up using your experience as one brand. </li><li>YouTubeDo you love being in front of a camera, have something that you are desperate to share with the world or even skills you can teach for others to benefit from (...it can be literally anything). Then becoming a YouTuber is a great way to start building a brand and making some money from AdSense and sponsorships. HOWEVER, it's important to note this is a slow burner and will take a while before you actually hit the riches! </li><li>TikTok Theme PagesIF you don't like being in front of a camera then this for you - These were super popular on Instagram and are making an appearance on TikTok, essentially they are pages that are curated with a specific topic, niche or industry in mind such as health, cats or food, over time you can quickly amass a big following and make money from affiliate links, shout outs and even selling the account on. </li><li>YouTube Script WriterOnce again, if you don't like the limelight but have a passion or a keen interest in a particular topic or subject area you can write scripts for other YouTubers. This is the same concept as writing songs for super famous musicians. </li><li>CoachingDo you have a particular skill set or knowledge like playing the piano or guitar and are able to teach others, then this is a great way to make some extra money. Plus, if you are worried people may not want to pay, you can always start with a more affordable hourly rate and increase accordingly. </li><li>Video EditingThis is a highly sought after skill and many creators are willing to pay a premium for talented editors that help bring flair to their videos but most importantly can keep a viewer engaged. </li><li>Flipping ProductsThis has been around for decades, buying and selling stuff on platforms like e-bay are great especially if you can figure out how to market the products better then your competitors, so better listings, photos, descriptions all will come to your aid and help you stand out! </li><li>Copywriting"Copywriting consists of the words, either written or spoken, marketers use to try to get people to take an action after reading or hearing them" so if you can help people create compelling emails, newsletters, Instagram captions or anything written that helps companies sell more and grow...then you are onto a winner and can make a lot of money. This is a skill that is hard to master but can definitely be learnt and honed. </li><li>SalesBeing able to sell, is a great skill to develop and master, there are many remote sales jobs that pay handsomely so this is something you can always be on the lookout for 👀 </li><li>Thumbnail DesignerSimilar to video editing, being able to design captivating and engaging thumbnails for YouTubers that help increase their CTR (Click-through rate) meaning how many people click on their videos when they appear...well you already know there is money to be made and a lot of it. You can use many platforms to help you get started for free including Canva (my all time favourite). You can have multiple clients on a rolling monthly basis and increase your rate as you grow and become better. </li><li>Website DesignerPretty much everyone that enters the world of business or startups will most likely want a website created or designed, this is a very competitive landscape so if you can sell on the added perks such as loading times, faster speeds, better design then you only need one or two a month to help your bottom line. </li><li>Affiliate MarketingThis is ideal for the creators or influencers that have a big following and can reach many 1,000s of people either via their YouTube, Instagram or TikTok with an audience they have amassed over many years. A relatively easy way to make money if you have a pre-existing audience. </li><li>Community ModerationThere are so many increasing communities online that need moderating from Discord servers to Facebook groups, which you can help moderate and manage, and the cool thing here is if you become really good and build a reputation you can even turn this into a moderation agency. So instead of offering your services for a set time and price, you can offer a team of moderators who all work for you and pitch it as a 24-hour moderation service. </li></ol>There are so many side hustle ideas, all you need to do is do some research, be creative and start figuring out which one appeals to you the most and just get started.

15 side hustles that you can start while studying at university to make some extra money 💰

15 Side Hustles you can start during University

In the emergency department we are privileged to have consultant teaching once a week every Thursday. It is very beneficial and particularly useful as it goes through things that you may come across in real life when working in the department.One particular week the teaching was on analgesia. In A&amp;E we are particularly bad at remember that in front of us is a real person and not just a collection of symptoms that we need to piece together to find out the diagnosis. Whilst playing Sherlock Holmes with somebody’s health is very interesting and fun at times – we forget that when someone says they’re in pain, we should give them pain relief. Simple, yet so often forgotten. We leave patients for hours waiting for scans and blood test results forgetting we can ease the current suffering they’re going through whilst they wait.The consultant spoke to us on a basic level – helpful, especially because people don’t realise as F2s we have literally forgotten EVERYTHING from medical school. He went through anatomy, physiology and mechanisms of actions of different analgesics. He started by giving us case scenarios and we would come up with management plans then he would explain what the best choice of analgesia should’ve been. Interestingly, paracetamol, despite nobody knowing the details of exactly how, increases your pain threshold centrally in the brain. Whilst the likes of ibuprofen, a COX inhibitor, works more peripherally. So a combination of the two can be just as effective as giving morphine.What stood out to me was when the consultants discussed the unnecessary tests we do. In particular, arterial bloods gases (ABGs). We went through the few instances when they are actually needed and the consultant reminded us that each time a patient is stabbed it is extremely painful. But why? Because the nerve endings are found in the skin and lots are found near the radial artery where we take ABGs from. Within an instant, suddenly the verse came to mind where Allah says “We shall send those who reject Our revelations to the Fire. When their skins have been burned away, We shall replace them with new ones so that they may continue to feel the pain: Allah is mighty and wise.” {4:56} Have you ever thought that the reason we can feel pain is because we have skin? When people have extensive burns and their skin is entirely removed sometimes they experience less pain because their skin and nerve endings are no longer there. So when Allah talks about replacing their skin, He’s illustrating to us that in the fire there is not even the slightest lessening of pain for those who rejected the revelation. Whenever their nerve endings are burnt off, they are replaced so they can feel the pain over and over again.Reflections:1.&nbsp;Beneficial knowledge is the inheritance of a believer. Wherever it is found, he takes it. It doesn’t matter where the reminder is coming from, whether it’s a Muslim, non-Muslim, doctor or patient – take the lesson from it.2. Allah directs us on so many occasions to look at and marvel about His creation – the human body is one of the most amazing of them and doctors have the huge blessing of having studied it to a relative high level of detail.3. Search for the lessons of each today. Every day is a school day. There is a reason people say the older you get the wiser you get. Every single day Allah sends you things that are there to teach you. Just like in school, there are some who will pay attention to the lessons and some that won’t. Which are you?

People will always tell you that an intention can make almost anything worship - and they're right. But Allah talks about people of intellect, people who remember, people who think - how do you think about the things you experience each day? 

Medicine in the Qur'an Series: Skin - Story of a Muslim Medic 

It wouldn't be a surprise for me to say that I have experienced a few discouraging comments from male consultants in procedural heavy specialities. It is more common than we think and is significant enough to make female doctors reconsider their career choice. While these comments may be well-meaning, it is time we shift the view that women should stick to 9-5, non-technical, (more) 'family friendly' specialities. Needless to say, having more women in all specialities brings as many positives as I have received these comments.This article will focus on provide tips on how we can all encourage female empowerment:<ol><li>Don't let gender-biased comments stop you from pursuing your choice of careerInstead, let them be fuel for you to find out more about the speciality and ways to increase female representation. Persist in remaining curious in the conversation and show that you are keen in being in this speciality. No doubt will you be pointed towards female colleagues for more discussion and mentorship opportunities.</li><li>Know all the pros in having more women in specialitiesThe obvious one is that women will diversify male-dominating specialities. It will also improve representation for female medical students and trainee doctors, increase creativity, GDP, ideas and service provision. Lastly, they can attend to women's health issues that female patients may feel sensitive about.</li><li>Male colleagues should know all this, tooFemale empowerment should be encouraged by both men and women. We should actively challenging our own and each others bias. It is good to have an open discussion when this topic arises and squash misconceptions that can stop women from pursuing their career choice.</li><li>Find out everything you need to know about the speciality It is really important to know what a speciality will involve, such as the daily tasks of a consultant or trainee and what the work-life balance is. A great piece of advice that I received from a consultant was: 'choose a speciality where you will enjoy the day-to-day routine.' This was when I was in 4th year of university.</li><li>Find female mentors in a speciality you're interested inThis isn't to say that we should choose mentors based on gender as to not create an 'us vs them' atmosphere but it is necessary for female empowerment. Girls can gain an understanding of their experiences and it increases the likelihood of applying to that speciality. When we find someone who looks like us in a position we aspire to be in, we are more likely to feel encouraged to follow in their footsteps. So there you have it, a few tips to equip all of us on how to empower and encourage our female doctors in Medicine. Here's a thought, what sort of impact would you want to leave on a young female aspiring doctor? Trust me, they will never forget.</li></ol>

Here are a few tips, for both men and women, on how we can empower our female colleagues in pursuing the careers they want.

How to empower women in Medicine

So here you are. A junior doctor. After all that hard work, here you are. Well done. All that effort learning the Krebs cycle and the coagulation cascade has paid off. You're on call, seeing patients and doing jobs. But you need to write notes. There was no module for this in medical school. Fear not. I have you covered. The Basics of Every Clinical Note-Legibility: A lot of hospitals are using Electronic Patient Records now, but if you are handwriting notes, make sure you and others can read them!-Name: Seems obvious, but you should write your name clearly in the margins of the note-Grade:FY1, FY2, SHO, Registar, Intern, Resident, RMO, you need to identify your position-Registration NumberYou should clearly write your medical council registration number. -Date and TimeSeems obvious, but you should write the date and time you saw the patient. If writing retrospective notes, write the current data and time, and the date and time you saw the patient. -SignatureYou should sign your note-Who else was there?Write the names of other members of your team or the multi-disciplinary team who were present when you saw the patient. If performing intimate exams, document the full name of your chaperone. With electronic records, a lot of the above will be included automatically but be sure that it does!ConsultsIf seeing a patient as a consult, document this at the start of your note. Being asked to review or give an opinion is a privilege, so be sure to thank the referring team or nurse for asking for your advice. Its nice to be nice, it is good practice and polite. Always document the name of the senior clinician responsible i.e. consultant. They are (usually) ultimately responsible for your work and this information needs to be clear. SOAP NotesThese are the basic components of your clinical assessment. SOAP is a mnemonic which starts for Subjective, Objective, Assessment, Plan. All good notes need a plan (it is often the first thing colleagues will read!).SubjectiveThis is what the patient is telling you. Their subjective findings, or symptoms. Shortness of breath, duration etc. Included in this is broadly medical history, social history, family history etc. ObjectiveThese are your findings. Observations, exam findings, these are objective findings which are facts and shouldn't be open to interpretation (although some exam findings can vary from observer to observer). This can also include interpretation of clinical data such as laboratory results, radiology findings, ECG changes etc.AssessmentThis is where you document your overall assessment of the patient. What is their primary complaint, what is your working or differential diagnosis. You can include your thoughts, your negative findings and your overall impression here.PlanThe all important plan. What do you plan to do? Treatment plan, further investigations, escalation to a colleague, this is the "action" component of your note. Make it clear and concise!I hope this article was of health to you. Follow me on instagram @jack_thesurgeon for more medical education and productivity posts.

As a junior doctor starting out, you will be asked to write notes for every clinical interaction or activity you or your team has with a patient. It is important to understand the basic components of these notes. It is often taught, but it is often not!

The Basics of Clinical Note Writing: A How-To Guide For Junior Doctors

<h2>Investing in Startups</h2>Investing in startups is fairly high up in options for healthcare professionals for building up passive incomes.Investing in startups, because they are creating new markets, industries and sectors, can achieve much higher returns, but of course carries higher risk. Returns typically depend on the stage of the startup.The earlier the startup, the higher the expected return, because of course it also carries higher risk, but higher opportunity for growth too (1).Typically, investing in a startup is investing in its future value rather than receiving returns on an annual basis. Benefits of Investing in Startups: Earn up to 50% tax relief on your investmentsThere are two key, and very generous, tax breaks to look out for when it comes to investing in startups, on platforms like CrowdCube. Both of which can be carried back to the previous tax year. Seed Enterprise Investment Scheme (SEIS)Investors, including directors, can receive initial tax relief of 50% on investments up to £100,000 and Capital Gains Tax (CGT) exemption for any gains on the SEIS shares. Enterprise Investment Scheme (EIS)Investors can invest up to £1,000,000 in any tax year and receive 30% tax relief on their investment.Look out for the EIS and SEIS tags eligible investment opportunities.The Enterprise Investment Scheme (EIS) and Seed Enterprise Investment Scheme (SEIS) are UK government schemes designed to help smaller higher-risk trading companies raise finance, by offering a range of tax relief to investors who purchase new shares in those companies. Where a business is listed as ‘EIS’ or ‘SEIS’ on Crowdcube, this tax relief will be available to qualifying investors. The benefits of EIS tax relief<ul><li>You can claim up to 30% income tax relief on investments up to £1 million per tax year.</li><li>Any gain is Capital Gains Tax (CGT) free if the shares are held for at least three years.</li><li>Payment of CGT can be deferred when the gain is invested in shares of an EIS qualifying company.</li><li>If the shares are disposed of at a loss you can elect that the amount of loss be set against any income tax of that year or of the previous year.</li></ul><h2> Tax reliefs available:</h2>1. Income Tax ReliefThere is no minimum investment through EIS in any one company in any one tax year. Tax relief of 30% can be claimed on investments (up to £1,000,000 in one tax year) giving a maximum tax reduction in any one year of £300,000, provided you have sufficient Income Tax liability to cover it.EIS allowances are allocated individually; therefore a married couple could invest up to £2 million each tax year and be eligible for Income tax relief. The shares must be held for at least three years from the date of issue or the tax relief will be withdrawn.People connected with the company are not eligible for Income Tax Relief on their shares. 2. Capital Gains Tax exemption (CGT)Any gain is CGT free if the shares are held for at least three years and the income tax relief was claimed on them. Shares can be held for much longer and therefore potentially enable the investor to be accrue their CGT exemption over a long period of time which can be a great attraction. 3. Loss reliefIf shares are disposed of at a loss, the investor can elect that the amount of the loss, less Income Tax relief given, can be set against income of the year in which they were disposed or, on income of the previous year instead of being set of against any capital gains. 4. Capital Gains Tax deferral reliefPayment of CGT can be deferred when the gain is invested in shares of an EIS qualifying company. The gain can be made from the disposal of any kind of asset but the Investment must be made one year before or three years after the gain arose — connection to company does not matter. Unconnected investors are eligible for relief from both Income tax and CGT referral relief. Carry BackThere is a ‘carry back’ facility which allows the all or part of the cost of shares acquired in one tax year, to be treated as though those shares had been acquired in the preceding tax year. Relief is then given against the Income Tax liability of that preceding year rather than against the tax year in which those shares were acquired. This is subject to the overriding limit for relief for each year.For more information, please see the HMRC website.Restrictions ExamplesHere’s a few examples of how EIS tax relief works. To make the maths easy, let’s assume you invest £10,000 in each case and you’re in the 45% tax bracket. Case 1:The company does well and doubles its value and you hold the shares for three yearsInvestment = £10,000Income Tax relief = £3,000 (as a reduction in your income tax bill)Capital Gains Tax = £ZeroYour gain = £13,000 (£10,000 profit from the sale plus £3,000 income tax relief) Case 2:The company value stays the sameInvestment = £10,000Income Tax relief = £3,000 (as a reduction in your income tax bill)Share sales = £10,000Your gain = £3,000 (from the income tax relief) Case 3:The company closes and your shares are worth nothingInvestment = £10,000Income Tax relief = £3,000 (as a reduction in your income tax bill)At risk capital = £7,000Loss relief on at risk capital @ 45% = £3,150Your actual loss = £3,850 (£10,000 — [£3,000 + £3,150])The Seed Enterprise Investment Scheme, or SEIS, is incredibly generous. Of course we all hope our investments do well, but if you pay tax at 45% and make an investment of £10,000 that fails completely, you only lose £2,750 due to the tax relief.That’s what makes the Seed Enterprise Investment Scheme (SEIS) so attractive to investors and why we encourage all entrepreneurs to seek advance assurance from HMRC that they are eligible for SEIS. The benefits of SEIS tax relief· Investors can receive initial income tax relief of 50% on investments up to £100,000 per tax year in qualifying shares issued on or after 6 April 2012.· A CGT exemption will offered in respect of gains realised on the disposal of assets in 2012–13, that are reinvested through SEIS in the same year.Who can claim?<ul><li>The individual investor can be a director of the company, but not an employee</li><li>An individual’s stake in the company can be no more than 30%</li><li>SEIS tax relief applies only to recently incorporated companies</li><li>The company must have 25 or less employees and gross assets of up to £200,000</li><li>For 2012–2013 only, a CGT exemption will be offered in respect of gains realised on the disposal of assets that are invested through SEIS in the same year. </li></ul>ExamplesAs with our EIS tax relief examples, we’re going to keep the numbers straightforward and assume you invest £10,000, pay income tax at 45% and capital gains tax at 28%. Case 1:The company does well and doubles in valueInvestment = £10,000Income Tax Relief = £5,000 (you get 50% of your investment back as a tax bill reduction)Profit from sale = £10,000Capital Gains Tax = £Zero (if you have held the shares for three years)Tax free return = £15,000 Case 2:After three years the company’s value is the sameInvestment = £10,000Profit from sale = £ZeroYour gain = £5,000 reduction in your income tax bill Case 3:The company folds and the shares hold no valueInvestment = £10,000Income Tax Relief = £5,000 (you get 50% of your investment back as a tax bill reduction)At risk capital = £5,000Loss relief = £2,250 (45% of at risk capital)Your actual loss = £2,750 (£10,000 — [£5,000 + £2,250]) Carry BackDid you know that you can carry back your SEIS tax relief back to the previous tax year?An investor may elect under ITA07/S257AB(5) to have part or all of an issue of shares treated as though acquired in the tax year preceding that in which the shares were actually acquired. This is subject to the maximum annual investment limit for that earlier year (£100,000). The SEIS rate for the earlier year is then applied to the shares treated as acquired in the earlier year and relief given accordingly. As there is no SEIS rate for periods before 6 April 2012 an election under S257AB(5) will be effective only for shares acquired in 2013–14 and later tax years.For further information please visit the HMRC website. Example 1:Jenny invests £20,000 in the tax year 2012–13 (6 April 2012 to 5 April 2013) in SEIS qualifying shares.The SEIS relief available is £10,000 (£20,000 at 50 percent). Her tax liability for the year before SEIS relief is £15,000 which she can reduce to £5,000 (£15,000 less £10,000) as a result of her investment. Example 2:James invests £20,000 in the tax year 2012–13 in SEIS qualifying shares. The relief available is £10,000 as for Example 1.However his tax liability for the year before SEIS relief is £7,500. James can reduce his tax bill to zero as a result of his SEIS investment, but loses the rest of the relief available of £2,500 (£10,000 less £7,500). Things to rememberFirst of all, check that the pitch you’re interested in has got SEIS ‘advanced assurance’ — this is a certificate emailed to the investor by HMRC confirming that investors will benefit from SEIS.Secondly, you can claim your money back once the business has been trading for a minimum of four months or has spent 70% of the investment they received.Finally, and this is a big one, SEIS relief can be claimed up to five years after the 31st January in the year you made the investment. How to claimWhen the company you’ve invested in has been trading for four months or spent 70% of the total investment, the company must submit form SEIS1 to HMRC (or, more specifically, the Small Companies Enterprise Centre otherwise known as the SCEC).Once SEIS1 has been reviewed and the requirements met, the SCEC will issue a copy of form SEIS3 for every investor. These are sent to the company and they can be passed on to each investor for them to complete and submit as part of their tax return.Of course, startup investments carry higher risks than. References(1) https://startonpurpose.com/Article/what-rate-of-return-do-investors-expect

Earn as you sleep: How and why invest in startups

<h2>1. Research, research, research </h2>When applying to medicine being strategic is so so important. To maximise your chances of getting in start your research early- that way you can rule out any you might not have the best chance at, then focus on other aspects and smashing those applications. For example some medical schools favour great GCSEs and for others it won't matter at all, some will take resits and others won't...knowing about this will help boost your chances of 4/4 interviews...<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2F6-tips-for-starting-your-medicine-application-8sh8xu%2Fimages%2Fai-1.png?alt=media&amp;token=72b5da9e-5e73-43dc-a1af-04735cec86e8"><h2>2. Keep a reflective diary </h2>This is key for making life as easy as possible when it comes to writing your personal statement and then later interview prep. Having a place where all your activities are stored will help you &gt; reflect in your PS and interview- a key skill that they want to see. <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2F6-tips-for-starting-your-medicine-application-8sh8xu%2Fimages%2Fai-2.png?alt=media&amp;token=d8c782bb-6d83-4f3a-9b35-53dd500d4cea"><h2>3. Self Care </h2>Applying to medicine can be a long and sometimes stressful process, balancing this with exams and admissions tests means it's so important to have activities that help you de-stress and unwind. Furthermore, this is a key part of medicine interviews, making sure you have ways to unwind when things are more stressful. Whether it's knitting, playing football in the park or in a team, finding new recipes to cook or painting/ drawing whatever you do to relax keep doing it! <h2>4. Fill the gaps</h2>Read this list of core attributes for medical students and Doctors. Are there any areas you feel like you might want to work on? Being able to reflect on this is so important and shows a real insight into your own strengths and weakness'.<ul><li>Motivation to study medicine and genuine interest in the medical profession</li><li>Insight into your own strengths and weaknesses</li><li>The ability to reflect on your own work</li><li>Personal organisation</li><li>Academic ability</li><li>Problem solving</li><li>Dealing with uncertainty</li><li>Manage risk and deal effectively with problems Statement on the core values and attributes needed to study medicine</li><li>Ability to take responsibility for your own actions</li><li>Conscientiousness</li><li>Insight into your own health</li><li>Effective communication, including reading, writing, listening and speaking</li><li>Teamwork Ability to treat people with respect</li><li>Resilience and the ability to deal with difficult situations</li><li>Empathy and the ability to care for others</li><li>Honesty </li></ul><h2>5. Make a note of key dates</h2> There is a lot to stay on top of, from UCAS and personal statement deadlines to admissions tests. Also, in terms of financial assistance, bursaries and scholarships there may be deadlines for applications. Having a diary or planner will help you keep on top, stay organised and feel in control of the process. <h2>6. Keep an eye out for conferences, webinars and other resources </h2>There are so many free resources or assistance that costs very little out there, we have tagged a few accounts to follow who often post advice, host webinars and conferences.

6 Tips for Starting your Medicine Application

Every day, millions of individuals go to work in unsatisfying jobs. They have the same uninspiring morning routine or take the same uninspired route to work every day. To make matters worse, this unfulfilling, uninspired job probably doesn’t pay much.So why do we stay?The pandemic has transformed the digital space as we know it. With remote working becoming the norm and more businesses moving online, countless opportunities have been unlocked. Tech has never been more accessible and ludicrous, and more people are switching careers to improve their quality of life.Jobs in technology aren’t going away; they’ll be around for a while, and robots will not take over!<img src="https://miro.medium.com/max/1400/1*d1IZ1abNkaSlrczzNZG5_w.jpeg" alt=""><h1>Tech is booming</h1>Every industry is becoming increasingly reliant on technology. Consider this: newspapers are now digital, TV shows and movies are available to stream on Netflix and Disney+, and so on. It is affecting a wide range of industries.But what if you’re not keen on coding?Product Management, Digital Marketer, Technical Writer, UI Designer, and other non-coding positions exist. To work in technology, you don’t need to be an experienced coder or ‘computer savvy.’Making money online has never been easier, and with numerous niches out there, the possibilities are endless. Here are a just few that could potentially earn you an extra £500 per month:<ul><li>social media marketing</li><li>video editing</li><li>copywriting</li></ul><h1>Best way to get started</h1>I get a lot of DM’s asking me what is the best way to get into tech. I always give them the same answer: find your interest. It’s easy to get overwhelmed with all the choices out there, I certainly was, so it’s imperative to do your research. I chose to specialise in web design &amp; development mainly due to my background in photography. I enjoy the creative element in this field and it aligned well with my creative side.There is something for everyoneIf you enjoy problem-solving — software engineeringare you creative? — UX/UI designenjoy writing? — freelance copywritingWatch a day-in-the-life video of these jobs to see if it's something you’re willing to do long term before committing to a bootcamp or online course. Networking is also critical, try to find like-minded people and groups, learn from them and build relationships.The key is to RESEARCH RESEARCH RESEARCH.<ul><li>Follow #100daysofcode on all socials</li><li>Join online communities like tech twitter</li><li>join slack channels</li></ul><h1>Once you’ve found your interest, make SMART goals</h1>When I was learning how to code, I spent an average of 1hr a day. Its perfectly doable seeing as most of us spend that time browsing TikTok or Netflix. Try to stay disciplined by minimising distractions that only contribute to short-term happiness. If you want to change your life, it starts with prioritising where you spend your time.I’ve written a few articles on productivity, and they all have one underlying message. Consistency.When it comes to developing and maintaining a new habit, frequency matters more than intensity.One particular concept to understand is compound interest. This is the idea that the effects of your habits multiply as you repeat them. They seem to make little difference on any given day and yet the impact they deliver over the months and years can be enormous.<h2>Tech Bootcamp</h2>I've recently started a Tech &amp; freelancing Bootcamp, we've had 400 students apply so this round of applicants is closed. To register your interest for the next one, sign up here: https://forms.gle/PXnE168jcfRqaRfu6Once again, thank you for reading. In case you didn’t know, I now have a newsletter called Over-Sharing Sundays where I send out blog snippets, book/podcast insights and my weekly thoughts.Click here to subscribe:https://www.getrevue.co/profile/shuaybcodes?via=twitter-profile-webview

Making money online has never been easier, and with numerous niches out there, the possibilities are endless.

Considering a career in tech?

The bones of the hand are divided into 3 groups:<ol><li>Carpals</li><li>Metacarpals</li><li>Phalanges</li></ol><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fbones-of-the-hand-8csbk9j%2Fimages%2Fai-1.png?alt=media&amp;token=83cb9f9c-5fb0-4669-9da1-9ef177f5be93"><h2>CARPALS</h2>The carpals are a group of 8 bones found proximally on the hand, near the wrist. They are arranged in 2 rows: proximal and distal.<ul><li>Proximal row (lateral to medial): scaphoid, lunate, triquetrum, pisiform</li><li>Distal row (lateral to medial): trapezium, trapezoid, capitate, hamate</li></ul><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fbones-of-the-hand-8csbk9j%2Fimages%2Fai-2.png?alt=media&amp;token=28d6bc97-0d0c-4dd8-a760-ca6009b3d061">In the proximal row, the scaphoid and lunate articulate with the radius to form the wrist (radiocarpal) joint. In the distal row, the carpals articulate with the metacarpals forming the carpometacarpal (CMC) joints.<h2>METACARPALS</h2>The metacarpals are located between the carpals and the phalanges. They are 5 in number (one for each digit). They articulate proximally with the carpal bones forming the carpometacarpal (CMC) joints and distally with the proximal phalanges forming the metacarpophalangeal (MCP) joints.The metacarpals have 3 parts: base, shaft (or body) and head.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fbones-of-the-hand-8csbk9j%2Fimages%2Fai-3.png?alt=media&amp;token=b9d7a5fe-488a-49a3-90ff-37a2e199e989"><h2>PHALANGES</h2>The phalanges are the bones found most distally on the hand. The 2nd, 3rd, 4th and 5th fingers all have 3 phalanges: proximal, middle and distal. The thumb only has 2 phalanges: proximal and distal.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fbones-of-the-hand-8csbk9j%2Fimages%2Fai-4.png?alt=media&amp;token=bdc47433-91a7-49a4-ad54-350debf2f2b4">Want to test yourself on what you’ve just learnt? Click the following link for a quiz!https://peerr.io/quiz/anatomy-bones-of-the-handThanks for reading!The following article was written and illustrated by myself - medblog.For more content, follow me on Instagram and TikTok @medblog_xoxo.For medical illustrations follow me @medart_xoxo.

Anatomy can be confusing and difficult to memorise. This article provides simplified notes and labelled illustrations to help make it easier! In this article we are focusing on the bones of the hand.

Bones of the hand

For me,&nbsp; being a GP is by far the best role I could see myself performing in the NHS. I haven't looked back since completing training and working as a GP over the past few years. As individuals we are all multifaceted and as doctors especially we have several things we do to a high degree. GP was the only specialty that I felt allowed me to develop my other skills whilst performing my life goal; to provide genuine care and compassion to patients during their time of need. As a medical student, I was lucky enough to be inspired by senior GPs who became a point of reference for their communities, impacting entire families and regions. I wanted to put myself in this position and also to be this person. Here is the pathway through to becoming a GP. 1) Complete medical school 2) Complete foundation years 1 and 2. 3)&nbsp; You usually apply for GP training in the first few months of F2 or F3 (or however many you decide to do) 4) Application process -&nbsp; Consists of an MCQ type exam + some SJT style questions. The difficulty of this exam is similar to what you would have had during your finals. I mainly prepared for this by going through question banks. 5) Depending on your exam score you will undergo an interview type process. This usually consists of a few OSCE type scenarios and one written station on prioritisation. 6) GP training -&nbsp; currently 3 years. Most people do a written exam in their second or third year. Then you have a communication based exam which is usually done in the final year. Throughout the 3 years of training you will be assessed on your engagement with a GP portfolio. You will also be expected to participate in audit and quality improvement activities. As a GP trainee you are given many opportunities to develop yourself and your interests. I was able to obtain fully funded post graduate qualifications in both medical leadership and medical education. Some of my colleagues have been able to further develop themselves by obtaining qualifications in areas such as minor surgery, sexual health and dermatology. As a GP the world is truly your oyster. My passion is Medical Education and I've benefitted from the flexibility as a GP by being able to&nbsp; start a company called Adu Med. Our goal is to help as many trainees as possible pass their exams. I am a clinical lead over an entire region in the North West helping to create funded projects to improve workforce development as well as educational events for new GPs. I hold leadership roles with a focus on tackling doctor burnout.Although it may seem daunting, training equips you with the skills needed to create comprehensive and safe management plans in a short period of time whilst maintaining excellent communication skills. My clinical sessions are busy and fast paced. But I enjoy the challenge and wouldn't have it any other way. It also feeds into my other roles and allows me to perform them to the best of my ability. If you are the kind of person that enjoys getting to know your patients, getting to truly see how your clinical intervention can improve the lives of your patients and enjoy the challenge of managing the 'whole' person, GP is a brilliant specialty for you to consider. If you are interested, you can see some more of what I get up to on here : 1) https://www.youtube.com/channel/UCUFdcaIrRDsT2VdFP0AbDSA 2) https://www.instagram.com/adu_med/

Here I share why I chose GP as a specialty and how it has helped me to develop other interests such as in medical education and clinical leadership. I also go through the process of entering and completing GP training.

The reality of GP training in the UK

Postgraduate exams are tough. The fail rate is high, you are expected to pay for it yourself (£578!) and you’ll be working throughout. I will break down my top tips below on how to ace the MRCS.<ol><li>Understand the exam. &nbsp;It is a five-hour multiple choice question (MCQ) exam consisting of two papers taken on the same day. The AM paper is three hours and the PM paper is two hours in duration. Pattern recognition is key with MCQ exams as is exam technique. Paper 1: applied basic sciences. Paper 2: principles of surgery in general.</li></ol>&nbsp;<ol start="2"><li>Timing. Timing your exam is key. Statistics show that the closer you sit this exam to your med school finals, the more likely you are to pass. But also have a look at what rotations you will be on. Usually the exams are 3 times a year - in January, May and September. I would give this exam at-least 4 months of good revision to make sure you pass. Therefore, plan to sit the exam after a relatively ‘easy’ rotation eg psychiatry or GP where you may not have multiple nightshifts/weekends and long days. You may also have downtime during the working day to study.</li></ol>&nbsp;<ol start="3"><li>How to tackle the syllabus. Everyone varies with how they study so I can just share my own experience. I recommend using books and online resources. I focused mainly on MCQ books and online resources. TeachMeAnatomy is a good online resource for anatomy. There are so many options – eg Basic Science for MRCS, PasTest MRCS Part A essential revision notes etc. For the online MCQ banks I definitely recommend using EMRCS and either Pastest or OnExamination – I personally found onExamination too hard. And you should also use Peerr for personalised MRCS Qs! Complete Emrcs 3-4 times to start with and make sure you read all of the notes. I was averaging 90%+ prior to my exam and just about passed – this is a similar story with all my friends.</li></ol>&nbsp;<ol start="4"><li>Dealing with failure. You are allowed to sit this exam around 5 times before you have to have a meeting with RCS to ask to sit the exam again. Failure is a part of this surgical journey and you wont always pass the first time. I failed this exam on my first sitting and passed on the next. It was a difficult time but one that I knew would be short lived. Believing in yourself, talking to friends who have passed and improving on your knowledge is key. Understanding where your weaknesses are and working on that etc. For me it was the trauma section – a friend advised to get the ATLS handbook and read the trauma section there to help answer the questions focussed on this as I found the online banks did not do a good job here.</li></ol>&nbsp;<ol start="5"><li>Good luck! I am sure you will smash it. If you are here reading this then you’ve already got a head start! Message me on Instagram when you pass! Or if you fail and need words on encouragement. You’ve got this.</li></ol>

My tips and tricks on passing the MRCS part A

How to Pass the MRCS Part A

“It’s really not my day…”Being an A&amp;E (or ED or ER if you’re from abroad) doctor can be challenging. Every day is different which makes it great. The good days can be really good but the bad days, well let’s just say we redefine what bad really means.Depending on where you work your rota will be different, mine just happens to be one of the worst. With an average of 48 hours per week (excluding the charity work we do by staying late to finish up our patients that we don’t get paid for at the end of our shifts) and day shifts in between night shifts, your body clock is no longer a clock and you end up spending more of your awake hours at hospital then you do at home.This week I was on nights – starting at 11:15pm and finishing at 8:15am. Only 9 hours – what could go wrong? On one particular night I had a patient who literally had everything possible wrong. I put my name against the patient’s name on the system – now they’re my patient. I pick up the notes and take a look at why they’re in hospital. “Family are concerned about changes in behaviour. Background of mental health issues.” No problem – quick medical review to make sure she’s okay and then refer to the specialist mental health team for tomorrow during the day – or so I thought…I check the ECG (EKG). Ischaemic changes – for the non-medics, that means the heart could be dying. But the nurse who performed the ECG had written no chest pain. Strange. I call the patient into a cubicle to be examined. She waddles to the bay, clearly in discomfort. “Are you in any chest pain Ms D?” “Yes doctor it’s right in the middle.” Great. It’s not just mental health, this patient is actually medically unwell. I continue trying to talk to Ms D then quite quickly realise she is very confused and is not making any sense. Her mother and daughter are here with her and they tell me she’s never been this confused before and she stopped eating for the last 2 weeks. “Did anything happen 2 weeks ago?” “Oh yes doctor, we had a road traffic accident. But we were okay so we just went home.” Like… seriously?! “Oh and doctor she’s been vomiting and she hasn’t opened her bowels for 10 days.”The nurses have taken a set of bloods and sent them to the lab – they won’t be back for at least 90 minutes. I need results now. I’ll do a venous blood gas (VBG) – I can get these results in a few minutes. I go and prepare the equipment and tie the tourniquet around her arm. I turn around to the table to get an alcohol wipe. She’s only gone and taken the tourniquet off. “Ms D you really need to keep this on so I can take some blood from you.” Her veins were terrible. Super thin, none of them were straight and with her level of dehydration it was looking virtually impossible. I try anyway. Surprise surprise – I failed. I tie the tourniquet around her other arm to try on that arm. She’s moving everywhere, kicking her legs around the bed like a child having a tantrum. Her mum and daughter try to calm her down. In my head I thought “I’m really not trying to stab her again when she needs fluids, let’s just get a cannula in and take the blood at the same time.” I insert the needle. BOOM! There’s blood. Awesome. I slowly start retracting the needle and pushing the cannula forward. Mrs D is frantically trying to grab hold of something, she finds something. My neck. I feel her squeezing my ID and stethoscope around my neck, getting tighter and tighter. “Mrs D. I know you’re confused, but you need to let go of my neck, RIGHT NOW.” She slowly released her hand. I secure the cannula and take the VBG sample. I run the gas… Potassium 1.9. Great. (That’s really low.)I look around. No consultant around. There’s been a trauma call and so he’s had to go to resus. I find one of the senior registrars and present the case to her and make sure she’s happy with my plan. Analgesia, magnesium, potassium replacement, CT head, XR abdomen, repeat ECG, cardiac monitoring, speak to the cardiologist about the ECGs. I start treatment. Cardiologist says if the CT Head shows no bleed then to start acute coronary syndrome (ACS) treatment.This lady isn’t going anywhere. I phone the medics to take over care of this patient and to admit her to the hospital. They refuse. I need to get the scan done and repeat the gas after some treatment because this lady might need ITU. Next challenge – getting her to CT. Low and behold, we have no staff. There’s no nurses available to take my patient to CT on a cardiac monitor, no porter to physically take my patient to CT. I’ll have to do it myself. I connect the defibrillator to my patient for cardiac monitoring and wheel her to CT myself. They try to get her to confirm her name and date of birth. I explain she has come in with confusion she’s not going to be able to give that information. They try to refuse to do the scan. She must have a wrist band. I explain I have already been with the patient for the last 3 hours and I can confirm her identity. Radiographers continue to refuse. I plead for them to simply do the scan and a wrist band can be arranged. They agree to do the scan. We try to explain to Ms D that she needs to lay on the bed. She does, in the wrong place. We try to get her to shuffle up to the correct position. She doesn’t. Eventually we manage to move her up the bed and strap her down. Time for her scan. She burst out crying. Wonderful. I manage to calm her down and explain what is about to happen. She settles. We go into the radiation protective room and the scan begins. Of course, she moved. Scan redundant, motion artefact. She’ll need sedation for the scan.I wheel her back to A&amp;E. At least if I can get this repeat gas after her treatment I can get a result to discuss with ITU then either they or medics will accept. I try to take some more blood. Ms D keeps moving. I fail again. I try again. This time I get a knee in the chest, not intentionally, but still hurts. Ms D is now refusing further blood tests due to the pain and how many times she’s been stabbed. Understandable, but not helpful. So medics won’t accept without a scan and repeat gas. ITU need a gas to discuss with them. She keeps moving in the scanner and won’t stay still for another gas. It’s been 4 and a half hours with this one patient. I can’t do this anymore; I’m going in circles.I discuss with my registrar and she says, “Omar, you need to stop. Leave it with me. Pick up a different patient or go on your break.” I needed to stop. I went for my break, had something to eat, prayed my morning prayers and came back, fresh, ready for the next patient. I come back to A&amp;E – it’s 6am. Medics still haven’t accepted the patient. I speak to the registrar – she said I’ll phone the medics myself. There’s a back and forth between the registrars. Medics finally accept. Alhamdulillah.Another day in the life of a Muslim medic…Reflections:1.&nbsp;Things are not always as they seem at the beginning. This goes for triage notes for a patient and life in general. Allah SWT says “Perhaps you hate a thing and it is good for you, perhaps you love a thing and it is bad for you, Allah knows and you know not.” Whenever you go through anything in life, look for the potential wisdoms behind them, they might not always be obvious.2. Being firm when it’s needed. This goes for dealing with patients, children, relationships and people in general. You must set boundaries – otherwise you’re setting yourself up to get walked all over. When people cross a line, you make it clear they have and that is completely unacceptable.3. Realising when it’s too much. You try – I’m not saying be lazy and not do difficult things or put effort in to achieve things. Try. Try hard. Do everything you can to get where you want to be. But at some point, you need to realise that it’s enough and you need a break. We will release a future article on burnout and how to deal with it insha Allah.4. Find comfort in salah. No matter what is going on. There’s always time for salah. When you need to step away from this world and it’s struggles, connect with the heavens for a break. Just like salah was given to us through raising the prophet SAW up to the heavens after great difficulties and tribulations, allow yourself to make this spiritual journey with each prayer, particularly when times are tough.5. It’s only a day. Every day, is still a day. Whether it’s a good day or a bad day. It will finish. The shift will end. The test will come to a close. You will get through it with Allah’s permission and aid. Don’t forget that. Tomorrow will come insha Allah.Follow me on Instagram @storyofamuslimmedic and twitter @muslimdrstories

We all have bad days. Medicine is no different. It's probably more common to have a bad day as a doctor than elsewhere because you're so tired and exhausted... pretty much all the time. 

"It's really not my day..." - Story of a Muslim Medic

What is the reality of working as a surgeon in the NHS in the UK?I can only really talk about my experience and that of what my colleagues/friends have told me. I am also yet to start my registrar years so this may be a little premature and require updating in the future.The current path for a surgeon:<ol><li>Being in the top 1% of your class in school - top A levels (AAA or better)</li><li>5-6 years of med school (student debt £££)</li><li>2-years of foundation training where you are paid between £12-14/hour for your services.</li><li>Applying for surgical interviews in the second foundation year of training - interviews in jan-march - these are stressful and require preparation (I will do a separate article on this). </li><li>For these interviews you need to have a competitive portfolio including publications, posters, oral presentations, evidenced leadership positions, audits/QIP, mandatory surgical courses and a surgical log book. This can cost thousands of pounds. You can reclaim some of the expenses from your study budget after the event. </li><li>Making sure you've passed postgrad exams MRCS A+B (£1.5K minimum) or MRCS A + DOHNS if you're ENT minded. These exams are also stressful and you would need to revise during working hours/out of working hours to pass. You have to pass at least MRCS part A before starting the next stage.</li><li>Once you've passed the exams and interview, you start your Core surgical training - two years where you have a mix of surgical jobs (they can be themed to a speciality or run-through). This is very hit and miss depending on where you are. I was lucky to be in Queen Victoria Hospital for 6 months doing plastic surgery where I was placed in elective lists every week - contrast this with my friend who is doing plastic surgery in another NHS trust where he was given 1 elective list in 4 months! Unfortunately you are still on the SHO rota so the wards become priority - if you are an ENT SHO this means you don't even have F1s around to help with the wards. You have to be organised and strategic to get theatre time - but make sure you speak to your team so they make it a priority for you! This is training and not service provision. You will also need to complete the second part of your exams here before registrar training (MRCS B or DOHNS). During this stage you will be paid around £20/hr.</li><li>You then most likely will sit an ST3 interview which requires plenty of revision itself. You may also have to move city (or even country - Wales/Scotland) to land your dream job. This is when your 'real' training begins in the speciality you've chosen. You now have clinics and theatre sessions with your name on it. More responsibility and a close relationship with your seniors/consultants. You will do this for 6 years - moving around in your region (in KSS I think you have to work in 3 different hospitals minimum). You may consider doing a Masters degree or PhD. You also now get paid £24-27/hr.</li><li>Finally you sit your exit exam (FRCS) and become a consultant 10 years after graduating medical school! Well done.. however you may now be required to do 1 or 2 more years as fellowships in a specialist area within your field prior to getting that consultant job. </li><li>As a consultant surgeon you make £80-100k/year with the NHS and can soon start to build up a private practice on top of this. </li></ol>I think its very important for everyone to understand before applying to surgery that you really need to commit to the speciality. You are learning to do some amazing things - changing lives in the space of minutes to hours. It requires hard work and dedication. If you are willing to put in the time to learn the art then this is the speciality for you. I find that the skills you learn and what you can do is so special that its worth the extra hours spent learning/practising this skill. If you're passionate about it or even curious - give it a go - spend time in theatre - It may inspire you.If you have any questions please don't hesitate to contact me via instagram!

Is it worth being a surgeon in the UK working in the NHS? I hope I don't get in trouble for this. This article is NOT intended to put people off surgery - just to understand the realities of it. 

The Reality of Surgical Training in the UK 

The bones of the foot are divided into 3 groups:<ol><li>Tarsals</li><li>Metatarsals</li><li>Phalanges</li></ol><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fbones-of-the-foot-8mxq0v%2Fimages%2Fai-1.png?alt=media&amp;token=42acbae1-c5ce-4017-88cc-0628440652c3"><h2>TARSALS</h2>The tarsals are a group of 7 bones found proximally on the foot, near the ankle. They are arranged in 3 rows: proximal, intermediate and distal.<ul><li>Proximal row: talus and calcaneus</li><li>Intermediate row: navicular</li><li>Distal row: cuboid, lateral cuneiform, intermediate cuneiform and medial cuneiform</li></ul><img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fbones-of-the-foot-8mxq0v%2Fimages%2Fai-2.png?alt=media&amp;token=34ce48f3-f238-412d-91c6-ebb19f25b47b">The talus is the most superior bone of the foot and the only tarsal bone that articulates with the leg bones (tibia and fibula) superiorly, at the ankle joint. It also articulates with the calcaneus inferiorly to form the subtalar joint, and the navicular anteriorly to for the talonavicular joint.The calcaneus is the largest tarsal bone and it lies underneath the talus where is constitutes the heel. It articulates superiorly with the talus forming the subtalar joint, and anteriorly with the cuboid to form the calcaneocuboid joint.The navicular is a flattened, boat-shaped bone positioned medially on the foot. It articulates anteriorly with the 3 cuneiforms, posteriorly with the head of the talus and laterally with the cuboid.The cuboid is the most lateral bone in the distal row of the tarsus. It lies anterior to the calcaneus and posterior to the 4th and 5th metatarsals.And finally the 3 cuneiforms: lateral, intermediate and medial. They are wedge-shaped bones which articulate with the navicular posteriorly and metatarsals anteriorly.<h2>METATARSALS</h2>The metatarsals are located between the tarsals and the phalanges. They are 5 in number (one for each digit). They articulate proximally with the tarsal bones forming the tarsometatarsal joints, and distally with the proximal phalanges forming the metatarsophalangeal joints. They also articulate laterally between adjacent metatarsals forming the intermetatarsal joints.The metatarsals have 3 parts: base, shaft (or body) and head.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fbones-of-the-foot-8mxq0v%2Fimages%2Fai-3.png?alt=media&amp;token=7beb7075-f56b-4cde-995c-e93105cd784f"><h2>PHALANGES</h2>The phalanges are the bones found most distally on the foot. The 2nd, 3rd, 4th and 5th toes all have 3 phalanges: proximal, middle and distal. The 1st toe (big toe) only has 2 phalanges: proximal and distal. Like the metatarsals, the phalanges also have 3 parts: base, shaft and head.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2Fbones-of-the-foot-8mxq0v%2Fimages%2Fai-4.png?alt=media&amp;token=b8b0b0cc-7d8a-4c64-b019-da9164c902ef">Thanks for reading!The following article was written and illustrated by myself - medblog. For more content, follow me on Instagram and TikTok @medblog_xoxo. For medical illustrations follow me @medart_xoxo.

Anatomy can be confusing and difficult to memorise. This article provides simplified notes and labelled illustrations to help make it easier! In this article we are focusing on the bones of the foot. 

Bones of the foot

It's not easy cold-emailing- nothing is worse than having your messages ignored. I sent multiple failed messages, to eventually landing 3 potential summer internships in health-tech with only cold-emails.Here are my 4 top tips to sending a strong cold-email to secure your next internship.<h1>1/ To maximise your chances of a reply, you need your messages to be seen.</h1>If you're going to send emails, you're going to need to begin with the right address. Use free services like http://Hunter.io and http://Lusha.com to help you find the email addresses of founders to contact.Linkedin is your bestfriend. With a company in mind, identify the co-founders. Linkedin offers a free 6-month Gold membership - make use of these credits to send DMs that sit at the top of the inbox (much better than sending random requests to connect). https://www.linkedin.com/help/linkedin/answer/72/try-premium-for-free?lang=en.<h1>2/ Start with commonalities</h1>Bridge that gap - whether you went to the same school or university, have mutual connections or shared interests, it's always a message starter that attracts attention. Nothing in common? Take the initiative to read-up on their work, include references to podcasts or published work. Show genuine interests in them and it'll make introductions much smoother. <h1>3/ Sell your strengths</h1>Internships are a two-way exchange - they're investing in you as much as you're investing in them. Have your ask but show the value you’ll bring rather than the benefits you’ll gain. Instead of simply asking for opportunities to intern, sell your strengths, using clear examples of experiences or projects, and propose the benefits of having you onboard. <h1>4/ Follow-up and follow-up.</h1>People are busy and inboxes get spammed, don't be disheartened if you don't receive a reply. Simply follow-up the next week. Schedule messages to be sent the morning of working days. Reach out to them on other platforms. It’s a hard graft to have your voice heard - but in the end what's the worse that could happen?To get you started, here's a template I created: <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2F4-tips-to-cold-emailing-your-way-into-your-next-internship-8u8h3k%2Fimages%2Fai-1.png?alt=media&amp;token=4d531bbc-768f-4bab-9c11-ccdbc1753b52">Best of luck!<blockquote><h2>Thanks for reading! You can reach out to me 🐦 @kienmh for any questions.</h2></blockquote>

It's not easy cold-emailing- nothing is worse than having your messages ignored. I sent multiple failed messages, to eventually landing 3 potential summer internships in health-tech.

Here are my 4 top tips to sending a strong cold-email.

4 Tips To Cold-Email Into Health-Tech

<blockquote>It's been a year of 'doctoring' already and I can't believe it!</blockquote>This time last year, I completed medical school and was starting work as a doctor. Although I had the preparatory experience over the years in medical school during various placements, I still didn't know what to fully expect. They always say 'no amount of medical school will prepare you for the job', and boy were they right! Additionally, I could no longer hide behind the real doctors on the ward as a medical student, I am now THE DOCTOR with the FULL responsibility. But first, how does the UK system work?I've built an international audience over the past few months here on LinkedIn and so it is only right that I explain how the initial medical training pathway works here in the United Kingdom. Medical school takes approximately 5 or 6 years, after which you become a junior doctor. The first 2 years of 'doctoring' are titled your Foundation Years; a very crucial time period with the first year being compulsory in order to receive your full medical license to practice.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2F5-lessons-learnt-in-my-first-year-of-being-a-doctor-8mc4di%2Fimages%2Fai-1.png?alt=media&amp;token=c876efe8-7823-49ba-921b-a0e91fc55785">With that being said, thank God I am now halfway through the Foundation Programme, as indicated by the arrow above and here are the 5 key lessons I have learnt over the past year: 1.Ask For HelpAsking for help is a strength, not a weakness.We are often afraid to ask for help and in some cases, we perceive it to be a sign of weakness. I believe the ability to assess and recognise that you are in a state of the unknown, thus requiring assistance - is a strength in itself. In the case of a junior doctor, being so new to the role, you heavily rely on your seniors. It is a must. Aside that, we have to ultimately remember that we have people’s lives in our hands. If we feel out of our depths, we MUST ask for help. The same principle applies across various industries too.&nbsp; 2. You are not aloneTeam work makes the dream work!Sometimes we succumb to the pressures of our jobs and as a result feel all alone. It is important you remember your core responsibilities, especially when you are junior in your role. You must know and be transparent about your capabilities and limitations. You have a team around you to support you. Do what you know you are capable of doing and lean on others who are there to support you in your role when needs to be.<img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2F5-lessons-learnt-in-my-first-year-of-being-a-doctor-8mc4di%2Fimages%2Fai-2.png?alt=media&amp;token=351c6b24-2c3d-4207-99a3-cbb39a4a747a"> 3. Imposter Syndrome is RealEveryone feels like an imposter sometimes, and that's okay.Imposter syndrome is a reality some of us often face and I pray you do not encounter this. However, just remember, you are there for a reason. You've made it to where you are now because it was meant to be, because you are more than capable and you deserve it! <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2F5-lessons-learnt-in-my-first-year-of-being-a-doctor-8mc4di%2Fimages%2Fai-3.png?alt=media&amp;token=efe69b51-fc58-422b-b4f5-4c59170d741a"> 4. Be your Biggest and Best AdvocateWorking in healthcare can often be a high-pressure environment. In a system that requires improvement, it's employees become overwhelmed, agitated and stressed. With that being said, you may encounter incidences completely out of the norm whereby you will have to be your own biggest advocate.I remember experiencing a moment whereby my duty was being questioned by a senior nurse. Prioritisation is one of the key skills that is required as a doctor and in this particular scenario, I had an acutely unwell patient that required my full attention. On the other hand, the nurse's ask was not urgent in that moment. As a result of me not completing her task according to her timeline, she became frustrated and let it out on me. In situations like this, you must always remain cool, calm and respectful; despite the other not being so. I simply explained that an urgent situation required my attention which meant her task was not a priority to be completed in that time. Most of the time, some people expect that you will simply accept the disrespect. That should never be the case. Surprisingly, you may even shock yourself at times with the level of confidence you never knew you had in such moments. That is exactly how I felt, right after I had defended myself.'Stand up for yourself' is what they alway say. Although it is easier said than done, it is necessary for a healthier work-life balance. It will boost your self-confidence and at the end of the day, you're also human, you deserve to be respected at all times in the workplace regardless of your role or even how junior you may be. 5. Do what makes you happy!Life only comes around once, so do whatever makes you happy, and be with whoever makes you smile!Finally, I cannot stress the importance of keeping at the things or activities that make you happy. Whether that be maintaining your personal relationships by making time for your family and friends, your hobbies, spending time with just yourself or even escaping by going on vacation? DO IT! <img src="https://firebasestorage.googleapis.com/v0/b/peerr-cea41.appspot.com/o/articles%2F5-lessons-learnt-in-my-first-year-of-being-a-doctor-8mc4di%2Fimages%2Fai-4.png?alt=media&amp;token=b616b10e-06c2-4c03-bb37-0b0f2e45e4cd">___________________________________________________________________Overall, it's been a great year full of many experiences and I can't complain! I look forward to what this new year of work brings for me and for you all too.If you're junior or even senior in your role and have any tips for those just starting out in their careers, regardless of the field; please share your tips!

ONE YEAR AS A DOCTOR! 👩🏾‍⚕️🙌🏾

Thank God, it's been a year and what an experience it has been. I thought I would share my thoughts on the 5 key lessons I've learnt in my first year of working as a medical doctor. 

5 lessons learnt in my first year of being a doctor

<h2>12:00 The second operation</h2>“I’m just feeling for the right space in your back, and then I’ll inject some local anaesthetic into the skin to numb the area and then I’ll give you the spinal injection”“That’s all done, you’ll feel your legs going very heavy now which is completely normal”“I’m just going to pop this oxygen mask on, are you warm enough? Let me know if you need any more pain relief or something to relax you a bit more”If another anaesthetist is available, then the emergency operating theatre list can continue while the CEPOD anaesthetist is attending an emergency, otherwise the list has to wait until they are available to anaesthetise the next patient.Not all emergency surgery requires the patient to be unconscious and on a ventilator, and in many cases it is actually safer to allow the patient to stay awake and keep breathing independently, especially if they have multiple significant medical problems. If the operation involves a limb or the lower half of the trunk, such as draining an abscess or a small hernia, then a spinal anaesthetic can provide safe anaesthesia and effective, long-lasting pain relief after the operation. In this situation a single injection of a few millilitres of local anaesthetic is injected into the fluid that surrounds the bottom of the spinal cord, essentially numbing all of the sensory nerves that travel from the lower half of the body, making the patient unaware of the pain. This naturally wears off after a few hours, but provides pain relief for up to 24hours, avoiding the need for other strong painkillers such as morphine, which can have nasty side effects.<h2>14:00 Sedation in the emergency department</h2>“Hello I’m calling from ED, we have an elderly lady with a shoulder dislocation we’d like to reduce, please can you help us with the sedation?”“Hello, my name is Will, I’m one of the anaesthetists, we need to get your shoulder back into place, so I’d like to give you some strong pain relief and a bit of sedation to make you more comfortable if that’s alright, do you have any allergies?”“Please can you open your mouth really wide and stick your tongue out for me? That’s great and just tilt your head back as far as you can…okay all done thank you”Procedural sedation is another core role of the on-call anaesthetist, and can be a very rewarding part of the job. Using exceedingly powerful drugs to help a patient to remain comfortable and safely unaware while undergoing an otherwise painful and distressing produre such as a joint relocation or fracture reduction requires skill, as well as a vigilant anticipation of what to do if things go wrong. Before giving a patient strong sedatives the anaesthetist needs to be prepared for what to do if the patient becomes oversedated and stops breathing, or if their blood pressure drops dangerously low as a result of the medication. The likelyhood of these things happening depends on the individual’s medical background, previous reactions to anaesthetics and clinical examination of the face and neck to see whether they are likely to obstruct their airway when they’re asleep, or whether they would be difficult to intubate in an emergency. It’s a strange and rewarding experience to witness someone’s shoulder clunk sickeningly back into place, only for the patient to sleepily smile and thank you for helping them.<h2>15:30 The Third operation</h2>“This man is seriously unwell, and is likely to crash on induction, so we’ll have a vasopressor infusion running and induce with ketamine. I need the surgeons scrubbed and ready to clean and drape as soon as the tube is in”“Before we go off to sleep sir, I need to put a line into your wrist, and another into the vein in your neck, to allow me to give you strong blood pressure medication before the general anaesthetic”“We’ll need four units of crossmatched blood, a pool of platelets and five units of fresh frozen plasma. I’ve given tranexamic acid and we’re running the blood pressure as low as he’ll tolerate”Occasionally a patient will be desperately unwell with a life-threatening condition for which the only solution is to operate immediately, such as injury to a major blood vessel that cannot be compressed from the outside. In this case the most important factors are good teamwork and communication, and optimising speed while keeping it safe. While the surgeon attempts to locate and control the source of bleeding, the anaesthetist is busy trying to ‘fly’ the patient’s physiology without the help of autopilot. By replacing blood products, infusing drugs to help the patient’s blood to clot, and by holding the blood pressure at a low-but-safe level to prevent excessive bleeding, the anaesthetist can help the surgeon by improving the visibility of the surgical field, and ensuring the patient still has enough blood on board once the bleeding stops. This requires clear, concise communication between multiple team members, and often the anaesthetist takes on the role of team leader, allowing the surgeon to focus on the task at hand.Once the operation is completed, the patient is often too critically unwell to wake up and extubate immediately, their body needing more time to rest and recover, so they are transferred by the anaesthetist to the intensive care unit where they are then monitored closely and kept asleep for another day or two to get over the stresses of the operation.<h2>17:30 Intubation and transfer</h2>“ADULT TRAUMA IN RESUS, ADULT TRAUMA IN RESUS”“What’s the story?”“38 year old male pedestrian hit by car, significant head injury with GCS 14 on scene, dropped to 3 with the crew, now has an igel in situ”“If you’re happy to request the CT, we’ll get drugs and equipment ready for intubation”“There’s a large epidural haematoma with midline shift, send it to the neurosurgeons and we’ll get packaged for transfer”“Ambulance is here – ready to go?”Many smaller hospitals don’t have on-site access to some specialties such as cardiothoracic surgery or neurosurgery, and so if a patient attends hospital with an emergency requiring treatment by that specialty, then they need urgent transfer to a bigger, tertiary centre hospital. A relatively common example is a young person with a head injury who is found to have a bleed inside their skull that compresses the brain. This is very often fatal unless surgically drained within the next few hours, so the priority is getting them safely to a neurosurgeon as soon as possible.The anaesthetist on call’s role is to assess the patient’s breathing and level of consciousness to determine whether they need to be intubated and have their breathing controlled by a ventilator. A patient who is unconscious following a head injury is not going to protect their lungs from inhaling secretions and vomit, and they may have irregular and ineffective respiratory effort. To fix both of these issues, the anaesthetist will intubate the patient and put them on a ventilator to take over their breathing. They then escort the patient to the CT scanner where the diagnosis can be confirmed, before accompanying the patient in the back of the ambulance to the specialist hospital. Trying to care for an unstable patient while travelling sideways at seventy miles an hour is an exhilarating experience, and can be hugely rewarding, albeit rather challenging! You just hope that the ambulance is able to bring you home before your shift ends…<h2>20:00 The Day Ends</h2>At the end of the day, the anaesthetist returns to the CEPOD board, and hands over in the same manner to the night team, before heading home to get some rest. One of the nicest things about anaesthetics is knowing that all of your patients have been safely handed over to another clinician or department before you leave, meaning you don’t lose (as much!) sleep worrying about them overnight.It is an incredibly rewarding and stimulating role to play in the hospital, and so if you’re a bit of a perfectionist who wants to work with their hands, see quick results and lead others in emergency scenarios, anaesthetics may just be for you!

Step inside the life of an on-call anaesthetist and see what we really get up to!

A Day in the Life of an Anaesthetist - Part 2

As an anaesthetic trainee you will spend time ‘on-call’ or on ‘CEPOD’ – which stands for Confidential Enquiring into Perioperative Death, a venture set up in 1987 – which basically just means ‘emergency surgery’.During these shifts, which are usually twelve hours or so in length, there isn’t a set pattern as to what the day will involve, you’re simply on hand to deal with any emergencies that may arise during the shift, which might include:<ul><li>A patient needing emergency surgery<ul><li>such as a laparotomy for a perforated bowel, or debridement of a severely infected wound that cannot safely wait until the next day</li></ul></li><li>A medical patient needing respiratory or cardiovascular support<ul><li>such as a patient with severe pneumonia or COVID-19 needing to go onto a ventilator to help their breathing</li></ul></li><li>A patient needing sedation for a procedure<ul><li>such as an adult reducing a fracture in the emergency department, or a child needing an MRI scan</li></ul></li><li>A critically patient needing transfer, between departments or to another hospital<ul><li>such as an intubated patient on intensive care needing a CT scan, or a transfer to another hospital for a specific specialist treatment</li></ul></li><li>A patient in acute severe pain for whom normal pain medications aren’t working<ul><li>such as a patient with rib fractures, who may benefit from a local anaesthetic nerve block to numb the specific nerves supplying the broken ribs</li></ul></li></ul><h2>08:00 – The Day begins</h2>“How was your night?”“Not too bad, thanks, we had a laparotomy at 21:00 which we took round to ITU at 01:00 and then I just had a few pain patients to review overnight. There’s no-one in resus or the cardiac catheter suite and no sick kids. There’s an appendix and a hernia on the board to do today, I’ve seen the appendix who looks fine, no medical problems and looks well, she’s not eaten since yesterday and should be an easy intubation”“Great thanks, I’ll take the bleep – go get some rest!”The day starts at eight o’clock with a morning handover from the night anaesthetist to the day team. They will discuss any patients that were operated on overnight, and any issues that occurred as a result. They will also mention any pain patients that need reviewing during the day, and any medical patients that are of particular concern, who may need further assistance from the day team. The night anaesthetist then hands the bleep to their daytime counterpart and heads home for some sleep!Often at this stage there will be cases booked on the the CEPOD board. This is a live list of patients who need urgent operations, but who could safely wait until daytime hours to have their operation. There is a general rule that only patients at risk of losing ‘life or limb’ should have their operation performed between midnight and 08:00, as it is far safer to operate during the daytime when there are more people around to help if anything goes wrong.The theatre team, anaesthetist and surgical team decide between them the order in which these patients need to have their operation, based on clinical need and availability of staff and equipment, and then the anaesthetist heads off to do their preoperative assessment. This involves finding out more about the patient’s background and medical problems, to help the anaesthetist construct a suitable anaesthetic plan. This is discussed and agreed with the patient, and the patient can then ask any questions they may have before the operation. In the case of very unwell patients, the anaesthetist must decide whether the operation should go ahead immediately, or whether they need to instigate further treatment or even admit the patient to intensive care before surgery, in order to stabilise them as much as possible and therefore improve the patient’s chances of surviving the operation.<h2>09:30 – The first operation</h2>*“Hello and welcome to the operating department! We’re your anaesthetic team today who will be looking after you. We just need to check a few details and then we’ll go inside and pop some routine monitoring on, which just lets us know how you’re getting on while you’re asleep…””Well done just some nice deep breaths now, I’m giving you a strong painkiller, and then we’re going to drift gently off to sleep. Keep your eyes open as long as you can, and we’ll take very good care of you…”*“I can see the vocal cords, tube please…. Tube is in, we’re on the ventilator, please can you call the surgeons to let them know we’re ready?”“Well done! Time to wake up now, operation’s all finished, it all went well… I’m just going to take this breathing tube out and you’ll feel a lot more comfortable”The patient is brought up to theatre and the theatre staff perform their usual checks to ensure the right patient has arrived, expecting the right operation. They then enter the operating room and specific monitoring is put on, including<ul><li>ECG<ul><li>An electronic heart trace that gives information about the rhythm and rate of the heart</li></ul></li><li>Blood pressure cuff<ul><li>To monitor blood pressure during the operation, when anaesthetic and surgical factors can dramatically alter a patient’s blood pressure outside of safe levels</li></ul></li><li>Pulse oximeter<ul><li>To monitor the oxygen levels in the blood to inform the anaesthetist of how much oxygen to give the patient through the ventilator</li></ul></li></ul>Once the patient is safely set up on the table with the correct monitoring in place, the patient is induced, or ‘drifted off to sleep’. This is usually done by giving the patient oxygen to breathe while injecting powerful sedating drugs such as propofol, along with a strong painkiller like fentanyl and then a muscle relaxant to allow the anaesthetist to pass a breathing tube into the patient’s trachea in a process called intubation. Once they are asleep, they are connected to the anaesthetic machine which keeps the patient asleep, either with a continuous infusion of anaesthetic drug into the vein, or via delivering an anaesthetic gas to the patient’s lungs. At this point the anaesthetist may perform other procedures such as insterting a tube through the nose into the stomach to help drain any excess fluid, or inserting a central venous catheter into the jugular vein to allow more powerful medications to be given in a more unstable patient. The surgeons are then called to begin the operation.The anaesthetist’s job is then to monitor the patient, making adjustments to the ventilator settings and blood pressure, administering fluids and drugs such as antibiotics, strong painkillers and medications to reduce bleeding, and – most importantly – adjusting the table height! Once the operation is completed, the patient is woken up by switching off the delivery of anaesthetic agent, and once they are safely awake, the breathing tube is removed.Much like flying a plane, the most interesting bits are the take off (intubation) and landing (extubation) with periods of steady monitoring in between. While it may appear that not very much is happening on the anaesthetist’s side of the drapes, this is a game of vigilance by the anaesthetist and operating department practitioner, making small adjustments when necessary to keep the patient steady without major changes in blood pressure or oxygen levels, and to ensure they stay deeply asleep and comfortable. It’s a good sign if you’re not needing to do much during the operation, because it means the patient is stable and handling the stress of the operation well. If there are problems, such as excessive bleeding or allergic reactions then it’s the anaesthetist’s job to resuscitate the patient and keep them stable through the operation.<h2>10:30 The first emergency</h2>“CARDIAC ARREST ON THE ACUTE MEDICAL WARD, CARDIAC ARREST ON THE ACUTE MEDICAL WARD”“57 year old male…..admitted with pneumonia and poor urine output…..found unresponsive in bed this morning…..”“Hello I’m from anaesthetics, would you like me to manage the airway?”“This is the third round of CPR…giving the next dose of adrenaline now…”“I can feel a pulse, he’ll need a central line and admission to intensive care, I’ll call the consultant, please can you update the family”At any point during the day, the crash bleep can go off, alerting the anaesthetist to a medical emergency somewhere in the hospital. This could be a patient that has gone into cardiac arrest, or someone who has suddenly become acutely unwell, and it can occur in any department, including the emergency department, paediatrics, maternity or one of the surgical wards. It can even happen in the car park. The anaesthetist’s job is to work as part of the on-call medical team of doctors to rapidly assess the patient and work out what is causing the problem and how to start fixing it, and this can be one of the most rewarding parts of the job, using your knowledge and technical skills to potentially safe someone’s life.While all doctors are trained to deal with medical emergencies and run a cardiac arrest team, the anaesthetist’s specific role is to determine whether the patient needs any advanced organ support, particularly any help with their breathing or blood pressure, which may require their specific set of skills, such as intubation and inserting central lines to deliver necessary medications. Often this is coordinated with the intensive care unit, who also have an on-call doctor who can assist with medical emergencies. Generally anaesthetics and intensive care are closely allied departments, and it varies between hospitals as to which department attends medical emergencies and cardiac arrest calls.Continued in Part 2!

A Day in the Life of an Anaesthetist - Part 1

<h2>Top Tips for a productive Taster week in Anaesthesia</h2>It can be difficult for prospective trainees to fully understand what a career in anaesthetics is like. Unless a trainee has an intensive care medicine job lined up before they apply to Core Training, the chances are that they may have only met the elusive anaesthetists at emergency or trauma calls, before a patient is whisked away to theatre, or after pleading to the vascular access gods. Luckily, taster sessions are at hand.<blockquote>Taster days are ‘not essential but will be desirable… to demonstrate interest in specialty and [to] also help you decide if it is the correct specialty for you.’HEE Yorkshire and Humber</blockquote>How can you organise a taster session, and what might you learn?<h2>How to organise taster sessions.</h2>Firstly, this is off your own back.Doctors in training, such as in the foundation years, will likely have a quota of salaried days that they may take to gain experience in specialties that interest them. Usually, it is only about 5 days – which co-incidentally appears to be the minimum number of days that will stand up as a sign of ‘commitment to specialty’ in job applications – so spend your taster days wisely and choose anaesthesia.It will definitely help to bring the topic up with your educational or clinical supervisors who may know the right contacts, so bring it up early at start of placement meetings.You need to find out who a few people in your Trust are:<ul><li>The RCoA College Tutor at your ‘local education provider’/Trust, who should be able to give some good advice about a career in anaesthesia and to point you in the direction of people to help you organise your taster sessions.</li><li>The anaesthetic rota coordinator, who will be able to find sessions that have availability for you to join. You shouldn’t turn up at the theatres without being rota-ed in because theatre time is essential learning time for anaesthesia trainees and for other learners, such as student ODPs, paramedics, nurses and medical students.</li><li>Your rota coordinator for your current specialty, who will need to find a time in your current rota that allows you to be released while the rota remains safe.</li><li>An additional avenue to pursue would be to become acquainted with your friendly neighbourhood anaesthetists, in theatres whilst on a surgical placement, during debriefs after emergency calls, or during lighter times at mess events. They might be able to point you in the direction of the anaesthetic consultants who really interested in teaching, or the lists that are particularly high-yield for practical skills e.g. the emergency CEPOD list, certain urology lists etc.</li></ul><h2>What your taster week might look like</h2><ul><li>With the help of the rota-coordinator, you should be able to form a structured schedule that should provide a wide exposure to anaesthesia.<ul><li>Look to attend lists with multiple different consultants<ul><li>Consultants working in anaesthesia often have other commitments, such as in research, ICU, pain medicine etc – so by meeting many consultants, you can gain insight into these additional anaesthesia-related specialties, too.</li></ul></li><li>Look to attend lists of different surgeries<ul><li>Different lists offer different opportunities. A relatively ‘simple’ list might have many short cases requiring only a supraglottic airway – useful if you’ve never put in an I-gel before, and useful to see a fast turnover of anaesthetic inductions. A good list for this might be a general surgery emergency list (with abscess drainages etc) or a gynaecological surgery list.</li><li>Longer operations often require a more complex anaesthetic, while operations in more frail patients likely need more sophisticated invasive monitoring. If you wanted to gain experience in laryngoscopy and intubation, or to see or partake in central venous access or arterial line placement, an elective or emergency colorectal list with big operations might provide a suitable learning environment.</li></ul></li><li>Look to meet trainees!<ul><li>It’s very important to learn from trainees – after all, they’re doing the job that you think you want. What’s it like, really?</li></ul></li></ul></li></ul><blockquote>What should you ask consultants and trainees to really understand what life in anaesthesia is like? Find out more in an upcoming blog post…</blockquote><h2>What you might expect to do and learn during your taster week</h2><ul><li>Practice tricky things<ul><li>Knowledge and skills of vascular access, airway manoeuvres and the use of emergency drugs are useful regardless of your future specialty.</li><li>Anaesthetic room time is a great opportunity to practice these tricky things in a controlled environment and readily accessible expertise</li><li>Learn how to cannulate properly.</li><li>Learn how to draw up drugs properly.</li><li>Jaw thrust and bag a patient properly.</li><li>Learn how to use an guedel/oropharygneal airway, an I-Gel/LMA, and direct/video laryngoscope, bougie and ETT properly.</li></ul></li><li>See how the anaesthetist does tricky things<ul><li>Textbooks will teach the alveolar gas equation and pharmacokinetics of anaesthetic agents, but watching or experiencing the changing of gears between I.V. and volatile agents, paralysis and reversal and the manipulation of cardiovascular or respiratory physiology is a demonstration of the art of anaesthesia.</li></ul></li><li>Meet a variety of people and gain an appreciation of the team-based environment of theatres.<ul><li>The presence of an ODP helps to aid the smoothness, safety and efficiency of an anaesthetic, while they provide an extra pair of eyes, hands and experience when things go awry. In the day to day, ODPs often do much of the essential hard work such as checking the anaesthetic machine and moving patients around the theatre environment, while also being great people to chat to and learn from as a prospective anaesthetic trainee.</li><li>You will meet some real characters!</li></ul></li><li>See how good communication is done!<ul><li>Some people are naturally good communicators, whilst some stumble over words or don’t quite say what they mean. I’m often in the latter category, but working towards being in the former, which means I listen particularly hard to the friendly and gentle babble of an anaesthetic room that effective teams create to comfort and quieten the anxieties and fears of patients.</li><li>If you want a masterclass in communication techniques, attend a paediatric anaesthesia list.</li><li>More broadly still, it’s just lovely to be in an environment where the team works together regularly, if not daily. Unlike many other theatres within medicine, my experience is that the anaesthetic room is not the place for big egos or enemies but is one of friendly banter and generally a good way to pass time; this must be all due to the wafts of Sevoflurane released during my poor preoxygenation attempts.</li></ul></li><li>Anaesthetics is based on the practical application of knowledge.<ul><li>Anaesthetics is fundamentally rooted in physiology, which although means that much of anaesthetics practice requires a sound understanding of physics, various eponymous constants, and other equations; by applying a stimulus, we can expect and predict a response. Whether it is understanding the pharmacology of a neuromuscular blocker on a neuromuscular junction with an expectation of the subsequent effect, or of the effects of metaraminol on the cardiovascular system, the effects of interventions in anaesthesia is much more tangible than, for example, the effect of a monoclonal antibody in a subtype of rheumatoid arthritis. For many, the rapid responses elicited by practical application of theoretical knowledge makes anaesthesia a very engaging and satisfying career.</li></ul></li></ul><h2>To conclude, here’s a checklist for your taster week:</h2><ol><li>Go in with an open mind and a desire to see, do, and learn everything.</li><li>Ask your own questions, find out what you want to know to see if anaesthesia can provide a career with interest and sustainability over the long-run.</li><li>Come out with practical skills and the perspectives of juniors, seniors and allied healthcare staff.</li><li>Enjoy the time away from the ward rounds, charts and discharge notes; you’ve only got 5 days of paid taster days.</li><li>Get feedback from your tutors, or obtain a certificate, and remember to reflect on your experience daily!</li></ol>

How to get the most out of your week in theatre with the anaesthetic team. 

Top Tips for a Productive Taster Week in Anaesthesia

Systems. Habits. Ways of doing things, lining things up, preparing vials of drugs or positioning the ultrasound just-so.Everyone has one.Everyone is a bit different; all built from advice from different mentors or in response to different previous disaster-pants moments – a product of the necessary learning curve in anaesthestic training.As a junior trainee, or a prospective doctor on a taster week, or maybe even an experienced doctor making a move to a new department, watching how other established anaesthetists set themselves, their kit, their drugs and their team up before launching into mission mode is an informative experience.Today I learned about one anaesthetist’s technique of putting opioids into 5ml syringes, muscle relaxants into a 10ml syringe, and propofol into a 20ml syringe – a system learned in the time-critical arena of pre-hospital care, where differing syringe sizes to identify which drug is which provide tactile information in addition to the visual reminder of a coloured drug label sticker – an extra layer of redundancy to ensure safety during an RSI in a dark corner at 3 in the morning, and a great tip for a junior.<blockquote>Sometimes, however, watching this preparation and comparing it to our own system (or lack of system) can be intimidating; Is my system not good enough? Which system is best? Which to choose? Will this make or break my anaesthesia delivery?</blockquote>Maybe there is one single anaesthetic preparation set up that will rule them all.On the other hand, we might be liberated by the existence of a wide breadth and individuality of the systems employed by individuals; That there are so many systems, yet many safe and effective anaesthetics given, means that there are no major differences between the outcomes of different systems.<blockquote>So, maybe there is no ‘optimal’ set up!?</blockquote>The excellent principles of rigour, organisation and checklists to enable safe practice are seen throughout anaesthetic practice, and there are many circumstances where the consequences of poor systems are so disastrous that it should take much to contemplate whether an off-piste route should be taken e.g. CICO scenarios.But, with regard to the large and multi-faceted task of delivering an anaesthetic, the smaller, personal details might not matter so much (as in they probably won’t help another practitioner). Whether you protocolise your pre-gas checks by lining everything up, drawing some drugs up and but leaving others in their vials, or use specific syringe sizes to mark out opioid, hypnotic and muscle relaxants is by-the-by; its success for you probably won’t translate into success for another practitioner with different experiences, habits or foibles. Our systems just play around the edges of a greater whole i.e. the principles of anaesthesia.<blockquote>In summary, take comfort that no system is best, but the best one is the one that you choose and works for you (safely and consistently).</blockquote>

How productive and reliable habits can reduce your stress and improve your productivity.

The Power of Habits

<h4>Have you heard of the term ‘bandwidth’?</h4><blockquote>In simple terms, &nbsp;our ‘bandwidth’ can be thought of as how much capacity we have to deal with X.</blockquote>In anaesthetics,&nbsp;X&nbsp;is the&nbsp;RSI/nerve block/resuscitation/enter-other-that-you’re-about-to-perform&nbsp;– the task that has its complexities that need mastering to get right, escape plans if it goes wrong, and consequences if it goes&nbsp;really&nbsp;wrong.For an expert in the field it might not take much bandwidth to deal with a routine case, instead turning on auto-pilot to tackle other problems or tasks. An established consultant that I know comes to mind – breezily keeping one eye on the monitor while delivering engaging teaching to his trainee while simultaneously making jokes with the nurses about the surgeon.However, when tricky situations start to approach an individual’s level of confidence, they may find that their&nbsp;bandwidth becomes quickly consumed, almost filling at an exponential rate with increasing stress.Bandwidth can also be taken up by problems that aren’t being dealt with in the immediate present –&nbsp;tiredness,&nbsp;hunger,&nbsp;stress, a&nbsp;long commute, or&nbsp;worries&nbsp;and difficulties in life such as&nbsp;finances&nbsp;and&nbsp;relationships.The problem that will occur when bandwidth is exceeded is&nbsp;failure&nbsp;– which, depending on the circumstances, may mean different things.<blockquote>Often, bandwidth failure presents as&nbsp;short,&nbsp;sharp, or&nbsp;snappy&nbsp;communication&nbsp;–&nbsp;demanding, not asking.&nbsp;Stating, not suggesting.&nbsp;Arrogance&nbsp;versus humility.&nbsp;Words, not sentences. We’ve all been in situations when, in the heat of the moment, we have said something&nbsp;unpleasant&nbsp;or&nbsp;less-than-gracious&nbsp;that we look back on with&nbsp;regret.</blockquote>Knowing the capacity and status of your bandwidth is one way of predicting and avoiding errors of misjudged communication. We also know that,&nbsp;in a situation that is complex and overwhelming, progress can be made by asking for help and establishing teamwork; something that, ironically, a stressed-out bandwidth and choppy communication may seek to undermine. Treating team members with&nbsp;incivility&nbsp;or&nbsp;impatience&nbsp;when under pressure probably&nbsp;won’t kick start your colleagues into action&nbsp;but will&nbsp;subdue them&nbsp;with a reluctance to act to avoid further harm – a very real example of how stress and incivility may progressively dismantle teamwork to act as a contributor to disaster.Obviously, this is a disasterpants scenario that we hope to avoid. What about smaller errors, such as&nbsp;failing a cannula&nbsp;because of&nbsp;hunger,&nbsp;needing a wee, but also&nbsp;needing to see that really sick patient at the other side of the hospital?You already know what the solutions are to avoid bandwidth errors. While communication errors can derive from a saturated bandwidth, good and transparent communication frees them up. We can check in on our own bandwidths and those of our colleagues – a simple check that spreads the load of complex situations, and makes non-complex situations much more enjoyable for everyone involved.<blockquote>Addressing the easy stuff – are you and your team fed, watered, caffeinated, and happy in their jobs – will keep the complex stuff easy, too.</blockquote>Finally, if you feel stressed or that your bandwidth is being squeezed or stretched, take the opportunity to&nbsp;call for help or advice early. Asking for help won’t look bad, but will&nbsp;potentially avoid a tricky situation, and will&nbsp;certainly free up your own capacity to focus on what you can do to help, or what you can learn, or&nbsp;what next step in management&nbsp;you could do independently next time.

How to manage stress, and optimise your cognitive performance at work.

Managing Bandwidth

A 68-year-old man is brought into ED due to suddenly feeling short of breath 10 hours ago. His blood pressure is 86/60mmHg, and his heart rate is 130 beats per minute, and his respiration rate is 35 breaths per minute. Physical exam shows distended neck veins. Auscultation of the chest reveals muffled heart sounds. An ECG is undertaken, showing low voltage QRS complexes with fluctuating R wave amplitude. What is your likely diagnosis?&nbsp;Pericardial effusion is the accumulation of fluid in the pericardial space, with this space being defined as the space between the parietal and visceral layers of the serous pericardium. This fluid can either be blood filled, such as in a cardiac wall rupture after a myocardial infarction, or serous fluid, such as in acute pericarditis.&nbsp;The borders of the pericardial space are stiff. Therefore, the capacity of this space is limited. In chronic pericardial effusion, the pericardium can stretch to accommodate more fluid. In acute settings, added volume quickly exceeds the maximum capacity. In both cases, the result is often a cardiac tamponade. A cardiac tamponade occurs when elevated intrapericardial pressure from pericardial effusion compresses the heart (especially the right ventricle). In terms of the pathophysiology of this condition, this accumulation of fluid particularly presses the right ventricle, as the heart wall is thinner here. This pushes the interventricular septum towards the left chamber, decreasing diastolic filling, causing a decrease in stroke volume and thus cardiac output.&nbsp;Now that we have gotten our head around the pathophysiology, the symptoms are very easy to understand. Pericardial effusion is initially asymptomatic but can cause some shortness of breath (SOB), orthopnoea (which means SOB when lying down), and retrosternal chest pain. The symptoms of a cardiac tamponade can be remembered through Beck’s Triad, this including Hypotension (through pressure on the heart chambers causing a decreased cardiac output), muffled heart sounds through the accumulation of fluid around the heart, and distended neck veins (through elevated jugular venous pressure). Other symptoms include tachycardia, symptoms of right-side heart failure, obstructive shock, and cardiac arrest. Pulsus paroxudus is an important symptom of cardiac tamponade, occurring when there is a decrease in systolic BP &gt;10mmHg during inspiration. Let’s explain why this important phenomenon occurs.&nbsp;During inspiration, there is normally an increased filling to the right side of the heart, as intrathoracic pressure decreases allowing more fluid to enter. This filling to the right side causes the interventricular septum to bulge to the left. This would usually not have much of an effect on blood pressure. In a cardiac tamponade however, this deviation of the interventricular septum to the left causes a decreased filling volume of the left ventricle, hence decreasing systolic blood pressure.&nbsp;The gold standard for diagnosis of a cardiac tamponade is transthoracic echocardiography. This procedure involves the transducer being placed on the anterior chest wall and epigastrium to visualise the chambers, valves, ascending aorta, and pericardium. In this condition, the test will show an anechoic (meaning dark) space in the pericardial cavity, this being the fluid. It also shows predictable chamber collapse. This collapse involves the RA collapsing in systole and the RV collapsing in diastole in the initial stages, and then LA collapse in the later stages. A collapsed left atrium is 98% specific for a cardiac tamponade, hence why it is the gold standard diagnostic test. Supportive tests also involve an ECG. This shows tachycardia and electrical alternans, which is consecutive QRS complexes alternating in height. This is due to the swinging motion of the heart when surrounded by pericardial fluid. A chest X-ray shows a water bottle shaped heart which we will post on our Instagram. This is essentially a bilaterally enlarged cardiac silhouette with complete loss of normal cardiac contour.&nbsp;To treat a cardiac tamponade, hemodynamically unstable patients should undergo pericardiocentesis, where the pericardial cavity is drained of excess fluid. If the patient is stable, treatment is conservative and should focus on treating the underlying cause.&nbsp;Thanks for reading our transcript. Give our Instagram a follow @5.min.medicine, DM us for any questions, and happy studying.

Here is our transcript from our podcast on Cardiac Tamponade! We hope it helps you with your studies and gets you ready for your tricky exams. Don't forget to give our Instagram a follow @5.min.medicine

Cardiac Tamponade 

A 54-year-old man is brought to his local GP by his wife. His wife complains that he is confused and agitated. She suspects his extensive daily alcohol consumption over the past 10-years may be contributing to his difficulties. A mental exam reveals that the man is only orientated to person and recalls 0 out of 3 words in 5 minutes. Neurological exam shows horizontal nystagmus on lateral gaze. A gait examination reveals difficulty walking without assistance. What is your likely diagnosis?&nbsp;Wernicke’s encephalopathy and Korsakoff syndrome are both conditions that occur because of thiamine deficiency. Wernicke’s encephalopathy is reversible, but chronic thiamine deficiency progresses to Korsakoff syndrome, which causes irreversible damage. The main causes for this deficiency are chronic alcohol use (the most common, leading to decreased thiamine absorption), inadequate intake of thiamine (such as in anorexia nervosa), and when there is an increased demand for thiamine, such as in hypermetabolic states like pregnancy and lactation.&nbsp;It is important to remember thiamine’s active form, thiamine pyrophosphate, is important for metabolism of cerebral glucose. In terms of the pathophysiology of Wernicke’s encephalopathy, thiamine deficiency reduces cerebral glucose metabolism, depleting ATP and increasing free radicals. As such, neuronal elements are injured such as the myelin sheaths of nerves and the blood brain barrier, and neurotransmitters are reduced. This impairs axonal conduction.&nbsp;In the progression to Korsakoff syndrome, long term thiamine deficiency permanently damages the limbic system. This deficiency results in atrophy to the mammillary bodies and the anterior thalamic nuclei. As such, this causes apathy, loss of memory and emotional processing.&nbsp;The clinical presentation of Wernicke’s encephalopathy and Korsakoff syndrome, can be remembered by the pneumonic “Wernicke’s COAT and Korsakoff’s CART. Wernicke’s COAT , stands for Confusion, Oculomotor dysfunction, Ataxia and Thiamine Administration, referring to treatment”. Gaze-induced horizontal or vertical nystagmus is the most common oculomotor dysfunction in Wernicke’s encephalopathy. Now, looking at the symptoms of Korsakoff’s syndrome, Korsakoff’s cart stands Confabulation, Anterograde and Retrograde amnesia, and altered Temper”. It is important to note that confabulation occurs when the patient produces fabricated memories to fill lapses in memory. In this pneumonic, altered temper refers to personality changes, due to lesions in the frontal lobe&nbsp;In terms of diagnosis, these pathologies are diagnosed clinically. In ambiguous cases, lab studies show decreased thiamine levels, and a T2 MRI shows hyperintense lesions of the mammillary bodies, representing periventricular haemorrhage or atrophy&nbsp;Treatment of Wernicke’s encephalopathy involves high dose IV thiamine for 2 days, followed by a lower dose for 5 days. It is extremely important to note that this should be done before glucose infusion, or the encephalopathy will worsen. This should be followed by long term vitamin B complex and folic acid replacement, and abstinence from alcohol. Treatment of Korsakoff syndrome involves oral thiamine, abstinence from alcohol and psychiatric and psychological therapy.&nbsp;Thanks for reading our transcript. Give our Instagram a follow @5.min.medicine, DM us for any questions, and happy studying.

Here is our transcript from our podcast on Wernicke’s Encephalopathy and Korsakoff Syndrome! We hope it helps you with your studies and gets you ready for your tricky exams. Don't forget to give our Instagram a follow @5.min.medicine

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